Ferro-Folgamma is the drug of choice for iron deficiency conditions

Nosological classification (ICD-10)

• D50 Iron deficiency anemia
• D50.9 Iron deficiency anemia, unspecified
• D52 Folate deficiency anemia
• D61.1 Drug-induced aplastic anemia
• D63.0 Anemia due to neoplasms (C00-D48+)
• D63.8 Anemia in other chronic diseases classified elsewhere
• D64.9 Anemia, unspecified
• E53.8.0* Vitamin Bc deficiency
• E61.1 Iron deficiency
• I84.8 Hemorrhoids with other complications, unspecified
• K92.2 Gastrointestinal bleeding, unspecified
• N92.0 Heavy and frequent menstruation with a regular cycle
• N92.1 Heavy and frequent menstruation with irregular cycles
• N92.4 Excessive bleeding in the premenopausal period
• O99.0 Anemia complicating pregnancy, childbirth and the puerperium
• R58 Bleeding, not elsewhere classified

Compound

Pharmacodynamics

Ferro-Folgamma® is a complex antianemic drug containing divalent iron in the form of a simple ferrous sulfate salt, vitamins B12, folic and ascorbic acid, intended for the treatment of iron deficiency conditions. Iron is an important component of the human body. It is a constituent of hemoglobin, myoglobin and various other enzymes. Ascorbic acid improves the absorption of iron in the intestines. Vitamin B12 and folic acid are involved in the formation and maturation of red blood cells.

The active components of Ferro-Folgamma® are in a special neutral shell, which ensures their absorption, mainly in the upper part of the small intestine. The absence of local irritation on the gastric mucosa contributes to good tolerability of the drug in the gastrointestinal tract.

• Magazine archive /
• 2012 /
• №12

Ferro-Folgamma in the treatment and prevention of iron deficiency conditions

A.N. Gratian

Russian National Research Medical University named after. N.I. Pirogov, Moscow

Iron deficiency is one of the most common global health problems. Even if it is possible to establish the origin of iron deficiency, a necessary component of treatment (in addition to influencing the factor that caused the disease) is the administration of ferrodrugs, and, if the clinical situation allows, preference is given to the oral route of administration as it is safer. Ferro-Folgamma is considered one of the oral drugs with an attractive efficacy and safety profile. The article highlights some aspects of the use of Ferro-Folgamma in clinical practice.

Key words: ferropreparations, Ferro-Folgamma, iron deficiency anemia

Iron deficiency anemia (IDA) is the most common form of malnutrition, registered, according to WHO, in more than 2 billion (about 30% of the population) people on the planet, i.e. more often than any other condition [1]. Despite the fact that iron deficiency is not the only possible cause of anemia, in areas where anemia is widespread, iron deficiency is usually detected in the population. More than other categories of the population, children and adolescents during periods of intensive growth and puberty, as well as women of childbearing age (especially during pregnancy and lactation), are susceptible to IDA. Thus, statistics show that 20–30% of women of childbearing age have a latent iron deficiency, and 8–10% have IDA (iron deficiency can occur even with normal hemoglobin levels, anemia develops later - when iron deficiency worsens). At the end of the third trimester of pregnancy, almost all women have hidden iron deficiency and almost 30% of them develop IDA [2].

Iron deficiency in women of any age occurs mainly as a result of acute or chronic blood loss: • in adolescent girls, it is usually a consequence of iron deficiency in the mother during pregnancy. At the same time, the existing relative iron deficiency with the appearance of menstrual blood loss can lead to the development of signs of IDA; • women of childbearing and menopausal age lose 15–250 mg of iron during one menstruation (depending on the duration of menstruation and the amount of blood loss). In addition, iron deficiency conditions can be caused by menorrhagia due to uterine fibroids, endometriosis, intrauterine contraceptives, gynecological operations, etc.

Treatment of IDA consists primarily of eliminating the cause of the disease.

