Preparations containing iron: differences, "chips", pharmaceuticals. custody, cheat sheets

Final rating 0 (0 reviews)

Thanks to the author - Marina Kuznetsova

Today we will look at popular preparations containing iron for oral administration.

Here's what we'll look at:

1. Differences between divalent and trivalent iron preparations. Their advantages and disadvantages.
2. Features of some popular products.
3. What effect do iron supplements have on teeth? How to avoid darkening?
4. What questions should a buyer ask when selling iron supplements?
5. What C.U. give to the client?
6. Why can vegetarians have normal hemoglobin?
7. What can be recommended to a buyer without a doctor’s prescription so as not to cause harm?
8. Why does hemoglobin not increase despite long-term use of iron-containing medications?
9. How long can pregnant women take iron supplements?

Well then. Let's get started.

All iron preparations can be divided into two groups: ferrous and trivalent iron preparations.

Ferrous iron preparations, their advantages and disadvantages

Representatives:

• Aktiferrin,
• Sorbifer Durules,
• Tardiferon,
• Totem,
• Fenyuls,
• Ferretab comp.

Benefits of ferrous iron supplements

1. Well absorbed through the gastrointestinal mucosa.

1. Increases hemoglobin faster than ferric iron supplements. They normalize hemoglobin after 1 - 2 months, and iron reserves return to normal after 3-4 months. For comparison: on average, ferric iron preparations normalize hemoglobin within 2-4 months, and iron reserves within 5-6 months from the start of treatment.

Disadvantages of ferrous iron preparations

• Very toxic. There is a high risk of iron overload, because the absorption of ferrous iron through the mucous membrane of the digestive tract is uncontrolled, and it may happen that all the transport proteins that should pick up iron and carry it either to the depot or to the sites of hemoglobin formation are occupied. Free iron then enters the bloodstream and causes various damage. There are many side effects from this. The risk of overdose is especially high in children. Do not recommend these drugs yourself!
• Ferrous iron promotes the formation of a large number of free radicals - harmful atoms or molecules that trigger a chain of new damage.
• Eating reduces their absorption, so ideally approximately 30-60 minutes before meals But they often cause abdominal pain, constipation, diarrhea, and patients are forced to take them during or after meals.

Some manufacturers, knowing such a sin behind their brainchild, recommend taking them before or after meals. “After” means if it is poorly tolerated. But this affects the absorption of iron and the speed of onset of the effect.

How do ferrous iron preparations differ from each other?

First of all, because they contain different iron salts: sulfate, fumarate, gluconate.

Of these, ferrous sulfate is the most toxic.

Ferrous sulfate preparations are prohibited for use in a number of countries for pregnant women, children and those with digestive tract diseases.

Remember, Ferroplex used to be in dragees? When I worked as a local pediatrician, a 9-month-old baby died in my area from Ferroplex poisoning - the adults left the package open in a visible place.

Other iron salts (fumarate, gluconate) are less toxic and safer.

The preparations also differ in the form of release and the content of “pure” iron.

The minimum effective therapeutic daily dose of iron is 100 mg, and the average daily therapeutic dosage is 100-300 mg.

The dosage of an iron supplement primarily depends on the purpose for which the drug is taken, and then on the severity of the anemia.

And the goal could be like this:

1. Raise iron reserves in the depot. This is called “latent iron deficiency,” when hemoglobin and red blood cells are normal, but ferritin and some other blood parameters are reduced. It can be suspected by sticking in the corners of the mouth, dry skin, brittle hair, and split nails.
2. Cure iron deficiency anemia.
3. Prevent anemia in pregnant women.

After reading all this, you should have questions:

• Which preparations contain less toxic iron salts?
• How much iron is contained in different preparations?

A small cheat sheet for this group will help you. The download link is at the end of the article.

Five years of experience in using the drug Sorbifer Durules in the treatment of iron deficiency conditions

AND

Iron deficiency anemia (IDA) is one of the most serious medical problems.
According to WHO data [1], 20% of the world's population has iron deficiency to varying degrees. Anemia due to iron deficiency accounts for 80–95% of all anemias
[2]. In women it is detected much more often than in the male population. In 60% of cases, IDA occurs in patients over 65 years of age [3].

Iron is an essential and indispensable component of various proteins and enzymatic systems, providing the necessary level of systemic and cellular aerobic metabolism, as well as redox homeostasis in the body as a whole. Iron plays an important role in maintaining high levels of immune resistance. Adequate iron content in the body contributes to the full functioning of nonspecific defense factors, cellular and local immunity (Kazakova L.I. et al., 1990).

Daily iron requirement

is 10 mg, for women 18 mg (during pregnancy and lactation - 38 and 33 mg, respectively). In the body, iron is contained in hemoglobin (about 65.5%), in depot (31%), a small part is in myoglobin (3.5%), heme-containing enzymes and in blood plasma [1, 6].

