What are the common side effects of iron tablets. How can iron supplement side effects be managed. When should you consult a doctor about iron tablet side effects. What precautions should be taken when using iron supplements. How do iron tablets interact with other medications.

Understanding Iron Supplements: Uses and Benefits

Iron supplements are essential medications used to treat or prevent iron deficiency anemia. These supplements come in various forms, including tablets, capsules, and liquid formulations. But why are they so crucial?

Iron is a vital component of hemoglobin, the protein in red blood cells responsible for carrying oxygen throughout the body. When iron levels are low, the body can’t produce enough healthy oxygen-carrying red blood cells, leading to anemia. This condition can cause fatigue, weakness, pale skin, and other symptoms that significantly impact quality of life.

• Treat iron deficiency anemia
• Prevent anemia in high-risk individuals
• Support proper fetal development during pregnancy
• Enhance athletic performance in some cases

While iron supplements can be highly beneficial, it’s essential to understand their potential side effects and use them responsibly under medical supervision.

Common Side Effects of Iron Tablets: What to Expect

Iron supplements, while beneficial, can cause various side effects. It’s crucial to be aware of these potential reactions to manage them effectively. What are the most common side effects of iron tablets?

• Constipation
• Nausea and vomiting
• Abdominal pain or cramps
• Diarrhea
• Dark or black stools
• Heartburn
• Metallic taste in the mouth

These side effects are generally mild and often subside as the body adjusts to the supplement. However, if they persist or become severe, it’s important to consult a healthcare provider.

Gastrointestinal Discomfort: A Common Concern

Gastrointestinal issues are among the most frequently reported side effects of iron supplements. Why do these occur? Iron can be irritating to the digestive tract, particularly when taken on an empty stomach. To minimize these effects, consider the following strategies:

1. Take iron supplements with food
2. Start with a lower dose and gradually increase
3. Try a different form of iron (e.g., iron bisglycinate instead of ferrous sulfate)
4. Consider taking iron supplements at bedtime

If gastrointestinal symptoms persist despite these measures, consult your healthcare provider for alternative options or dosing schedules.

Serious Side Effects: When to Seek Medical Attention

While most side effects of iron supplements are mild, some can be more serious and require immediate medical attention. What are the signs that indicate a need for urgent care?

• Severe abdominal pain
• Signs of an allergic reaction (rash, itching, swelling, severe dizziness)
• Chest pain
• Difficulty breathing
• Fast or irregular heartbeat
• Severe headache
• Bloody or tarry stools

These symptoms may indicate a severe reaction or complication related to iron supplementation. If you experience any of these, stop taking the supplement and seek medical help immediately.

Iron Overdose: A Serious Concern

Iron overdose is a potentially life-threatening condition, particularly in children. What are the symptoms of iron overdose?

• Severe nausea and vomiting
• Diarrhea (may contain blood)
• Abdominal pain
• Pale or bluish skin
• Weakness
• Drowsiness or loss of consciousness

If iron overdose is suspected, it’s crucial to seek emergency medical care immediately. Always keep iron supplements out of reach of children and never exceed the recommended dosage.

Managing Iron Supplement Side Effects: Practical Tips

While side effects from iron supplements can be uncomfortable, there are several strategies to manage them effectively. How can you minimize the impact of these side effects?

1. Take iron with vitamin C to enhance absorption and potentially reduce side effects
2. Avoid taking iron with calcium-rich foods or antacids, which can interfere with absorption
3. Stay well-hydrated to help prevent constipation
4. Increase dietary fiber intake to promote regular bowel movements
5. Consider a slow-release iron formulation, which may be gentler on the stomach

Remember, if side effects persist or worsen despite these measures, consult your healthcare provider. They may recommend adjusting your dosage or trying a different form of iron supplement.

Precautions and Interactions: Ensuring Safe Iron Supplementation

Taking iron supplements requires careful consideration of various factors to ensure safety and effectiveness. What precautions should be taken when using iron supplements?

• Inform your healthcare provider about all medications and supplements you’re taking
• Disclose any pre-existing medical conditions, especially gastrointestinal disorders
• Follow the prescribed dosage strictly
• Store iron supplements safely out of reach of children
• Be aware of potential interactions with other medications

Iron can interact with several medications, potentially affecting their absorption or efficacy. Some notable interactions include:

• Antibiotics (tetracyclines, quinolones)
• Thyroid medications
• Levodopa (used for Parkinson’s disease)
• Bisphosphonates (used for osteoporosis)

Always consult your healthcare provider or pharmacist about potential interactions before starting iron supplementation.

Special Considerations for Pregnant Women

Pregnant women often require iron supplements to support the increased blood volume and fetal development. However, they should take special care when using these supplements. What precautions should pregnant women consider?

• Consult with an obstetrician before starting any supplementation
• Monitor iron levels regularly through blood tests
• Be aware of increased risk of constipation during pregnancy
• Consider prenatal vitamins with appropriate iron content

Proper iron supplementation during pregnancy is crucial, but it should be done under close medical supervision to ensure the health of both mother and baby.

Optimizing Iron Absorption: Dietary Considerations

While taking iron supplements is important for addressing deficiency, optimizing absorption can enhance their effectiveness and potentially reduce side effects. How can you improve iron absorption from supplements?

1. Take iron supplements with vitamin C-rich foods or a vitamin C supplement
2. Avoid consuming iron with calcium-rich foods, tea, coffee, or whole grains
3. Consider consuming iron supplements on an empty stomach if tolerated
4. Include iron-rich foods in your diet, such as lean meats, leafy greens, and legumes
5. Cook in cast-iron cookware to increase dietary iron intake

By optimizing absorption, you may be able to achieve therapeutic effects with lower doses of iron, potentially reducing the risk of side effects.

The Role of Vitamin C in Iron Absorption

Vitamin C plays a crucial role in enhancing iron absorption. How does vitamin C improve iron uptake?