The main causes of iron deficiency are well known: • insufficient intake of iron into the body (iron-poor diet, vegetarianism, anorexia); • impaired iron absorption during resection of part of the small intestine; • increased need for iron (growth period, pregnancy, lactation); • increased iron loss (heavy menstruation, bleeding from the gastrointestinal tract - gastrointestinal tract, nosebleeds, prolonged donation, etc.).

However, even when the cause of the disease is established, it is not always possible to eliminate it. In this case, the only treatment option is the administration of iron supplements (ferrous preparations). Ferric preparations are also used in the prevention of iron deficiency states during periods of increased body need for iron (Table 1).

The route of administration of the drug to patients with IDA is determined by the specific clinical situation.

In the absence of special indications - such as impaired absorption of iron, poor tolerability of oral ferrotherapy drugs or for social reasons, iron-containing drugs are prescribed orally, since with comparable effectiveness (recovery of hemoglobin levels usually occurs only 2-4 days later than with parenteral administration) , the safety of oral medications is significantly higher. In particular, it must be remembered that the presence of hypochromic anemia does not exclude the possibility of the so-called. sideroachrestic anemia (achresia - lack of use). In sideroachrestic (iron-saturated) anemia, the iron content in the body is within normal limits or even in excess, but for various reasons iron is not used to build heme in the hemoglobin molecule, which ultimately leads to the formation of hypochromic erythrocytes with a low hemoglobin content. Unused iron is deposited in organs and tissues (liver, pancreas, skin, macrophage system, etc.), leading to the development of hemosiderosis. An erroneous diagnosis of iron deficiency in a patient with iron-saturated anemia and unjustified prescription of ferrodrugs can increase the “overload” of organs and tissues with iron. In this case, the therapeutic effect of iron supplements will be absent, but unlike parenteral administration, oral intake of iron does not lead to the development of hemosiderosis, even if anemia is incorrectly interpreted as iron deficiency.

Modern oral ferrous preparations are either ferrous iron salts (since ferric ions are not absorbed in the digestive tract) or compounds consisting of a hydroxide-polymaltose complex of ferric iron (the absorption mechanism differs from ionic preparations).

The main compound included in traditionally used iron salts (ionic iron preparations) is ferrous sulfate. It is believed that ferrous sulfate has a higher bioavailability compared to other iron salts (chloride, fumarate) and causes few side effects during therapy [3].

Only divalent iron is absorbed from the gastrointestinal tract in the form of ions. The combination of iron with ascorbic acid (desirable ratio –3:1) helps to increase the bioavailability of iron, since it improves the absorption of iron ions in the intestine [6]. An important role in hematopoiesis is played by folic acid, which is involved in DNA synthesis, and vitamin B12 (cyanocobalamin), the main factor in the activation of folic acid [7]. Deficiency of folic acid and vitamin B12 is often observed in iron deficiency conditions caused by bleeding and is associated with impaired DNA synthesis in the hematopoietic organs. The inclusion of folic acid and vitamin B12 in ferrous preparations enhances the active absorption of iron in the intestines and its subsequent utilization.

All of the listed components are included in the complex antianemic drug Ferro-Folgamma [8], the capsule of which contains the following components: • 112.6 mg of ferrous sulfate (corresponding to 37 mg of iron); • 5 mg folic acid; • 0.010 mg cyanocobalamin; • 100 mg ascorbic acid.

Ferro-Folgamma provides an average increase in hemoglobin of 2.5 g/l per day (the highest rate of increase in hemoglobin among ferrous sulfate preparations). When using Ferro-Folgamma, there is a fairly rapid (within the first 10 days of use) weakening of the clinical symptoms of posthemorrhagic anemia [9]. Ferro-Folgamma is prescribed 1 capsule 3 times a day after meals for 3-4 weeks, and for severe forms of anemia, 2 capsules 3 times a day for 16 weeks or more. After cessation of treatment with FerroFolgamma, the positive effect and stabilization of blood serum parameters (hemoglobin levels, red blood cells, serum iron, total iron-binding capacity of blood serum) persist for at least a month [10].