The development of IDA is caused by chronic blood loss, impaired iron absorption, an increase in the body’s need for iron during growth, pregnancy and lactation, and insufficient nutritional intake of iron into the body [3].

The clinical picture of IDA consists of symptoms characteristic of any anemia (increased fatigue, decreased exercise tolerance, dizziness) and signs associated with tissue sideropenia. Trophic disorders are associated with a lack of enzymes containing iron: hair loss, brittle nails, dry skin, cracks in the corners of the mouth, perversion of taste. With severe tissue iron deficiency, koilonychia, dysphagia, impaired gastric secretion, and urinary incontinence when laughing or coughing appear. Changes in the cardiovascular system in patients with IDA manifest themselves with slight physical exertion as shortness of breath, palpitations, and tachycardia in 60% of cases. Experimental and clinical studies have established that with IDA, one of the most important functions of the blood is disrupted - the transfer of oxygen to tissues with the development of tissue hypoxia and changes in the cardiovascular system [5, 6].

A.V. Lierman et al. [7] draw attention to the fact that iron deficiency conditions in young people are often interpreted as neurocirculatory dystonia: with increased heart rate, decreased blood pressure, enlarged or normal boundaries of the heart, and systolic murmur at the apex of the heart.

A number of studies have noted [8,9] that in elderly people with IDA, with aging, there is a decrease in the level of iron in the blood serum and bone marrow, a decrease in the efficiency of iron inclusion in erythrocytes, which correlates with a decrease in hemoglobin levels and the severity of changes in the cardiovascular system. There is an exacerbation of coronary heart disease and congestive heart failure. Works have appeared [4] indicating that patients with IDA were diagnosed with silent myocardial ischemia, which increased as the severity of the disease increased. The cause of its occurrence is myocardial hypoxia, which increases with physical activity.

Thus, the question of the relationship between the severity of damage to the cardiovascular system and iron deficiency in patients with IDA is of scientific and practical interest, especially with regard to the reversibility of these changes.

Our study aimed to evaluate the tolerability and effectiveness of treatment of iron deficiency anemia, including those with concomitant cardiovascular pathology, with the drug Sorbifer Durules.

Material and methods

Over the course of 5 years, the study included 1426 patients aged from 18 to 70 years (the average age of men and women was 48.3±4.5 and 42.5+2.3 years, respectively). Of the examined patients, 5% had newly diagnosed IDA, 24% of patients suffered from anemia for a year, 71% for 5 years. The cause of IDA in young women was prolonged menorrhagia (46%), in 28% - menorrhagia associated with the presence of uterine fibroids. In 14% of patients (mostly in men), the cause of IDA was previous gastrointestinal bleeding, in 12% it was malnutrition.

The patients were treated with Sorbifer Durules

within 4 weeks. When passing through the gastrointestinal tract from the porous matrix of Sorbifer Durules tablets, a continuous release of divalent iron ions occurs for 6 hours. Due to the slow release of iron ions, a high concentration of iron is not formed locally and thus it is possible to avoid irritation of the mucous membrane of the gastrointestinal tract. The coated form of the drug prevents the formation of a yellow border on the teeth during long-term use. The drug contains 320 mg of ferrous sulfate, corresponding to 100 mg of ferrous iron, and 60 mg of ascorbic acid, which improves absorption and assimilation of the microelement. We used a dosage regimen of 1 tablet 2 times a day.

Laboratory parameters were assessed over time: the beginning of the study, after 2, 3, 4 weeks of treatment with the drug. Clinical blood analysis was carried out on an automatic analyzer. The laboratory parameters included in the study were: red blood cell count, hemoglobin, color index, hematocrit, mean red blood cell volume, mean hemoglobin content in red blood cells, mean hemoglobin concentration in red blood cells. Laboratory parameters characterizing iron metabolism in the body were used: serum iron (SI), total iron binding capacity of serum (TIBC), latent iron binding capacity of serum (LIBC) and transferrin saturation coefficient (TSC). Instrumental research methods included ultrasound examination of the abdominal cavity (ultrasound), ECG-ST monitoring according to Holter before and after treatment in case of detected changes in the ECG. Statistical processing of the material was carried out using the medical and biological statistics program.

results

Mild IDA was detected in 36.4% of the examined patients, moderate in 27.3%, and severe in 18.2%.

Before treatment, 36% of patients complained of increased fatigue, 18% of palpitations and 46% of tissue manifestations of iron deficiency (koilonychia, dysphagia, impaired gastric secretion, urinary incontinence when laughing, coughing).

48 patients had a history of coronary heart disease (CHD) and changes were detected during ECG monitoring. Patients noted complaints of increased chest pain, palpitations, and shortness of breath.