• Converts iron into a more easily absorbable form
• Helps overcome the inhibitory effects of certain compounds on iron absorption
• May reduce gastrointestinal side effects of iron supplements

Consider taking your iron supplement with a glass of orange juice or a vitamin C supplement to maximize its benefits.

Alternative Forms of Iron Supplementation: Exploring Options

For individuals who experience significant side effects from traditional iron tablets, alternative forms of supplementation may be worth exploring. What are some alternative forms of iron supplements?

• Liquid iron supplements
• Iron patches
• Intravenous (IV) iron infusions
• Iron injections
• Newer formulations like iron bisglycinate or carbonyl iron

Each of these alternatives has its own set of benefits and potential drawbacks. For instance, IV iron infusions can quickly correct severe deficiency but require medical supervision and carry a risk of allergic reactions. Discuss these options with your healthcare provider to determine the most suitable form for your specific needs.

Newer Iron Formulations: Reducing Side Effects

Recent advances in iron supplementation have led to the development of new formulations designed to minimize side effects. How do these newer forms of iron differ from traditional supplements?

• Iron bisglycinate: Often better tolerated and less likely to cause constipation
• Carbonyl iron: Reduced risk of accidental overdose due to its unique properties
• Sucrosomial iron: Designed for improved absorption and reduced gastrointestinal side effects

While these newer formulations may offer benefits in terms of reduced side effects, they may also be more expensive. Discuss the potential advantages and costs with your healthcare provider to make an informed decision.

Long-Term Iron Supplementation: Monitoring and Considerations

For individuals requiring long-term iron supplementation, regular monitoring is crucial to ensure safety and effectiveness. What factors should be considered for long-term iron therapy?

• Regular blood tests to monitor iron levels and prevent iron overload
• Periodic reassessment of the need for continued supplementation
• Vigilance for potential long-term side effects
• Consideration of underlying causes of iron deficiency

Long-term iron supplementation may be necessary for certain conditions, such as chronic gastrointestinal disorders or heavy menstrual bleeding. However, it’s important to address the root cause of iron deficiency whenever possible.

Preventing Iron Overload

While iron deficiency is a common concern, excessive iron intake can lead to iron overload, a condition where too much iron accumulates in the body. How can iron overload be prevented?

• Follow prescribed dosages strictly
• Undergo regular blood tests to monitor iron levels
• Be aware of symptoms of iron overload, such as joint pain, fatigue, and skin discoloration
• Inform healthcare providers about long-term iron supplementation

Certain individuals, particularly those with hereditary hemochromatosis, are at higher risk of iron overload and may require careful monitoring when using iron supplements.

In conclusion, while iron supplements are vital for treating and preventing iron deficiency anemia, they come with potential side effects and risks. By understanding these effects, taking necessary precautions, and working closely with healthcare providers, individuals can maximize the benefits of iron supplementation while minimizing adverse effects. Regular monitoring, appropriate dosing, and consideration of alternative formulations when needed can help ensure safe and effective iron therapy.

Iron Supplement (Oral Route, Parenteral Route) Side Effects

Side Effects

Drug information provided by: IBM Micromedex

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

More common

1. 
   Backache , groin, side, or muscle pain
2. 
   chest pain
3. 
   chills
4. 
   dizziness
5. 
   fainting
6. 
   fast heartbeat
7. 
   fever with increased sweating
8. 
   flushing
9. 
   headache
10. 
    metallic taste
11. 
    nausea or vomiting
12. 
    numbness, pain, or tingling of hands or feet
13. 
    pain or redness at injection site
14. 
    redness of skin
15. 
    skin rash or hives
16. 
    swelling of mouth or throat
17. 
    troubled breathing

More common

1. 
   Abdominal or stomach pain
2. 
   cramping (continuing) or soreness

Less common or rare

1. 
   Double vision
2. 
   general unwell feeling
3. 
   weakness without feeling dizzy or faint

Less common or rare

1. 
   Chest or throat pain, especially when swallowing
2. 
   stools with signs of blood (red or black color)

Early symptoms of iron overdose

1. 
   Diarrhea (may contain blood)
2. 
   fever
3. 
   nausea
4. 
   stomach pain or cramping (sharp)
5. 
   vomiting, severe (may contain blood)

Late symptoms of iron overdose

1. 
   Bluish-colored lips, fingernails, and palms of hands
2. 
   convulsions (seizures)
3. 
   pale, clammy skin
4. 
   shallow and rapid breathing
5. 
   unusual tiredness or weakness
6. 
   weak and fast heartbeat

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

1. 
   Constipation
2. 
   diarrhea
3. 
   leg cramps
4. 
   nausea
5. 
   vomiting

Less common

1. 
   Darkened urine
2. 
   heartburn
3. 
   stained teeth

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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Taking iron supplements: MedlinePlus Medical Encyclopedia

ABOUT IRON SUPPLEMENTS

Iron supplements may be taken as capsules, tablets, chewable tablets, and liquids. The most common tablet size is 325 mg (ferrous sulfate). Other common chemical forms are ferrous gluconate and ferrous fumarate.

Ask your health care provider how many pills you should take each day and when you should take them. Taking more iron than your body needs can cause serious medical problems.

Blood counts return to normal after 2 months of iron therapy for most people. You may need to continue taking supplements for another 6 to 12 months to build up the body’s iron stores in the bone marrow.

TIPS FOR TAKING IRON

Iron is best absorbed on an empty stomach. Yet, iron supplements can cause stomach cramps, nausea, and diarrhea in some people. You may need to take iron with a small amount of food to avoid this problem.

Milk, calcium and antacids should NOT be taken at the same time as iron supplements. You should wait at least 2 hours after having these foods before taking your iron supplements.