As with any long-term treatment (when oral ferrodrugs are prescribed in sufficient doses, normalization of hemoglobin levels is observed in most cases after 3-4 weeks from the start of treatment), good tolerability ensures high adherence to treatment and, thus, increases the likelihood of success of therapy. Modern oral iron preparations rarely cause significant side effects that require their discontinuation and switching to the parenteral route of administration. Adverse events associated with the use of oral iron supplements usually occur in the gastrointestinal tract: nausea, metallic taste in the mouth, constipation (one possible explanation is the binding of hydrogen sulfide in the intestine, which stimulates peristalsis), less commonly, diarrhea, anorexia. It must be taken into account that the absorption of iron from salt preparations may be reduced under the influence of certain substances contained in food (phosphates, calcium salts, phytin, tannin), as well as with the simultaneous use of certain drugs (tetracyclines, chloramphenicol, antacids). Some foods, on the contrary, improve the absorption of iron from the intestines (Table 2).

The active components of Ferro-Folgamma are located in a special neutral shell, which ensures their absorption - mainly in the upper part of the small intestine. The Ferro-Folgamma capsule protects the gastric mucosa and promotes good tolerability of the drug in the digestive tract [11, 12]. Due to the absence of an aggressive effect on the mucous membrane of the digestive tract, Ferro-Folgamma can be used to correct anemic syndrome, characteristic of hidden prolonged bleeding, as well as in cases of vitamin B12 and folic acid deficiency due to impaired absorption in the gastrointestinal tract (atrophy of the mucous membrane of the stomach and duodenum).

Thus, currently, the indications for the use of the drug Ferro-Folgamma are anemia caused by deficiency of iron, folic acid and vitamin B12, occurring against the background of chronic blood loss (menorrhagia and metrorrhagia, from hemorrhoids, etc.), as well as chronic alcoholism , infectious diseases, taking anticonvulsants and oral contraceptives. The drug is also suitable for the prevention and treatment of iron and folic acid deficiency in the second and third trimesters of pregnancy, in the postpartum period and during lactation.

Thus, regardless of the cause of menorrhagia and the need to influence the corresponding factor, long-term therapy with ferrodrugs for oral administration is necessary. The dose and regimen are selected individually, taking into account the iron content in the drug, its tolerability, etc. After normalization of hemoglobin levels, it is necessary to carry out maintenance therapy with the ferrodrug for 5–7 days after the end of menstruation. If the condition is satisfactory and hemoglobin levels are stable, breaks in treatment are possible, which, however, should not be long, since menorrhagia that continues in women quickly depletes iron reserves with the risk of relapse of IDA. When treating teenage girls, after normalization of hemoglobin levels, repeated courses of treatment are possible, especially if heavy menstruation occurs or there are other blood losses (nasal, gingival).

Literature

1. https://www.who.int., 2012. 2. Khabib O.N., Iron deficiency anemia: treatment and prevention // RMZh 2002. T. 2. No. 7. 3. Kazyukova T.V., Samsygina G.A., Kalashnikova G.V. and others. New possibilities of ferrotherapy for iron deficiency anemia // Clinical pharmacology and therapy 2000. No. 9 (2). pp. 88–91. 4. Jacobs P. Equivalent bioavailability of iron from ferrous salts and a ferric polymaltose complex. Clinical and experimental studies. Arzneimittelforschung 1987;37(1A):113–16. 5. Arvas A, Gur E. Are ferric compounds useful in the treatment of iron deficiency anemia? Turk J Pediatr 2000;42(4):352–54. 6. Teucher B, Olivares M, Cori H. Enhancers of iron absorption: ascorbic acid and other organic acids. Int J Vitam Nutr Res 2004;7 4(6):403–19. 7. Dvoretsky L.I., Treatment of iron deficiency anemia // RMJ 1998. T. 6. No. 20.S. 1312–16. 8. Ghinea MM. Treatment of iron deficiency anemia with Ferro-Folgamma Rom J Intern Med 2004;42(1):225–30. 9. Maev I.V., Samsonov A.A., Vyuchnova E.S., Gastrointestinal bleeding: modern methods of treatment // Farmateka 2004. No. 5(83). 10. Maev I.V., Samsonov A.A., Busarova G.A., Agapova N.R. Acute gastrointestinal bleeding (clinic, diagnosis, therapy) // Attending physician 2003. No. 5. 11. Ferro-Folgamma. Therapy with iron, folic acid, vitamin B12 and ascorbic acid. Scientific review. Wӧrwag Pharma. M., 2001. 12. Bozhinova S, Penkov V, Bogdanova A. Ferro-Folgamma-a drug for treatment and prophylaxis of iron deficiency anemia in pregnant women. Akush Ginekol 2004;43(3):27–31.