The effectiveness of treatment was determined every week based on the patients’ subjective assessment of drug tolerance, the degree of improvement in well-being, and according to peripheral blood counts. The drug was well tolerated, with constipation noted only in a few cases during the first week of therapy. No other side effects of the drug were identified.

After two weeks of treatment, the subjective assessment of the effectiveness of treatment was determined by patients as “the condition has improved” - in 36%, “the condition has improved significantly” in 18%, and in 18% – “the condition has improved little.” After 4 weeks of taking the drug, patients noted a significant improvement in their condition, so 54% of patients rated their condition as “significantly improved.” At the same time, 55% had no complaints, 18% noted increased fatigue, manifestations of tissue iron deficiency were noted only in 18% of patients, and 9% of patients complained of palpitations.

The laboratory data obtained confirm the general trend of improvement in the clinical condition of patients during therapy. The increase in hemoglobin and hematocrit is shown in Fig. 1. The level of hemoglobin in the blood increased significantly already in the 2nd week of treatment. Hematocrit increased on average from the initial value of 26.8±1.3% to 39.0±2.5% after treatment.

Rice. 1. Dynamics of hematological parameters during treatment with Sorbifer Durules

The number of red blood cells increased from 3.2±0.51 to 4.7±0.21x1012/l. A significant increase in this indicator was observed in the 3rd week of treatment. Analysis of the dynamics of the color index, determined by the level of average hemoglobin content in an erythrocyte and the average volume of an erythrocyte, indicates a transition from the state of hypochromia to a normochromic characteristic (Table 1).

Serum iron content before treatment was 6.2±0.3 µmol/l, after treatment after 4 weeks it significantly increased to 13.6±1.2 µmol/l (p<0.05), CVS returned to normal after 4 weeks in 86% of patients (Fig. 2).

Rice. 1. Dynamics of hematological parameters during treatment with Sorbifer Durules

In 48 patients with IDA with concomitant coronary artery disease, ventricular extrasystole was noted in 38.2% of cases, and sinus tachycardia was noted in 14 patients. A shift of the ST segment down from the isoline during ECG monitoring was detected in 36 patients with IDA, including 24 who had painless episodes of myocardial ischemia. Therapy with Sorbifer Durules led to relief of cardialgia in 16 patients and tachyarrhythmias in 4 patients. In addition, in 18 patients, according to 24-hour ECG monitoring, there was a decrease in the number and duration of episodes of painful and silent myocardial ischemia against the background of standard antianginal therapy.

Complete clinical and hematological remission (normalization of hemoglobin levels and ferrokinetic parameters) were obtained after 4 weeks from the start of treatment in 75% of patients. To maintain the achieved remission, with persistent blood loss caused by cyclic menorrhagia, it was recommended to continue taking Sorbifer Durules 1 tablet for the next 4 months after the course of treatment.

Treatment of IDA should begin immediately after the diagnosis has been verified and the causes of iron deficiency have been established. It should be noted that in order to correctly select an iron supplement, it is necessary to take into account the amount of microelement in each tablet of the drug. The drug should have a prolonged effect, which reduces the frequency of administration and is well tolerated by patients. The daily and course dose of the drug is calculated taking into account the severity of the anemic syndrome, visceral lesions, and serum iron levels.

Thus, the main principles of treatment for IDA are the correction of the causes underlying iron deficiency, the elimination of not only anemia, but also iron deficiency in the blood and tissues.
Patients should be informed that compensation for iron deficiency and correction of IDA cannot be achieved using special diets. The high content of ferrous iron in the drug Sorbifer Durules, its high therapeutic efficacy and good tolerability with minimal side effects, which the drug demonstrated in our study, allow us to recommend it for widespread use in the treatment of iron deficiency conditions. Literature:
1. Beloshevsky V.A., Minakov E.V. Anemia in chronic diseases./ Voronezh University Publishing House. 1995 – From 34–37.

2. Volkov V.S. , Kirilenko N.P. Iron deficiency states./ Cardiology – No. 6, – vol. 31., 1991, – P 64–67

3. Wood Marie E., Bann Paul A., Tokarev Yu.N., Bukhni A.E. Secrets of hematology and oncology. / under. ed., M.: BINOM, 1997.

4. Gorokhovskaya G.N., Ponomarenko O.P., Parfenova E.S. State of the cardiovascular system in iron deficiency anemia./ Kremlin Medicine, Clinical Bulletin – No. 2, 1998, – P. 34–37.

5. Kozinets G.I., Makarov V.A. Study of the blood system in clinical practice./ Ed. , M.: Triada-X, 1997.

6. Korovina N.A., Zaplatnikov A.L., Zakharova I.N. Iron deficiency anemia in children./Moscow 1999, pp. 25–27.

7. Lirman A.V., Strenev F.V. About changes in the heart in iron deficiency conditions. / Wedge. Med., 1986, t 64, No. 5, – pp. 69–72.