Foods that you should NOT eat at the same time as you take your iron include:

• High fiber foods, such as whole grains, raw vegetables, and bran
• Foods or drinks with caffeine

Some doctors suggest taking a vitamin C supplement or drinking orange juice with your iron pill. This can help the iron absorb into your body. Drinking 8 ounces (240 milliliters) of fluid with an iron pill is also OK.

Tell your provider about all the medicines you are taking.

• Iron tablets may cause other drugs you are taking to not work as well. Some of these include tetracycline, penicillin, and ciprofloxacin and drugs used for hypothyroidism, Parkinson disease, and seizures.
• Medicines that reduce stomach acid will impair iron absorption. Your provider may suggest changing these.
• Wait at least 2 hours between doses of these drugs and iron supplements.

SIDE EFFECTS

Constipation due to iron pills is common. If constipation becomes a problem, take a stool softener such as docusate sodium (Colace).

Nausea and vomiting may occur with higher doses, but they can be controlled by taking the iron in smaller amounts. Ask your provider about switching to another form of iron rather than just stopping.

Black stools are normal when taking iron tablets. Talk to your provider right away if:

• The stools are tarry-looking as well as black
• If the stools have red streaks
• Cramps, sharp pains, or soreness in the stomach occur

Liquid forms of iron may stain your teeth.

• Try mixing the iron with water or other liquids (such as fruit juice or tomato juice) and drinking the medicine with a straw.
• Iron stains can be removed by brushing your teeth with baking soda or peroxide.

Keep tablets in a cool place. (Bathroom medicine cabinets may be too warm and humid, which may cause the pills to fall apart.)

Keep iron supplements out of the reach of children. If your child swallows an iron pill, contact a poison control center right away.

Ferrous fumarate: medicine for treating iron deficiency anaemia

If you or your child are prescribed ferrous fumarate, follow your doctor’s instructions about how and when to take it.

If you buy ferrous fumarate from a pharmacy, follow the instructions that come with the packet.

Ferrous fumarate tablets comes in 2 strengths – 210mg and 322mg.

Ferrous fumarate capsules are 305mg.

Liquid ferrous fumarate contains 140mg of ferrous fumarate in each 5ml spoonful (140mg/5ml).

The liquid may be easier for children and people who find it difficult to swallow tablets or capsules.

How much will I take?

The dose of ferrous fumarate depends on why you’re taking it and whether you have tablets, capsules or liquid.

To treat anaemia

The usual dose of ferrous fumarate for adults and children over 12 years old is:

• 210mg tablets – 1 tablet, taken 2 to 3 times a day
• 322mg tablets – 1 tablet, taken 1 or 2 times a day
• 305mg capsules – 1 capsule, taken 2 times a day
• liquid (140mg/5ml) – two 5ml spoonfuls, taken 2 times a day

For children under the age of 12, a doctor will use your child’s age or weight to work out the right dose.

To prevent anaemia

The usual dose of ferrous fumarate for adults and children over 12 years old is:

• 210mg tablets – 1 tablet, taken 1 or 2 times a day
• 322mg tablets – 1 tablet, taken once a day
• 305mg capsules – 1 capsule, taken once a day
• liquid – one 5ml spoonful, taken 2 times a day, or two 5ml spoonfuls taken once a day

For children under the age of 12, the doctor will use your child’s age or weight to work out the right dose.

How to take it

Ferrous fumarate works best when you take it on an empty stomach. Take it 30 minutes before eating, or 2 hours after eating. But if it upsets your stomach, you can take it with or just after food.

Your doctor (or a pharmacist) may recommend taking ferrous fumarate with orange juice or a vitamin C supplement. Vitamin C is believed to increase the amount of iron absorbed by the body.

Swallow tablets or capsules with a glass of water or juice only. Do not take them with milk, as milk stops the iron getting into your system.

If you’re taking ferrous fumarate as a liquid, it will come with a plastic syringe or spoon to help you measure the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as you will not get the right amount.

Ferrous fumarate is not harmful if it has been prescribed for your child and you follow your doctor’s instructions, or the instructions on the packet.

What if I forget to take it?

If you usually take it:

• once a day – take it as soon as you remember. But if it’s less than 12 hours until your next dose, skip the missed dose.
• 2 times a day – if you remember within 4 hours of your missed dose, take it as soon as you remember. If you remember more than 4 hours after your missed dose, skip the missed dose and then take your next one as normal.
• 3 times a day – skip the missed dose and take your next dose as normal.

Do not take a double dose to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on other ways to remember your medicine.

What if I take too much?

If you go to A&E do not drive yourself. Get someone else to drive you, or call an ambulance.

Take the ferrous fumarate packet or the leaflet inside it with you and any remaining medicine.

Ferrous Sulfate Side Effects – Iron

What Is Ferrous Sulfate?

Iron, or ferrous sulfate (Feosol®, Slow FE®) is a mineral that your body needs to produce red blood cells. When the body does not get enough iron, it cannot produce enough red blood cells to keep itself healthy. This is called iron-deficiency anemia. Lack of iron can cause tiredness, shortness of breath, and decreased physical performance. It also can increase the chance of a liver transplant patient getting infections.

Ferrous sulfate uses include treating or preventing low levels of iron in the blood; it treats or prevents iron-deficiency anemia.

Foods rich in iron include lean red meat, beans, nuts, asparagus, oatmeal, and dried peaches. Vitamin C can increase the absorption of iron, which can be found in citrus fruits and fresh vegetables. Ferrous sulfate might be prescribed if your child is not able to maintain a healthy level of iron through diet alone after a liver transplant.

Ferrous Sulfate Dosage

Ferrous sulfate medication is taken by mouth. It is available in liquid form, as caplets, and as 300- and 324-mg tablets.

How to Properly Take Ferrous Sulfate

Ferrous sulfate should be taken on an empty stomach and with water or fruit juice. However, if the medication upsets your child’s stomach, he or she can take ferrous sulfate with food.