About the authors / For correspondence

Gratsianskaya A.N. – Associate Professor of the Department of Clinical Pharmacology, Russian National Research Medical University named after. N.I. Pirogov

Similar articles

• Iron deficiency anemia in diseases of the gastrointestinal tract
• Gastrointestinal bleeding: clinical picture, diagnosis and treatment
• Helicobacter pylori infection and chronic iron deficiency anemia: features of the combined course and therapy
• New possibilities for predicting and assessing the effectiveness of treatment of iron deficiency anemia
• Iron deficiency anemia in the practice of a general practitioner: diagnosis and treatment

Indications of the drug Ferro-Folgamma®

treatment of combined iron-folate-B12-deficiency anemia caused by chronic blood loss (bleeding from the stomach, intestines, bladder, hemorrhoids, menorrhagia, metrorrhagia), chronic alcoholism, infections, taking anticonvulsants and oral contraceptives;

anemia during pregnancy and lactation;

prevention of iron and folic acid deficiency in the II and III trimesters of pregnancy, in the postpartum period, during breastfeeding.

Ferro-Folgamma is the drug of choice for iron deficiency conditions

According to WHO, 3.6 billion people have IDA, and 1.8 billion are diagnosed with IDA. In Russia, about 480 thousand people suffer from anemia, of which 430 thousand have IDA. IDA is quite common in patients with cardiovascular diseases. For example, the prevalence of IDA was recently shown in 10% of patients with ischemic disease [7] and in 37% of patients with chronic heart failure [10]. Iron deficiency and IDA are most often observed in adolescents (especially young girls) and pregnant women, which is due to the increased need for iron in these categories of people. From 50 to 99% of pregnant women have iron deficiency, from 20 to 80% of pregnant women suffer from IDA. The entry of exogenous iron into the body is ensured by its absorption in the gastrointestinal tract (GIT). The process of microelement absorption is highly integrated and depends on a number of factors associated with both the nutritional forms of incoming iron and the individual characteristics of the body. Dietary and medicinal iron is absorbed most intensively in the duodenum (duodenum), as well as in the upper parts of the jejunum. The process of iron absorption is determined by 3 factors: – amount in food; – bioavailability; - the body's need. The stages of the iron absorption mechanism have been studied to varying degrees. It is known that under physiological conditions, the absorption of iron in the intestine consists of successive stages, such as: 1) capture of mucosal cells by the brush border; 2) membrane transport; 3) intracellular transport and formation of reserves in the cell; 4) release from the cell into the bloodstream. Oxalates and phosphates reduce its resorption, and fructose, hydrochloric, ascorbic, succinic, pyruvic acids, cysteine, sorbitol and alcohol increase it. Ferrous inorganic iron is absorbed much better than oxide iron contained in meat products. In industrialized countries, the average content of non-heme iron in food is much higher than in developing countries, amounting to 10–14 mg. However, according to a number of foreign authors, even in developed countries, women following fashionable diets experience a lack of iron in their food. Thus, normally, the homeostasis of iron metabolism in the body is maintained due to the absorption of the bioelement adequate to the loss of food [1, 3, 5]. As is known, the biological role of iron in the body is great and is determined by its participation in redox processes, tissue growth and aging, and immunity mechanisms. Hematopoiesis, the functioning of a number of enzymes, and the supply of oxygen to organs and tissues are closely related to iron metabolism [1]. Rapid growth, physical development and puberty of adolescents, pregnancy, growth and development of the fetus also determine a high need for B vitamins and especially for