8. Meerson D.Z., Sukhomlinov A.B., Evseeva M.E., Abdikaliev N.A. Prevention of myocardial damage in hemolytic anemia using antioxidants. / Cardiology., 1983., t. 23, No. 6, – pp. 94–99.

9. Strenev F.V. About changes in the heart, central hemodynamics and physical performance under the influence of mild and moderate iron deficiency anemia. / 1989, – pp. 45–47.

The most common side effects of drugs containing iron

1. Pain, discomfort in the abdomen.
2. Constipation or diarrhea.
3. Nausea, vomiting.
4. Darkening of tooth enamel.
5. Painting the stool black. Nothing wrong with that. Simply unabsorbed iron leaves the body naturally.

Drug interactions of ferrous iron preparations

• Calcium, magnesium, levothyroxine (Euthyrox, L-thyroxine), antacids reduce iron absorption.
• In turn, iron supplements reduce the absorption of fluoroquinolones and tetracyclines (Doxycycline, Unidox, Tetracycline, etc.).
• If you take these drugs together with drugs from the NSAID group, the risk of damage to the mucous membrane of the digestive tract increases.
• During treatment with ferrous iron preparations, you should refrain from drinking alcohol - it increases the frequency of toxic reactions.

Interaction with food of ferrous iron preparations

Milk and dairy products, cereals, egg yolks, coffee, tea and some other foods reduce iron absorption. In this regard, the interval between taking the ferrous iron preparation and consuming these products should be at least 2 hours.

What else?

Ferrous iron preparations can cause exacerbation of chronic inflammatory diseases of the stomach and intestines.

If a patient has such a problem, the drug must be chosen especially carefully.

As a last resort, as I already said, take it during or after meals.

The treatment will be longer but safer.

Now do you understand what questions you need to ask the buyer when selling these funds? What recommendations should you give, what should you warn about?

I will list it all below.

In the meantime, I’ll dwell on the features of individual ferrous iron preparations. Let me remind you once again that I will only talk about drugs for oral administration.

Aktiferrin

Oral dosage forms: drops, syrup.

Previously, there were also capsules, but now I don’t see them in the assortment of Russian pharmacies.

The composition contains ferrous sulfate, which, let me remind you, is characterized by maximum toxicity, and the amino acid serine. It improves iron absorption, since only 10-15% of ferrous iron is absorbed through the mucous membrane of the small intestine.

(And trivalent without helpers is not absorbed at all).

Pregnant and lactating women can.

Children: syrup from 2 years, drops from birth.

The dose is calculated per kg of weight.

The course of treatment is at least 8 weeks.

After hemoglobin returns to normal, you need to continue taking the drug for the same amount of time to replenish iron reserves.

What's not to like about Aktiferrin?

The manufacturer's instructions indicate the iron content in 100 ml of syrup or drops. This means that the doctor must calculate the daily dosage, taking into account the child’s weight and iron deficiency, which is determined by the formula. And if he is not good at mathematics, it is easy to make a mistake and either overdo the dose, or vice versa.

In the first case, this threatens with intoxication, in the second - too long a course of treatment.

General characteristics

The compared antianemic drugs have approximately similar contraindications:

• Age up to 12 years (Ferrum has only an infusion solution);
• Anemia not of iron deficiency;
• Some liver diseases (acute hepatitis, cirrhosis);
• Excessive iron content;
• Problems of iron metabolic processes.

Among the minor similarities that do not affect health in any way is darkening of the stool.

No significant effect on the nervous system has been registered; the use of anti-anemic drugs does not reduce concentration. There are also no restrictions on eating different types of food.

The duration of treatment is approximately the same: on average 3-5 months.

Sorbifer Durules

Release form: film-coated tablets.

The composition is the same ferrous sulfate (100 mg of pure iron) and ascorbic acid (60 mg).

The word “Durules” means a technology for the gradual release of the active substance, which in theory should reduce the number and frequency of adverse reactions.

The active substance is released from the tablet within 6 hours. This prevents the accumulation of high concentrations of iron on the gastrointestinal mucosa and supposedly avoids its damage. Although judging by the reviews, side effects when taking it are quite common.

Last time I asked you a question about ascorbic acid.

With its help, ferric iron turns into divalent iron, which is absorbed through the gastrointestinal mucosa. So why was it added to the ferrous iron preparation?

I told you above that ferrous iron contributes to the formation of a large number of free radicals, and I believe that ascorbic acid is added here as an antioxidant to neutralize them, although the manufacturer writes that it improves the absorption of iron.

I think that the need for ascorbic acid in the drug Sorbifer Durules is greatly exaggerated, otherwise it would be introduced into all ferrous iron preparations. But this is not the case.

Children - from 12 years old.