Missed Doses

If your child misses a dose of ferrous sulfate, take it as soon as you or your child remembers. If you remember within two hours of your next scheduled dose, skip the missed dose and resume your child’s usual dosing schedule. Do not double the dose to catch up.

Ferrous Sulfate Side Effects

Some people do experience stomach discomfort that ranges from heartburn to nausea and vomiting, but taking ferrous sulfate with food instead may help avoid or lessen it. Constipation or stools that are black or green also occur. (The unusual coloring is because of absorbed iron, and is not harmful.)

In rare cases, ferrous sulfate side effects include:

• Diarrhea
• Stomach pain
• Chest pain
• Dark urine

If your child has trouble with any of these side effects, inform your doctor or transplant coordinator.

Ferrous Sulfate Drug Interactions

Tell your transplant coordinator about all the medication your child uses, whether over-the-counter or prescription, so you can be warned of undesirable interactions and prevent them.

Precautions for Children

Take ferrous sulfate as prescribed. Eggs, milk, dairy products, coffee, tea, spinach, fiber, and antacids can decrease iron absorption. Your child should take iron tablets one to two hours after eating these foods or taking other medication.

Ferrous Sulfate Availability

Most pharmacies stock ferrous sulfate.

Drug information changes periodically. For the most updated information on drugs, visit www.drugs.com.

Do side-effects reduce compliance to iron supplementation? A study of daily- and weekly-dose regimens in pregnancy

Side-effects of iron supplementation lead to poor compliance. A weekly-dose schedule of iron supplementation rather than a daily-dose regimen has been suggested to produce fewer side-effects, thereby achieving a higher compliance. This study compared side-effects of iron supplementation and their impact on compliance among pregnant women in Bangladesh. These women were assigned to receive either weekly doses of 2 x 60 mg iron (one tablet each Friday morning and evening) or a daily dose of 1 x 60 mg iron. Fifty antenatal care centres were randomly assigned to prescribe either a weekly- or a daily-supplementation regimen (86 women in each group). Side-effects were assessed by recall after one month of supplementation and used for predicting compliance in the second and third months of supplementation. Compliance was monitored using a pill bottle equipped with an electronic counting device that recorded date and time whenever the pill bottle was opened. Of five gastrointestinal side-effects (heartburn, nausea, vomiting, diarrhoea, or constipation) assessed, vomiting occurred more frequently in the weekly group (21%) than in the daily group (11%, p<0.05). Compliance (ratio between observed and recommended tablet intake) was significantly higher in the weekly-supplementation regimen (93%) than in the daily-supplementation regimen (61%, p<0. 05). Overall, gastrointestinal side-effects were not significantly associated with compliance. However, the presence of nausea and/or vomiting reduced compliance in both the regimens-but only among women from the lower socioeconomic group. In conclusion, weekly supplementation of iron in pregnancy had a higher compliance compared to daily supplementation of iron despite a higher frequency of side-effects. The findings support the view that gastrointestinal side-effects generally have a limited influence on compliance, at least in the dose ranges studied. Efforts to further reduce side-effects of iron supplementation may not be a successful strategy for improving compliance and effectiveness of antenatal iron supplementation.

multivitamin with iron | Michigan Medicine

What is the most important information I should know about multivitamins with iron?

Never take more than the recommended dose of a multivitamin. Avoid taking any other multivitamin product within 2 hours before or after you take multivitamins with iron.

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects. Iron and other minerals contained in a multivitamin can also cause serious overdose symptoms if you take too much.

What is multivitamins with iron?

Multivitamins are a combination of many different vitamins that are normally found in foods and other natural sources.

Iron is normally found in foods like red meat. In the body, iron becomes a part of your hemoglobin (HEEM o glo bin) and myoglobin (MY o glo bin). Hemoglobin carries oxygen through your blood to tissues and organs. Myoglobin helps your muscle cells store oxygen.

Multivitamins with iron are used to provide vitamins and iron that are not taken in through the diet. They are also used to treat iron or vitamin deficiencies caused by illness, pregnancy, poor nutrition, digestive disorders, and many other conditions.

Multivitamin and iron may also be used for purposes not listed in this medication guide.

What should I discuss with my healthcare provider before taking multivitamins with iron?

Iron and certain vitamins can cause serious or life-threatening side effects if taken in large doses. Do not take more of this medicine than directed on the label or prescribed by your doctor.

Ask a doctor or pharmacist if it is safe for you to take a multivitamins with iron if you have other medical conditions.

Do not use this medicine without a doctor’s advice if you are pregnant. Some vitamins and minerals can harm an unborn baby if taken in large doses. You may need to use a prenatal vitamin specially formulated for pregnant women.

Your dose needs may also be different while you are nursing. Do not use this medicine without a doctor’s advice if you are breast-feeding a baby.

How should I take multivitamins with iron?

Use this medicine as directed on the label, or as your doctor has prescribed. Do not use the medicine in larger amounts or for longer than recommended.

Never take more than the recommended dose of multivitamins with iron. Avoid taking any other multivitamin product within 2 hours before or after you take multivitamins with iron. Taking similar vitamin products together at the same time can result in a vitamin overdose or serious side effects.

Many multivitamin products also contain minerals such as calcium, magnesium, potassium, and zinc. Minerals (especially taken in large doses) can cause side effects such as tooth staining, increased urination, stomach bleeding, uneven heart rate, confusion, and muscle weakness or limp feeling. Read the label of any multivitamin product you take to make sure you are aware of what it contains.

You may take the medicine with food if it upsets your stomach.

The chewable tablet must be chewed or allowed to dissolve in the mouth before swallowing.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Liquid or powder multivitamin may sometimes be mixed with water, fruit juice, or infant formula (but not milk or other dairy products). Follow the mixing directions on the medicine label.

Do not crush, chew, break, or open an extended-release capsule or tablet. Swallow it whole.