folic acid, which is necessary for cell proliferation [8]. VDN and IDA in adolescents and pregnant women are in most cases accompanied by folic acid deficiency and elements of folate deficiency anemia. Deficiency of iron and folic acid is equally dangerous for a pregnant woman and for the fetus and is manifested by various disorders of the course of pregnancy, pathology of labor and congenital iron deficiency anemia in a newborn (usually premature) child. With folic acid deficiency, the conversion of homocysteine ​​to methionine is impaired; the accumulation of homocysteine ​​in the blood of the fetus leads to congenital anomalies of the development of the central nervous system; hyperhomocysteinemia in adults provokes atherogenesis and progression of atherosclerosis of coronary and cerebral localization. Therefore, for the prevention and treatment of iron deficiency syndrome and iron deficiency anemia in adolescence and in pregnant women, complex preparations containing not only iron, but also folic acid and other B vitamins are recommended. In nature, iron exists in 2 chemical forms: divalent oxide and trivalent oxide. . Heme (ferrous) iron is absorbed well in the intestine, while non-heme (trivalent) iron is poorly absorbed. Meat (especially beef) and blood sausage are the richest in heme (ferrous) iron, so meat products are the main source of iron in human nutrition. There is less heme iron in poultry and fish. Liver and other by-products, liver sausage are rich in ferritin and hemosiderin, which contains non-heme ferric iron, which is poorly absorbed in the gastrointestinal tract. A lot of non-heme ferric iron is found in some brands of red wine, fruit juices, apples, pomegranates, buckwheat, dairy products, eggs, nuts, and chocolate. The bioavailability of such iron is minimal, and all these foods are not dietary sources of iron. The bioavailability of iron with a traditional mixed diet ranges from 5 to 10%, and with a vegetarian diet it is only 2–3%. That is why vegetarianism is a powerful risk factor for VDD and IDA at any age. Iron that enters the human body with food is absorbed in the duodenum and the proximal segment of the jejunum. Gastroferrin (a protein synthesized by the gastric mucosa) and androgens (male sex hormones) stimulate the absorption of iron in the intestine. Ascorbic acid prevents the oxidation of iron, maintains it in the ferrous divalent form and thereby promotes the absorption of iron in the intestines. The acid-forming function of the stomach and the acidity of gastric juice do not affect the absorption of iron in the gastrointestinal tract. In chronic atrophic gastritis with reduced secretory activity, the absorption of iron in the intestine is impaired due to a decrease in the production of gastroferrin, but not hydrochloric acid. It is important to note that the most pressing causes of iron deficiency in adolescence and young adulthood are not chronic recurrent blood loss, but an increased need for this microelement against the backdrop of rapid growth, physical development and puberty; dyshormonal and dysmetabolic disorders against the background of pubertal development and puberty of adolescents. Iron replacement therapy (IR) is a key component of the standard treatment for patients with IDA, especially when there are limited possibilities for radical elimination of the causes of anemia. This applies primarily to the treatment of a large population of women with menorrhagia of various origins, pregnant and lactating women, as well as some other groups of patients. Adequate therapy of the pancreas helps to normalize the level of NV in erythrocytes, which eliminates the clinical manifestations of anemic and sideropenic syndromes, restores ability to work and improves the quality of life of patients. The relevance of the problem of IDA requires optimization of pathogenetic therapy for IDA of the pancreas, studying their safety and possible negative effects on various body systems. Currently, the doctor has at his disposal a