Pregnant and lactating women can.

How to take: 1 tablet. 1-2 times, i.e. 100-200 mg of iron per day.

Comparison of side effects of Ferrum Lek and Sorbifer durules

Side effects or adverse events are any adverse medical event that occurs in a subject after administration of a drug.

Ferrum Lek's side effects are almost the same as those of Sorbifer Durules. They both have few side effects. This implies that the frequency of their occurrence is low, that is, the indicator of how many cases of an undesirable effect of treatment are possible and registered is low. The undesirable effect on the body, the strength of influence and the toxic effect of Ferrum Lek is similar to Sorbifer Durules: how quickly the body recovers after taking it and whether it recovers at all.

Tardiferon

Release form: available in the form of film-coated tablets with prolonged release of the active substance.

The composition again contains ferrous sulfate.

Differences from the drug Sorbifer: a smaller dosage of pure iron in one tablet (80 mg versus 100 mg), so you will have to wait longer for the effect. No ascorbic acid.

Children - from 6 years old.

Pregnant and lactating women are allowed.

Standard therapeutic dosage for adults: 1-2 tablets. per day (80-160 mg of iron).

Totema

Release form: solution for oral administration. 1 ampoule - 50 mg of pure iron.

Why is the liquid form better?

The fact that the solution is more evenly distributed throughout the mucous membrane of the digestive tract, and the likelihood of irritation is reduced.

Secondly, this form is good for those who do not know how to swallow tablets, or for bedridden patients.

Another advantage of the drug Totema: it contains a safer iron salt - gluconate. The risk of side effects is less.

Fourthly, Totema contains copper and manganese, which improve iron absorption.

Children – from 3 months.

Pregnant women can.

Caution for patients with diabetes mellitus, because For taste, a lot of all sorts of chemical rubbish has been added to it. This is why I don't like liquid forms. In addition to the active and auxiliary substances necessary for stability, they contain all sorts of flavorings, dyes, sweeteners, etc., so the likelihood of allergic reactions is higher.

How to take: the contents of the ampoule should be dissolved in plain or sweetened water and drunk before meals. To treat IDA, take 1-2 ampoules 2 times a day. This is 100-200 mg of iron per day.

Fenyuls

Release form: capsules coated with a compound that forms a semi-permeable film of a certain thickness. This ensures a gradual release of iron.

If there are current instructions on the drug’s website, then it seems that this is the only iron supplement that can be dispensed without a doctor’s prescription.

But I wouldn't do it, and here's why.

Fenyuls contains ferrous sulfate and a number of vitamins (B1, B2, B6, PP, ascorbic acid, calcium pantothenate). All this, as the manufacturer claims, improves iron absorption and prevents the formation of free radicals.

But there are more side effects, since in addition to the side effects for iron, side effects for vitamins have been added: allergic reactions, dizziness, tachycardia, sweating, numbness of the extremities, an increase in the number of platelets, leukocytes, increased blood sugar levels, etc.

Maybe that's why the manufacturer is so careful with the recommended dosage? Pure iron in 1 capsule - 55 mg. Take 1-2 capsules per day. This dosage is more suitable for the prevention of anemia or the treatment of latent iron deficiency.

Contraindicated for children, allowed for pregnant and lactating women.

Ferretab comp.

Release form: extended-release capsules.

It is interesting because each capsule contains three mini-tablets of iron (total 50 mg of pure iron) and one mini-tablet of folic acid in a good dosage (500 mcg).

See:

Abbreviation "comp." in the name of the drug means “complex”.

It is best recommended for anemia caused by deficiency of iron and folic acid, and for iron deficiency anemia in pregnant women or for the prevention of it.

Iron is represented by a safer salt than ferrous sulfate - fumarate. Gives fewer side effects.

How to take: on an empty stomach, 1 capsule (50 mg of iron) per day. If necessary, the doctor may increase the dosage to 2-3 capsules per day.

Conclusions:

ferrous preparations , I came to the following conclusions:

The safest drugs are Totema, Ferretab comp., because they do not contain ferrous sulfate, but other salts.

The most adequate dosages of iron for the treatment of IDA, in my opinion, are in the preparations Sorbifer Durules and Totema.

Comparison of ease of use of Ferrum Lek and Sorbifer durules

This includes dose selection taking into account various conditions and frequency of doses. At the same time, it is important not to forget about the release form of the drug; it is also important to take it into account when making an assessment.

The ease of use of Ferrum Lek is approximately the same as that of Sorbifer Durules. However, they are not convenient enough to use.

The drug ratings were compiled by experienced pharmacists who studied international research. The report is generated automatically.

Last update date: 2020-12-04 13:43:07

Ferric iron preparations

Benefits of ferric iron supplements

• Low toxicity. They cannot be overdosed.
• Better tolerated.
• They can be taken before, during, and after meals, without fear of inflammation or ulceration of the gastrointestinal mucosa.
• Fewer drug interactions.
• Fewer food interactions.