It is important to take multivitamins with iron regularly to get the most benefit.

Store in the original container at room temperature away from moisture and heat. Do not allow the liquid to freeze.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of vitamins A, D, E, or K can cause serious or life-threatening side effects. Iron and other minerals contained in a multivitamin can also cause serious overdose symptoms.

Overdose symptoms may include severe stomach pain, vomiting, bloody diarrhea, coughing up blood, constipation, loss of appetite, hair loss, peeling skin, warmth or tingly feeling, changes in menstrual periods, weight loss, severe headache, muscle or joint pain, severe back pain, blood in your urine or stools, black and tarry stools, pale skin, easy bruising or bleeding, weakness, shallow breathing, weak and rapid pulse, pale skin, blue lips, and seizure (convulsions).

What should I avoid while taking multivitamins with iron?

Avoid taking any other multivitamin product within 2 hours before or after you take multivitamins with iron. Taking similar vitamin products together at the same time can result in a vitamin overdose or serious side effects.

Avoid taking an antibiotic medicine within 2 hours before or after you take multivitamins with iron. This is especially important if you are taking an antibiotic such as ciprofloxacin, levofloxacin norfloxacin, doxycycline, minocycline, tetracycline, and others.

Certain foods can also make it harder for your body to absorb iron. Avoid taking this multivitamin within 1 hour before or 2 hours after eating fish, meat, liver, and whole grain or “fortified” breads or cereals.

Do not take this medicine with milk, other dairy products, calcium supplements, or antacids that contain calcium. Calcium may make it harder for your body to absorb certain ingredients of the multivitamin.

What are the possible side effects of multivitamins with iron?

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

When taken as directed, multivitamins are not expected to cause serious side effects.

Call your doctor if you have:

• bright red blood in your stools; or
• pain in your chest or throat when swallowing a tablet.

Common side effects may include:

• constipation, diarrhea;
• nausea, vomiting, heartburn;
• stomach pain, upset stomach;
• black or dark-colored stools or urine;
• temporary staining of the teeth;
• headache; or
• unusual or unpleasant taste in your mouth.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect multivitamins with iron?

Other drugs may interact with multivitamins with iron, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

Your pharmacist can provide more information about multivitamins with iron.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2021 Cerner Multum, Inc. Version: 3.07. Revision date: 1/26/2017.

Side Effects, Dosage, and Benefits

• Iron supplements can cause side effects like dizziness, fainting, and hives. 
• Too many iron supplements can cause long-term side effects like liver damage and heart disease.
• If you want to take iron supplements, talk to your doctor about finding the proper dosage for you. 
• Visit Insider’s Health Reference library for more advice.

When a person isn’t getting enough iron, they may experience symptoms such as excessive fatigue, shortness of breath, and anemia.

Taking iron supplements may help alleviate these problems but can also come with its own potential side effects when iron is taken in high doses and in excess of your needs.

Medical term: Iron is an essential mineral that helps your body create red blood cells, and is found in foods, such as dark chocolate, spinach, and beef. 

Here’s what you need to know about taking iron supplements and how to lower your risk of unpleasant side effects.

Iron supplement side effects   

Iron supplements can contain more than 100% of your daily iron needs, which means it can be easy to exceed your upper limit for iron and experience side effects as a result.

General advice: The upper limit for iron is 40 mg for people 13 years or younger and 45 mg for people 14 years or older. 

Ingesting too much iron can corrode tissue in the gastrointestinal tract. “Over time, iron can accumulate in the organs, and cause irreversible damage to organs like the liver and brain,” says DeMasi.   

• Chills
• Gastrointestinal distress
• Dizziness
• Fainting
• Hives
• Tingling sensation in the feet or hands

Although rare, if you consume too much iron over time it can cause iron toxicity, which can lead to:

• Liver disease
• Brittle bones
• Heart disease 

Visit a doctor immediately if you or children in your care experience any side effects from iron supplements. 

An iron overdose can be deadly for children. Between 1983 and 2000, 43 children died after ingesting high doses of iron. 

“Iron toxicity is extremely dangerous for children and can lead to multi-organ failure or death in severe cases,” says DeMasi. “The first signs of toxicity are nausea, vomiting, diarrhea, and stomach pain.” 

Iron supplement dosage 

Before taking an iron supplement, speak with a doctor to determine the proper dosage. Overall, the amount of iron a person should take per day depends on their age and gender:

• Children 1 to 3 years: 7 mg
• Children 4 to 8 years: 10 mg 
• Children 9 to 13: 8 mg 
• Adolescent males: 11 mg
• Adolescent females: 15 mg 
• Adult males: 8 mg 
• Adult females: 18 mg 
• Pregnant people: 27 mg

According to DeMasi, people who are at a high-risk of iron overdose, and therefore, should not supplement, include those with:

Related

How to recognize the symptoms of iron deficiency and effectively treat it

Most other individuals do not need to take iron supplements. “Individuals who have normal iron and hemoglobin levels and are not pregnant and of child-bearing age do not generally need iron supplements,” says Bansari Acharya, a registered dietitian-nutritionist.  

General advice: If you think you may have an iron deficiency or are considering taking iron supplements, reach out to your doctor. They can run a hemoglobin test to diagnose you and help you find the proper dosage.

Iron supplements are available in many forms, including: 

• Powder
• Chewable tablet 
• Capsule
• Extended-release 
• Liquid
• Syrup

Tips for taking iron supplements

The body does not absorb iron as well if it’s coming from supplements. However, there are a few ways you can improve your body’s ability to absorb iron. According to DeMasi and Acharya, these include: 

• Eat more vitamin C-rich foods like citrus fruits, strawberries, bell peppers, and broccoli.
• Avoid consuming food or beverages high in calcium, like milk or yogurt when you take supplements, as they can limit iron absorption.  
• Take iron supplements one hour before a meal or two hours after since it’s best absorbed on an empty stomach. 