large arsenal of pancreas, characterized by different composition and properties, the amount of iron they contain, the presence of additional components that affect the pharmacokinetics of the drug, and various dosage forms. Even if it is possible to establish the origin of iron deficiency, a necessary component of treatment (in addition to influencing the factor that caused the disease) is the administration of ferrodrugs, and, if the clinical situation allows, preference is given to the oral route of administration as it is safer. Modern oral ferrous preparations are either ferrous iron salts (since ferric ions are not absorbed in the digestive tract), or compounds consisting of a ferric hydroxide-polymaltose complex (the absorption mechanism differs from ionic preparations). The main compound included in traditionally used iron salts (ionic iron salts) is ferrous sulfate. It is believed to have higher bioavailability compared to other iron salts (chloride, fumarate) and causes few side effects during therapy [6, 8, 9]. Only divalent iron is absorbed from the gastrointestinal tract in the form of ions. The most effective in increasing the bioavailability of iron are stimulators of NV synthesis and erythropoiesis - folic acid and B vitamins. Folic acid stimulates the synthesis and reduplication of nucleic acids (DNA and RNA), cell proliferation, and is therefore vital for adolescents for rapid growth and physical development and for pregnant women for normal course of pregnancy, growth and development of the fetus. Folic acid regulates myeloid hematopoiesis, stimulates proliferation and differentiation of hematopoietic cells in the bone marrow, ensures normal maturation of erythroblasts, preventing their transformation into megaloblasts. It stimulates the absorption and utilization of iron and thereby increases its bioavailability. According to modern concepts, the intake of pancreatic acid should be combined with folic acid in order to prevent its secondary deficiency against the background of successful treatment of IDA and the transformation of hypochromic microcytic anemia into hyperchromic macrocytic megaloblastic anemia [9]. Vitamin B12 is required to activate folic acid and convert it into its active metabolite, tetrahydrofolic acid. B vitamins (B1, B2, B6) and microelements (manganese, cobalt, nickel, copper, zinc) stimulate the synthesis of NV and erythropoiesis and thereby potentiate the therapeutic and preventive effect of the pancreas. Deficiency of folic acid and vitamin B12 is often observed in VHD caused by bleeding and is associated with impaired DNA synthesis in the hematopoietic organs. The inclusion of folic acid and vitamin B12 in ferrous preparations enhances the active absorption of iron in the intestines and its subsequent utilization. All of the listed components are included in the complex antianemic drug Ferro-Folgamma (Germany) [2, 9], the capsule of which contains: 112.6 mg of ferrous sulfate (corresponding to 37 mg of iron), 5 mg of folic acid, 0.010 mg of cyanocobalamin, 100 mg ascorbic acid. Ferro-Folgamma provides an average increase in NV of 2.5 g/l/day (the highest rate of NV increase among ferrous sulfate preparations). When using Ferro-Folgamma, there is a fairly rapid (within the first 10 days of use) weakening of the clinical symptoms of posthemorrhagic anemia [4]. The drug is prescribed 1 capsule 3 times a day after meals for 3-4 weeks, and for severe forms of anemia - 2 capsules 3 times a day for 16 weeks. and more [8]. After cessation of treatment with Ferro-Folgamma, the positive effect and stabilization of blood serum parameters (levels of NV, red blood cells, serum iron, total iron-binding capacity of blood serum) persist for at least 1 month. [8]. As with any long-term treatment (when oral ferrodrugs are prescribed in sufficient doses, normalization of NV levels is observed in most cases within 3–4 weeks from the start of treatment), good tolerability ensures high adherence to treatment and, thus, increases the