Disadvantages of ferric iron preparations

They act more slowly, so the treatment time increases.

If you need to quickly increase your iron level (surgery is coming up, severe anemia, etc.), at the beginning of treatment the doctor will most likely prescribe a ferrous iron supplement. In the future, he can transfer the patient to a ferric iron preparation if he does not tolerate divalent iron.

Let's look at the features of some popular drugs in this group.

Optimal choice

It is impossible to take different types of antianemic drugs at the same time, since they neutralize each other. Hence it is important to choose the best option.

Just a decade ago, Sorbifer was the most popular remedy against anemia. However, studies have been conducted showing that ferric iron compounds are absorbed faster and better absorbed, and since then new, more modern drugs have appeared on the market.

Despite this, Sorbifer remains in demand due to its adsorbing properties. It has proven to be a high-quality remedy for quickly increasing hemoglobin.

Ferrum Lek is suitable for the complex treatment of anemia and the prevention of iron deficiency (including in adolescents and pregnant women) due to its rapid absorption, variety of dosage forms, and good cumulative properties.

Medicine and healthComment

Maltofer

Release forms for oral administration: drops, syrup, chewable tablets.

Main feature: iron hydroxide is combined with carbohydrates. This complex is called: “Iron hydroxide polymaltosate.” In articles and instructions it is referred to by the abbreviation HPC (hydroxide-polymaltose complex).

Its structure is similar to that of the natural iron compound ferritin. Thanks to this, it can connect with the transport protein, which delivers iron from the intestines to the blood.

GPC is stable. “pure” iron is not released into the gastrointestinal tract, and therefore there are significantly fewer adverse reactions when using it.

Pregnant and breastfeeding women can. Maltofer Fol will be optimal , which contains folic acid necessary for normal growth and development of the fetus.

Children: Maltofer drops, syrup - from birth, tablets - from 12 years.

Adverse reactions: nausea, constipation, diarrhea, dark stool, rash, itching, discoloration of tooth enamel.

Drug interactions - no.

There are no food interactions.

How to take: for the treatment of IDA, adults take 40-120 drops or 10-30 ml of syrup or 1-3 tablets per day. (100-300 mg pure iron) during or after meals. Chewable tablets can be swallowed as usual.

Maltofer in the form of drops or syrup can be mixed with fruit juice, vegetable puree, and milk mixture.

Ferrum Lek chewable tablets 100 mg 50 pcs. in Moscow

Inside,

during or immediately after meals.

Ferrum Lek® chewable tablets can be chewed or swallowed whole.

The daily dose can be divided into several doses or taken at one time.

Ferrum Lek® syrup can be mixed with fruit or vegetable juices or added to baby food.

Doses and duration of treatment depend on the degree of iron deficiency.

The measuring spoon included in the package is used for precise dosing of Ferrum Lek® syrup.

Iron-deficiency anemia

Duration of treatment is about 3–5 months. After normalization of hemoglobin levels, you should continue taking the drug for several more weeks to replenish iron reserves in the body.

Children under one year of age

: 2.5 ml (½ measuring spoon) - 5 ml (1 measuring spoon) Ferrum Lek® syrup per day.

Children aged 1 to 12 years

: 5–10 ml (1–2 scoops) of Ferrum Lek® syrup per day.

Children over 12 years of age, adults and mothers breastfeeding

: 1–3 chewable tablets or 10–30 ml (2–6 scoops) Ferrum Lek® syrup.

Latent iron deficiency

The duration of treatment is about 1–2 months.

Children aged 1 to 12 years

: 2.5–5 ml (1/2–1 scoop) Ferrum Lek® syrup per day.

Children over 12 years of age, adults and mothers breastfeeding

: 1 table. or 5–10 ml (1–2 scoops) of Ferrum Lek® syrup per day.

Pregnant women

Iron-deficiency anemia

: 2–3 chewable tablets per day or 20–30 ml (4–6 scoops) of Ferrum Lek® syrup until hemoglobin levels normalize. After this, you should continue to take 1 chewable tablet or 10 ml (2 scoops) of syrup per day, at least until the end of pregnancy to replenish iron stores in the body.

Latent iron deficiency and prevention of iron deficiency

: one chewable tablet or 5–10 ml (1–2 scoops) of Ferrum Lek® syrup per day.

Daily doses of Ferrum Lek® for the prevention and treatment of iron deficiency in the body

(-) Due to the fact that this group of patients requires low doses of iron, it is not recommended to use tablets or syrup in these cases.

V/m

(only).