The form of iron supplements you take can also help mitigate side effects. According to DeMasi, some people find liquid iron and slow-release iron cause fewer gastrointestinal side effects, since they are more readily absorbed.

Insider’s takeaway

Iron supplements can lead to side effects such as gastrointestinal distress and fainting. If you continue to supplement with much more iron than you need, you may experience iron toxicity, which can lead to brittle bones or liver disease.

Unless you are in a high-risk group or have low iron levels, iron supplementation is usually unnecessary. 

If you are considering taking iron supplements, speak with your doctor first as they can help you determine the correct dosage. 

Iron preparations (reception) – Medical center “Liko-Med”

Publication date
3 October 2018

What is it?

The body needs iron to form red blood cells (erythrocytes). Not having enough iron can lead to anemia or low blood counts. Iron deficiency and / or anemia require iron supplementation. Sometimes these drugs can cause side effects:

• headache;
• metallic taste in the mouth;
• nausea;
• vomiting;
• constipation;
• black or dark green chair;
• stomach pains.

Excessive iron intake can cause severe vomiting, severe abdominal pain and fever. Overdose in children can even be fatal.

How much iron is required? Most adult men need 8 mg of iron per day, while women need 18 mg. Pregnant women should receive 27 mg of iron per day. Iron supplements come in the form of tablets, liquids, syrups, and elixirs.

What to expect?

A doctor should be consulted about the correct dose of iron in each case.Iron is better absorbed when taken on an empty stomach, but sometimes it can increase your risk of indigestion. Therefore, it is recommended to start taking with half of the prescribed dose to reduce this effect. It may also be necessary to divide the daily dose into several doses.

When taking the drug for more than a few months, it is imperative to consult a doctor because of the ability of iron to accumulate in the body, leading to poisoning.

Prevalence

About 2% of men, 20% of women and up to 80% of pregnant women do not get enough iron.

Treatment

Depending on the condition, the doctor determines the amount of iron to be taken.

What can you do yourself?

Since different people absorb iron differently, have different needs in it, then you should discuss the intake of medications with your doctor.

When using iron supplements without a doctor’s prescription, the instructions must be carefully followed.

How does it get worse?

The incidence of side effects increases when iron supplements are taken on an empty stomach and when more iron is consumed than is required.You should not take iron supplements if you have a medical condition such as hemochromatosis.

When to see a doctor?

If side effects develop, consult a doctor. If a child suspects an overdose or accidental use of the drug, emergency medical attention is required.

What to ask a doctor?

• Could the observed symptoms be caused by taking an iron supplement?
• Is there a need to take iron supplements?
• How much iron should you take?
• Is it possible to increase iron levels without taking special supplements?

Diagnosis

Iron supplements are prescribed by the doctor after examining the patient, studying his medical history and checking the level of iron in the blood.

Risk factors

• Female
• Heavy menstrual bleeding.
• Breastfeeding.
• Celiac disease.
• Crohn’s disease.
• Taking antacids.
• Lack of iron in the diet.

90,000 Taking iron supplements one, two or three times a week to prevent anemia and its consequences in menstruating women

What is the problem?

Globally, approximately one in three non-pregnant women of reproductive age is anemic, i. e.That is, it has fewer red blood cells or a lower concentration of hemoglobin (a red substance that binds to oxygen and carries it around the body) in each red blood cell compared to normal. Despite the existence of a number of reasons for the development of anemia, very often it is due to prolonged iron deficiency. Standard practice for the prevention or treatment of anemia in women is daily supplemental iron supplementation (sometimes in combination with folic acid and other vitamins and minerals) for three months.However, this regimen is often associated with the development of side effects such as nausea or constipation. Intermittent dosing (that is, taking the drugs once, twice, or three times a week on non-sequential days) has been suggested as an effective and safe alternative to daily dosing.

Why is this important?

Women with anemia may have lower physical performance and a higher susceptibility to infectious diseases. Most of the world’s women are anemic at the time of pregnancy, putting them at increased risk of low birth weight babies and other birth complications.

According to some scientists, taking iron supplements several times a week instead of daily intake can improve the well-being of women with anemia and increase their hemoglobin concentration without causing many side effects. With fewer side effects, women are more likely to take iron supplements more regularly and longer.

What evidence have we found?

We reviewed the evidence in February 2018.The review included 25 randomized controlled trials (a type of pilot study in which participants are randomly assigned to one or more treatment groups), in which 10996 women participated. The review included studies comparing intermittent iron supplementation versus no intervention, taking a placebo (dummy tablet), or taking the same iron supplements daily. Most of the research was conducted in an academic setting and was funded primarily by international organizations, universities and ministries of health at the national level.Funding sources were not reported in about one third of the included studies.

Research results showed that women who took iron supplements on an intermittent basis (in pure form or in combination with folic acid or other micronutrients) were less likely to develop anemia than women who did not take iron supplements or took placebo. They also had higher concentrations of hemoglobin and ferritin (an iron-carrying protein).In addition, intermittent iron supplementation reduced the risk of developing iron deficiency. These findings indicate that intermittent iron supplementation was comparable in efficacy to daily iron supplementation in reducing the prevalence of anemia and increasing hemoglobin concentrations, as well as causing fewer side effects. This regimen did not affect the increase in ferritin concentrations.

We have found scant evidence of the effect of intermittent iron supplementation versus placebo or daily iron supplementation on iron deficiency anemia, all-cause morbidity, disease outcomes, adherence to treatment, cost-effectiveness, and performance.

What does this mean?

