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20-September-2008 09:29:05 - Iron supplements March 2007 Iron supplements are supplements that can be prescribed by a doctor for a medical reason. Iron can also be a dietary supplement, which can be purchased in supermarkets etc. These 2 categories should not be confused. Contents 1 Indications 2 Administration 3 Side effects 4 Contraindications 5 Interactions 6 Precautions 7 Follow-up 8 References 9 See also Indications Iron supplements are used in medicine to treat iron-deficiency anemia. First, it must be clear that iron deficiency and not another factor e.g. chronic, low-grade, undetected blood loss such as fecal occult blood causes the anemia. Preventive measures must be discussed with the patient for example when the patient is on a strict vegetarian diet because inorganic iron in plants has a lower bioavailability, or elderly patients with a poor diet. Another indication for giving extra iron is the second and third trimester of pregnancy, generally in association with folic acid. Indeed, in some condition like growth, menstruation and pregnancy, the body's need for iron is increased. Supplements may be needed to reach RDA life goals.1 Administration Iron can be supplemented using various pharmacological forms, such as ironII sulphate or sulfate this is the most common and cheapest salt, e.g. Feratab, Fer-Iron, Slow-FE,... and in complex with gluconate, dextran, carbonyl iron, and other salts. Sometimes ascorbic acid is added for better absorption. Generally, iron supplementation therapy is an oral therapy, and parenteral iron therapy intravenously or intramuscular is only given when resorption is seriously compromised by illnesses, or when the patient cannot swallow and benefit from oral therapy cannot be expected. It's more expensive and has increased morbidity. Since iron stores in the body are generally depleted, and there is a limit to what the body can process about 100mg per day without iron poisoning, this is a chronic therapy which may take 3-6 months. In some conditions e.g. after gastrectomy, in which there is production of intrinsic factor by the parietal cells of the stomach is complicated, even permanent iron substitution is necessary. Patients at risk of acute complications may be candidates for transfusion. Patients with anemia of chronic disease may benefit from erythropoietin. Side effects Side effects of therapy with iron are most often diarrhea or constipation and epigastric abdominal discomfort. Taken after a meal, side effects decrease but there is an increased risk of interaction with other substances. Side effects are dose-dependent, and the dose may be adjusted. The patient may notice that his/her stools become black. This is completely harmless, but patients must be warned about this to avoid unnecessary concern. When iron supplements are given in a liquid form, teeth may reversibly discolor this can be avoided through the use of a straw. Intramuscular injection can be painful, and brown discoloration may be noticed. When haematopoiesis resumes, other essentials for this process such as folic acid or vitamin B12 may be depleted, and care must be taken to avoid deficiencies of these elements. Treatments with ironII sulfate have higher incidence of adverse events than ironIII-hydroxide polymaltose complex IPC234 or iron bis-glycinate chelate.56 Contraindications Documented hypersensitivity and anemias without proper work-up i.e. documentation of iron deficiency. Hypersensitivity reactions can be very dramatic if iron is administered intravenously. Interactions Iron forms an insoluble complex with several other drugs, resulting in decreased absorption of both iron and the other drug. Examples include tetracycline, penicillamine, methyldopa, levodopa, bisphosphonates and quinolones. The same can occur with elements in food, such as calcium. Absorption of iron is better at a low pH an acid environment, and resorption is decreased if there is a simultaneous intake of antacids, phosphates, etc. Taken after a meal, there are fewer side effects but there is also less absorption because of interaction and pH alteration. Generally, an interval of 2-3h between the iron intake and that of other drugs seems advisable. Precautions Children who ingest tablets may become intoxicated, in which case they should be taken to an emergency department. Some formulations like carbonyl-iron may be safer. Follow-up Follow-up is needed to ensure compliance and to detect adequate response to therapy. If not, this may indicate another cause of anemia. Haematocrit, reticulocyte percentage, MCV, MCH and MCHC the latter three being signs of microcytic anemia should increase. References ^ Dietary Supplement Fact Sheet: Iron - U.S. National Institutes of Health, Office of Dietary Supplements. ^ Geisser P 2007. Safety and efficacy of ironIII-hydroxide polymaltose complex / a review of over 25 years experience. Arzneimittelforschung 57 6A: 439-52. PMID 17691594. ^ Toblli JE, Brignoli R 2007. IronIII-hydroxide polymaltose complex in iron deficiency anemia / review and meta-analysis. Arzneimittelforschung 57 6A: 431-8. PMID 17691593. ^ Saha L, Pandhi P, Gopalan S, Malhotra S, Saha PK 2007. Comparison of efficacy, tolerability, and cost of iron polymaltose complex with ferrous sulfate in the treatment of iron deficiency anemia in pregnant women. MedGenMed 9 1: 1. PMID 17435611. ^ Szarfarc SC, de Cassana LM, Fujimori E, Guerra-Shinohara EM, de Oliveira IM 2001. Relative effectiveness of iron bis-glycinate chelate Ferrochel and ferrous sulfate in the control of iron deficiency in pregnant women. Arch Latinoam Nutr 51 1 Suppl 1: 42-7. PMID 11688081. ^ Ashmead SD 2001. The chemistry of ferrous bis-glycinate chelate. Arch Latinoam Nutr 51 1 Suppl 1: 7-12. PMID 11688084. See also Human iron metabolism v d e Dietary supplements Types Amino acids Bodybuilding supplement Energy drink Energy bar Fatty acids Herbal Supplements Minerals Prebiotics Probiotics Lactobacillus, Bifidobacterium Vitamins Whole food supplements Vitamins and minerals Retinol Vitamin A B vitamins: Thiamine B1 Riboflavin B2 Niacin B3 Pantothenic acid B5 Pyridoxine B6 Biotin B7 Folic acid B9 Cyanocobalamin B12 Ascorbic acid Vitamin C Ergocalciferol and Cholecalciferol Vitamin D Tocopherol Vitamin E Naphthoquinone Vitamin K Calcium Choline Chlorine Chromium Cobalt Copper Fluorine Iodine Iron Magnesium Manganese Molybdenum Phosphorus Potassium Selenium Sodium Sulfur Zinc Other common ingredients Carnitine Chondroitin sulfate Cod liver oil Copper gluconate Creatine/Creatine supplements Dietary fiber Elemental calcium Ephedra Fish oil Folic acid Ginseng Glucosamine Glutamine Iron supplements Japanese Honeysuckle Krill oil Lingzhi Linseed oil Melatonin Red yeast rice Royal jelly Saw palmetto Spirulina Taurine Wheatgrass Wolfberry Yohimbine Zinc gluconate Related articles Codex Alimentarius Enzyte Metabolife Hadacol Nutraceutical Multivitamin Nutrition Retrieved from http://en..org/wiki/Iron_supplements Categories: Dietary supplements | HematologyHidden category: Articles needing additional references from March 2007 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page This page was last modified on 10 June 2008, at 14:52
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