Before administering the first therapeutic dose of the drug, each patient should be given a test dose of 1/4–1/2 amp. Ferrum Lek® (25–50 mg iron) for an adult and half the daily dose for a child. If there are no adverse reactions, the remainder of the daily dose can be administered within 15 minutes.

Doses of Ferrum Lek® must be selected individually, in accordance with the general iron deficiency, which is calculated using the following formula:

Total iron deficiency = body weight (kg) × (calculated hemoglobin level (g/l) − actual hemoglobin level (g/l) × 0.24) + deposited iron (mg)

Body weight up to 35 kg: estimated hemoglobin level = 130 g/l and deposited iron = 15 mg/kg

Body weight over 35 kg: estimated hemoglobin level = 150 g/l and deposited iron = 500 mg

Factor 0.24 = 0.0034 × 0.07 × 1000

(Iron content = 0.34%; total blood volume = 7% body weight; factor 1000 = conversion from g to mg).

Example

Patient body weight: 70 kg

Real hemoglobin concentration: 80 g/l

Total iron deficiency = (150 − 80) × 0.24 + 500 = 1700 mg iron

Total number of Ferrum Lek® ampoules to be administered = Total iron deficiency (mg) / 100 mg

Calculation of the total number of Ferrum Lek® ampoules that must be administered, based on the actual hemoglobin concentration and body weight

If the required dose of Ferrum Lek® exceeds the maximum daily dose, the drug should be administered in fractional doses (over several days).

If hematological parameters do not change 1–2 weeks after the start of treatment, the diagnosis should be clarified.

Calculation of the total dose for iron replacement due to blood loss

The required amount of the drug to compensate for post-hemorrhagic iron deficiency is calculated using the following formula.

If the amount of blood lost is known: administration of 200 mg IM (2 amps of Ferrum Lek®) leads to an increase in hemoglobin levels, which is equivalent to 1 unit of blood (400 ml of blood with a hemoglobin content of 150 g/l).

Iron to be replaced (mg) = number of blood units lost × 200 or required number of Ferrum Lek® ampoules = number of blood units lost × 2.

If the final hemoglobin level is known, the following formula must be used, taking into account that deposited iron does not need to be replaced.

Iron to be replaced (mg) = body weight (kg) × (estimated hemoglobin level (g/L) − actual hemoglobin level (g/L) × 0.24.

A patient with a body weight of 60 kg and a hemoglobin deficiency of 10 g/l should be replaced with 150 mg of iron, which is 1.5 ampoules of Ferrum Lek®.

Standard doses

Children: 0.06 ml/kg/day (3 mg iron/kg/day).

Adults: 1–2 amp. Ferrum Lek® (100–200 mg iron), depending on the hemoglobin level.

Maximum daily doses

Children: 0.14 ml/kg/day (7 mg iron/kg/day).

Adults: 4 ml (2 amps) per day.

Ferrum Lek

Ferrum Lek used to be almost the only iron preparation for parenteral administration. There were no oral forms of it.

And now they are: syrup and chewable tablets.

Ferrum Lek is an analogue of the drug Maltofer in the form of syrup and chewable tablets. So, if something happens, they can replace Maltofer.

How to take: for adults to treat IDA, 10-30 ml of syrup (100-300 mg of iron) or 1-3 tablets per day during or after meals. After hemoglobin returns to normal, continue taking the drug 1 tablet until ferritin (iron reserves) normalizes.

Comparison of addiction in Ferrum Lek and Sorbifer durules

Like safety, addiction also involves many factors that must be considered when evaluating a drug.

So, the totality of the values ​​of such parameters as “syndrome o” in Ferrum Lek is quite similar to the similar values ​​in Sorbifer durules. Withdrawal syndrome is a pathological condition that occurs after the cessation of intake of addictive or dependent substances into the body. And resistance is understood as initial immunity to a drug; in this it differs from addiction, when immunity to a drug develops over a certain period of time. The presence of resistance can only be stated if an attempt has been made to increase the dose of the drug to the maximum possible. At the same time, in Ferrum Lek the meaning of the “syndrome” is quite small, however, the same as in Sorbifer durules.

Ferlatum

Release form: solution for oral administration. 1 bottle contains 40 mg of pure iron.

Features of the composition: this is also a complex, only iron is in a complex not with carbohydrates, as in the previous case, but with protein. This prevents damage to the gastric mucosa.

Iron from this complex enters the blood from the intestines only thanks to carrier proteins, so an overdose is impossible. This means that there will be significantly fewer side effects than with treatment with ferrous iron preparations.

Adverse reactions: rarely - diarrhea, constipation, nausea, epigastric pain.

Drug interactions

• Reduces the absorption of tetracyclines.
• The absorption of iron increases if the drug is taken simultaneously with 200 mg of ascorbic acid. Keep it up! They ask Ferlatum, and you ask the buyer: “Did your doctor recommend you take ascorbic acid with it?” To be more convincing, you can show the instructions.
• Antacids reduce iron absorption.