Intermittent iron supplementation in menstruating women may be an effective intervention to reduce the risk of anemia and elevated hemoglobin concentrations compared to no intervention, placebo, or daily use of the same iron supplement. Intermittent dosing may be associated with fewer side effects compared to daily dosing. The results of the intervention were effective regardless of whether the drugs were taken once or twice a week, for less or more than three months, whether they contained less or more than 60 mg of elemental iron per week, and whether the intervention was performed in populations with varying degrees of anemia at baseline. level (starting point for comparisons).The evidence base was generally of low quality.

Instructions for use Sorbifer Durules tablets 30 pcs

Description

Round biconvex film-coated tablets of light gray – yellow color, engraved with “Z” on one side, on a fracture a gray core with a characteristic odor.

Active ingredients

Iron sulfate + Ascorbic acid

Form of issue

Tablets

Ingredients

Each film-coated tablet contains ferrous sulfate in an amount equivalent to 100 mg fe2 + and 60 mg ascorbic acid, excipients: magnesium stearate, povidone k-25, polyethylene powder, carbomer 934r.the shell contains: hypromellose, macrogol 6000, titanium dioxide, yellow iron oxide, solid paraffin.

Pharmacological effect

Bivalent iron (Fe (II)) as a component of the protoporphyrin prosthetic group of hemoglobin (Hb) plays an important role in the binding and transport of oxygen and carbon dioxide.
Iron of the protoporphyrin group of cytochromes plays a key role in the process of electron transport. In these processes, the capture and release of electrons is possible due to the reversible reaction of the Fe (II) ↔Fe (III) transition.
Iron is also found in significant amounts in muscle myoglobin.
Ascorbic acid promotes the absorption and assimilation of iron (it stabilizes the Fe (II) ion, preventing its conversion to the Fe (III) ion.
Mechanism of action
The prolonged release of Fe (II) ions is the result of the Durules tablet technology. – the intestinal tract (GIT), Fe (II) ions are constantly released from the porous matrix of the Durules tablet for 6 hours.The slow release of the active substance prevents the development of pathologically high local iron concentrations. Thus, the use of Sorbifer Durules allows you to avoid damage to the mucous membrane.
Iron is an essential component of the body, necessary for the formation of Hb and the course of oxidative processes in living tissues. The drug is used to eliminate iron deficiency. The plastic matrix of Sorbifer Durules tablets is completely inert in the digestive juice, but completely disintegrates under the action of intestinal peristalsis when the active ingredient is completely released.

Pharmacokinetics

Iron is absorbed from the duodenum and the proximal small intestine. The absorption of iron bound to heme is approximately 20% and that of iron not bound to heme is 10%. For effective absorption, iron must be in the form of Fe (II).
After oral administration, ascorbic acid is completely absorbed from the gastrointestinal tract. Hydrochloric acid in the stomach stimulates the absorption of iron, reducing it from Fe (III) to Fe (II).Ascorbic acid improves iron absorption and increases the bioavailability of the drug (MP).
Fe (II) entering the intestinal epithelial cells undergoes intracellular oxidation to Fe (III), which binds to apoferritin. Part of apoferritin enters the bloodstream, the other part temporarily remains in the epithelial cells of the intestine in the form of ferritin, which enters the bloodstream after 1-2 days or is excreted in the feces during desquamation of epithelial cells.
About 1/3 of the iron entering the blood binds to apotransferrin, the molecule of which is converted into transferrin.The iron-transferrin complex is transported to target organs and, after binding to receptors on the surface of their cells, enters the cytoplasm via endocytosis. In the cytoplasm, iron is separated and re-binds to apoferritin. Apoferritin oxidizes iron to Fe (III), and flavoproteins are involved in the reduction of iron.
“Durules” is a technology that provides a gradual release of the active substance (iron ions), a uniform flow of the drug.Taking 100 mg twice a day provides 30% more iron absorption from Sorbifer Durules compared to other iron preparations.
Deposited as ferritin or hemosiderin in hepatocytes and cells of the phagocytic macrophage system, a small amount in the form of myoglobin in muscles.
The half-life (T½) is 6 hours.
There are no data on the pharmacokinetics of the drug in liver or kidney dysfunction, as well as in elderly patients.
Indications
Iron deficiency anemia, prevention and treatment.
Conditions accompanied by iron deficiency.
Prevention of iron deficiency during pregnancy, lactation and blood donors.

Readings

Iron deficiency anemia, prevention and treatment.
Conditions accompanied by iron deficiency.
Prevention of iron deficiency during pregnancy, lactation and blood donors.

Contraindications

• Hypersensitivity to the active substance or any of the excipients,
• Pathological processes accompanied by increased iron deposition (for example, hemochromatosis, hemosiderosis),
• Regular blood transfusions,
• Other types of anemia not associated with iron deficiency (aplastic , hemolytic anemia, thalassemia, megaloblastic anemia) or due to impaired utilization of iron (sideroachrestic anemia, anemia caused by lead poisoning),
• Esophageal stenosis, intestinal obstruction and / or obstructive changes in the gastrointestinal tract, acute bleeding from the gastrointestinal tract,
iron preparations,
• Conditions associated with ascorbic acid: hyperoxaluria, oxalate kidney stones,
• Thrombophlebitis, tendency to thrombosis,
• Children under 12 years of age (due to lack of clinical data).

Precautions

Peptic ulcer of the stomach and duodenum, inflammatory bowel diseases (enteritis, diverticulitis, ulcerative colitis, Crohn’s disease).
elderly patient (due to lack of adequate clinical data).
diseases of the liver, kidneys (due to the lack of adequate clinical data), acute infectious and inflammatory processes (see section “special instructions”).

Use during pregnancy and lactation

Sorbifer Durules can be used during pregnancy and during breastfeeding.