likelihood of success of therapy. Modern oral PZ rarely cause significant side effects that require their discontinuation and switching to the parenteral route of administration. Adverse events associated with the use of oral progesterone usually occur in the gastrointestinal tract: nausea, metallic taste in the mouth, constipation (one of the possible explanations is the binding of hydrogen sulfide in the intestine, which stimulates peristalsis), less often - diarrhea, anorexia. It must be taken into account that the absorption of iron from salt preparations may be reduced under the influence of certain substances contained in food (phosphates, calcium salts, phytin, tannin), as well as with the simultaneous use of certain drugs (tetracyclines, chloramphenicol, antacids). Thus, currently, the indications for the use of the drug Ferro-Folgamma are anemia caused by deficiency of iron, folic acid and vitamin B12, occurring against the background of chronic blood loss (menorrhagia and metrorrhagia, from hemorrhoids, etc.), as well as chronic alcoholism , infectious diseases, anemia of chronic diseases, taking anticonvulsants and oral contraceptives. The drug is also suitable for the prevention and treatment of iron and folic acid deficiency in the second and third trimesters of pregnancy, the postpartum period and during lactation. Regardless of the cause of menorrhagia and the need to influence the corresponding factor, long-term therapy with ferrodrugs for oral administration is required. The dose and regimen are selected individually, taking into account the iron content in the drug, its tolerability, etc. After normalization of the level of NV, it is necessary to carry out maintenance therapy with a ferrodrug for 5–7 days after the end of menstruation. If the condition is satisfactory and the NV indicators are stable, breaks in treatment are possible, which, however, should not be long, because Women's ongoing menorrhagia quickly depletes iron stores with the risk of relapse of IDA. When treating teenage girls, after normalization of the NV level, repeated courses of treatment are possible, especially if heavy menstruation occurs or there are other blood losses (nasal, gingival). Literature 1. Goryachev V.V. Iron metabolism during pregnancy. Astrakhan, 1994. 100 p. 2. Gratsianskaya A.N. Ferro-Folgamma in the treatment and prevention of iron deficiency // Pharmateka. 2012. No. 12. P. 57. 3. Dvoretsky L.I. Treatment of iron deficiency anemia // Breast cancer. 1998. T. 6. No. 20. P. 1312–1316. 4. Kazyukova T.V., Samsygina G.A., Kalashnikova G.V. New possibilities of ferrotherapy for iron deficiency anemia // Clinical pharmacology and therapy. 2000. No. 9 (2). pp. 88–91. 5. Konovodova E.N., Burlev V.A. Comparative effectiveness of treatment of manifest iron deficiency in pregnant women with various iron preparations // RMZh. 2009. T. 17. No. 16. P. 1028–1031. 6. Ferro-Folgamma. Therapy with iron, folic acid, vitamin B12 and ascorbic acid. Scientific review. Worwag Pharma. M., 2001. 7. Boyd CM, Leff B., Wolff JL, Yu Q., Zhou J., Rand C., Weiss CO Informing clinical practice guideline development and implementation: prevalence of coexisting conditions among adults with coronary heart disease / / J Am Geriatr Soc. May 2011 Vol. 59(5). R. 797–805. 8. Ghinea MM Treatment of iron deficiencyane – mia with Ferro-Folgamma Rom // J Intern Med. 2004. Vol. 42(1). R. 225–230. 9. Isler M., Delibas N., Guclu M., Guldekn F., Sutcu R., Bahceci M., Kosar A. Superoxide dismuta-se and glutathione peroxidase in erythrocytes of patients with iron deficiency anemia: effects of different treatment modalities // Croatian medical journal. 2002. Vol. 43(1). P. 16–19. 10. Jankowska E.A., Rozentryt P., Witkowska A., Nowak J., Hartmann O., Ponikowska B., Borodulin-Nadzieja L., Banasiak W., Polonski L., Filippatos G., McMurray JJ, Anker SD, Ponikowski P. Iron deficiency: an ominous sign in patients with systolic chronic heart failure // Eur Heart J. 2010 Aug. Vol. 31 (15). R. 1872–1880.