Children, pregnant and lactating women are allowed. But it is better for pregnant women to take Ferlatum Fol , which contains a folic acid compound in the dispenser cap.

You need to remove the white cap from the bottle, press the red dispenser cap with your finger, and the powder with folic acid will pour into the bottle, and now the drug is ready for use.

How to take: standard dosage: 1-2 bottles per day before or after meals. This is 40-80 mg of pure iron. In my opinion, not enough.

The manufacturer does not say anything about its dilution, which means it is usually taken: drink it and wash it down with water. Has a cherry taste.

Friends, I draw your attention: I have indicated here the MEDICAL dosages of drugs. But they will be different if the drug is prescribed for latent iron deficiency or for prophylactic purposes.

How do iron supplements affect teeth?

Iron supplements can cause darkening of tooth enamel. This applies mainly to liquid forms (drops, syrup, oral solution) and chewable tablets.

Even if the instructions say that this drug does not stain tooth enamel, judging by the reviews of those who have taken iron supplements, sometimes it does.

Apparently, this is due to some characteristics of the microflora of the oral cavity or tooth enamel, because this does not happen to everyone.

Is it possible to avoid darkening of teeth while taking iron supplements?

Can. To do this, you need to follow several rules:

1. Do not bite, dissolve, coated tablets, or keep them in your mouth.
2. If a person has difficulty swallowing tablets or capsules and purchases chewable tablets, they should thoroughly rinse their mouth and brush their teeth after each dose.
3. It is better to take drops, syrup, or oral solution through a straw and rinse your mouth after taking it.
4. It is impossible to accomplish the previous point in small children, therefore you need to let the child drink the drug, preferably with a large amount of water, and then wrap a bandage around his finger, moisten it with clean boiled water and wipe his teeth.

Some of you asked:

“How do you solve the problem of teeth staining in chewable tablets?”

Please note that only complex iron preparations have the form of chewable tablets, because They are less likely than ordinary iron salts to cause staining of tooth enamel. Most likely, it is due to the different structure of the active substance, when iron is surrounded by either polysaccharides or protein.

Reviews for all iron preparations that we are talking about today, and almost all liquid forms or chewable tablets, in some cases cause staining of tooth enamel, with the exception of Ferlatum. If you heard that it also caused darkening of teeth in some of your customers, write about it in the comments.

You may also be asked:

“Do iron supplements destroy teeth?”

Judging by the reviews, children’s teeth sometimes get damaged from them, but I haven’t found any scientific evidence for this.

Perhaps it's all about the sweeteners that are included in the liquid forms, and not about the iron itself.

Comparing drugs

So, Ferrum Lek and Sorbifer do not have many similarities, so let’s pay attention to the differences. The main thing is the composition, but there are other important points.

1. Release forms . One of the main advantages of Ferrum Lek is the variety of dosage forms and dosages. Patients who have problems swallowing can take syrup.
2. Duration of action . Ferric iron compounds are absorbed faster, they enter the blood 15-30 minutes after administration, so Ferrum is more convenient. But the accumulative capacity is higher in Sorbifer, since it has a longer period of elimination from the body.
3. Digestibility . Sorbifer is swallowed whole, without chewing, and washed down with plenty of water. Many patients noted problems with its use; it may not be suitable for age, condition, or sensitivity to components. Ferrum can be chewed and swallowed. It does not have oxidizing properties, so it does not cause damage to mucous tissue.
4. Price . The cost of Ferrum Lek depends on the type of product; the infusion solution is more expensive. Chewable tablets are cheaper than a similar package of Sorbifer.

Thus, Ferrum benefits from the ability to choose the optimal type of medication, and Sorbifer benefits from a rapid increase in hemoglobin.

What questions should a buyer ask when selling iron supplements?

-Do you have any stomach or intestinal diseases? (and specify: gastritis, colitis, peptic ulcer?)

If there is, but the doctor still prescribed the drug, recommend taking it during or after meals, and if abdominal pain occurs, advise initially reducing the dosage and increasing it gradually. If the pain persists, let him see a doctor.

-What other medications are you taking?

We talked about drug interactions above, but it’s difficult to remember all this, so use the cheat sheets, which I hope you will download (download link at the end of the article).

These two questions are especially important to ask if the customer is prescribed ferrous iron.

I remind you once again that the iron supplement is taken until hemoglobin normalizes, plus another 1-3 months. The course of treatment for iron deficiency anemia is usually 3-6 months. The duration of the course depends on the severity of anemia, compliance with dosage recommendations, the presence or absence of diseases of the digestive tract, which may reduce the absorption of iron, and if we are talking about a ferrous iron preparation, on how the drug is taken: on an empty stomach or with food. Taking the drug during or after meals slows down the absorption of iron.