Interaction

Organic acids, calcium salts, phosphates, phytin, cholestyramine, as well as antacid preparations containing aluminum, magnesium, calcium, interfere with the absorption of iron due to the formation of insoluble complexes.

Preparations containing pancreatic enzymes may reduce iron absorption.

With the simultaneous use of phenobarbital, carbamazepine, valproate, sulfasalazine, hormonal contraceptives, folic acid antagonists, trimethoprim, pyrimethamine and triamterene, the absorption of folic acid is reduced.

Iron salts interfere with the absorption of tetracycline antibiotics in the gastrointestinal tract.

Solid foods, bread, raw cereals, dairy products, eggs reduce iron absorption.

When administered simultaneously with antibiotics of the tetracycline group, as well as with penicillinamine, complex compounds are formed that reduce the absorption of iron and reduce the antimicrobial activity of the antibiotics.

Ferro-Folgamma capsules No. 20

Compound

Active substances:

Excipients: ascorbic acid - 100 mg, solid fat - 168 mg, rapeseed oil - 172.4 mg, soy lecithin (E322) - 10 mg, gelatin - 11.4885 mg.
Shell composition: sorbitol 70% - 33.16 mg, glycerol - 51.26 mg, red iron oxide (E172) - 1.46 mg, black iron oxide (E172) - 1.165 mg, ethylvanillin - 0.7 mg.

Indications for use

Combined iron-folate-B12-deficiency anemia caused by chronic blood loss (stomach, intestinal bleeding, bleeding from the bladder, hemorrhoids, menorrhagia), as well as chronic alcoholism, infections, taking anticonvulsants and oral contraceptives; anemia during pregnancy and breastfeeding.

Prevention of iron and folic acid deficiency in the second and third trimesters of pregnancy, in the postpartum period, during breastfeeding.

Contraindications

Anemia not caused by iron deficiency (for example, hemolytic anemia or isolated megaloblastic anemia caused by vitamin B12 deficiency), hypersensitivity, liver failure.

Excessive iron content in the body (for example, hemosiderosis, hemochromatosis).

Disorder of iron utilization mechanisms (for example, lead anemia, sideroachrestic anemia).

Directions for use and doses

Take 1-2 capsules orally after meals.

Anemia: mild form, 1 capsule 3 times a day for 3-4 weeks; for moderate to severe cases - 1 capsule 3 times a day for 8-12 weeks; in severe cases - 2 capsules 3 times a day, for 16 weeks or more.

During pregnancy - to prevent folic acid and iron deficiency - 1 capsule 3 times a day in the 2nd and 3rd trimesters, in the postpartum period during breastfeeding.

Storage conditions

At a temperature not exceeding 25° C. Store out of the reach of children.

Best before date

2 years. Do not use after the expiration date indicated on the package

special instructions

The dark color of the stool is due to the excretion of unabsorbed iron and has no clinical significance.

Description

Iron supplement + multivitamins.

Pharmacodynamics

Ferro-Folgamma® is a complex antianemic drug containing divalent iron in the form of a simple ferrous sulfate salt, vitamins B12, folic and ascorbic acid, intended for the treatment of iron deficiency conditions.
Iron is an important component of the human body. It is a constituent of hemoglobin, myoglobin and various other enzymes. Ascorbic acid improves the absorption of iron in the intestines. Vitamins B12 and folic acid are involved in the formation and maturation of red blood cells. The active components of Ferro-Folgamma® are contained in a special neutral shell, which ensures their absorption mainly in the upper part of the small intestine. The absence of local irritation on the gastric mucosa contributes to good tolerability of the drug in the gastrointestinal tract.

Side effects

Nausea, allergic reactions: eczematous phenomena, urticaria, anaphylactic shock, anaphylactoid reactions.

Use during pregnancy and breastfeeding

Prescribed during pregnancy and lactation according to indications.

Interaction

Organic acids, calcium salts, phosphates, phytin, cholestyramine, as well as antacid preparations containing aluminum, magnesium, calcium interfere with the absorption of iron due to the formation of insoluble complexes. Preparations containing pancreatic enzymes may reduce iron absorption.

With the simultaneous use of phenobarbital, carbamazepine, valproate, sulfasalazine, hormonal contraceptives, folic acid antagonists, trimethoprim, pyrimethamine and triamterone, the absorption of folic acid is reduced.

Iron salts interfere with the absorption of tetracycline antibiotics in the gastrointestinal tract.

Solid foods, bread, raw cereals, dairy products, eggs reduce the absorption of iron; when administered simultaneously with tetracycline antibiotics, as well as with penicillinamine, complex compounds are formed that reduce the absorption of iron and reduce the antimicrobial activity of antibiotics.

Overdose

It is characterized by the appearance of epigastric pain, nausea, vomiting, stool upset, drowsiness, pallor, and the development of a state of shock up to coma.

Recommended therapeutic measures include gastric lavage, administration of desferroxamine and the organization of adequate supportive therapy.