Method of administration and dosage

Dosage regimen
Treatment
Adults and adolescents over 12 years of age:
The usual recommended starting dose is 2 tablets per day. If necessary, for example, with the development of adverse reactions, the dose can be reduced (1 tablet per day).
For patients with iron deficiency anemia, if necessary, the dose can be increased to 3-4 tablets per day in two doses (morning and evening).
The maximum dose is 4 tablets per day.
Prophylaxis and treatment during pregnancy
The recommended dose is 1 tablet once a day for the first 6 months and two tablets a day (in two doses) in the third trimester of pregnancy and during breastfeeding.
The duration of use is determined individually, based on laboratory parameters characterizing the state of iron metabolism.Treatment should be continued until the optimal hemoglobin concentration is reached and the laboratory parameters of iron metabolism in the blood plasma are restored. For further replenishment of the depot, it may be necessary to continue taking the drug for another two months. Usually, the duration of treatment for significant iron loss is 3-6 months.
Official local guidelines regarding the appropriate use of iron-containing drugs for the treatment and prevention of iron deficiency anemia should be considered.
Special groups of patients
Patients with impaired liver and kidney function
Due to the lack of adequate clinical data, drugs should be taken with caution.
Elderly patients
Due to the lack of adequate clinical data in elderly patients, drugs should be taken with caution.
Children and adolescents under 18 years of age
Tablets should not be administered to infants and children under 12 years of age.
Directions for use
Tablets for oral administration.
The tablet must not be divided, chewed, held in the mouth, or sucked.The tablet should be swallowed whole and washed down with water. The tablets can be taken before meals or with meals, depending on the individual tolerance of the gastrointestinal tract.
Do not take tablets while lying down.

Side effects

During treatment with Sorbifer Durules, the following side effects have been reported, which are listed below for organ systems.
Disorders of the blood and lymphatic system: paroxysmal nocturnal hemoglobinuria, erythropoietic porphyria or cutaneous porphyria tardive.
Immune system disorders: hypersensitivity, urticaria, anaphylaxis.
Nervous system disorders: headache, dizziness, weakness, irritability.
Disorders of the respiratory system, chest and mediastinal organs: laryngeal edema, sore throat.
Accidental inhalation of iron-containing drugs can lead to irreversible bronchial necrosis (especially in elderly patients and patients with difficulty swallowing).
Gastrointestinal disorders: nausea, abdominal pain, diarrhea, diarrhea, stool changes, dyspepsia, vomiting, gastritis, ulcerative lesions of the esophagus, esophageal stenosis, flatulence, staining of the teeth (with improper use of tablets), oral ulcers.
Skin and subcutaneous tissue disorders: skin rash, itching.
Disorders of the kidneys and urinary tract: when used in high doses – hyperoxaluria and the formation of oxalate kidney stones.
General disorders and disorders at the injection site: sensation of heat.
Post-registration period
In the post-registration period, the following adverse reactions were reported, the frequency of which is unknown.
Gastrointestinal tract disorders: development of mouth ulcers *.
* occurs when used incorrectly, when tablets are chewed, sucked or kept in the mouth. Elderly patients and patients with swallowing problems are at risk of developing damage to the esophagus and bronchial necrosis if accidentally inhaled.
Reporting of adverse reactions
Providing data on suspected adverse reactions of a drug is a very important point to allow continuous monitoring of the risk / benefit ratio of drugs.Health care providers should be provided with information on any suspected adverse reactions through the contacts listed at the end of the instructions, as well as through the national information collection system. Overdose
A relatively low dose of iron can cause toxic symptoms. An iron dose equivalent to 20 mg / kg can already cause some symptoms of intoxication, and with an iron content exceeding 60 mg / kg, manifestations of intoxication are expected to develop. Iron content equivalent to 200-250 mg / kg can be fatal.
Symptoms
Determination of serum iron concentration may assist in assessing the severity of poisoning. Although the concentration of iron does not always correlate well with symptoms, its concentration, determined 4 hours after ingestion, indicates the severity of poisoning as follows:
– less than 3 μg / ml – mild poisoning,
– 3-5 μg / ml – moderate poisoning,
>, 5 μg / ml – severe poisoning.
The maximum concentration of iron is determined 4-6 hours after the ingestion of iron.
Mild to moderate poisoning: Vomiting and diarrhea may develop within 6 hours of swallowing.
SEVERE POISONING: severe vomiting and diarrhea, lethargy, metabolic acidosis, shock, gastrointestinal bleeding, coma, convulsions, hepatotoxicity, later gastrointestinal stenosis. Severe toxicity also causes liver necrosis and jaundice, hypoglycemia, bleeding disorders, oliguria, renal failure, and pulmonary edema.
Iron overdose is especially dangerous in young children.
Overdose of ascorbic acid can cause severe acidosis and hemolytic anemia in susceptible individuals (glucose-6-phosphate dehydrogenase deficiency).
Treatment:
1. Give milk and vomiting fluid (as soon as possible).
2. Gastric lavage with 5% sodium bicarbonate solution and saline laxatives (eg sodium sulfate, 30 g for adults), milk and eggs in combination with 5 g of bismuth carbonate as emollients.
After gastric lavage, 5 g of deferoxamine, dissolved in 50-100 ml of water, is injected, and this solution is left in the stomach.Adult patients can be given a mannitol or sorbitol solution by mouth to stimulate bowel activity. Causing diarrhea in children, especially at an early age, can be dangerous and is therefore not recommended.
Patients should be closely monitored to prevent aspiration.
3. The pills give a shadow on the x-ray, so the abdominal x-ray can reveal the pills remaining after vomiting.
4. Do not use dimercaprol, as it forms toxic complexes with iron.
Deferoxamine is a specific drug that forms a chelate complex with iron. In acute severe poisoning in children, deferoxamine should always be prescribed at a dose of 90 mg / kg intramuscularly, then 15 mg / kg intravenously, until the concentration of iron in the blood serum corresponds to the total iron-binding capacity of the serum. If the infusion rate is too fast, hypotension may develop.
5. For less severe intoxication, deferoxamine is administered intramuscularly at a dose of
50 mg / kg to a maximum dose of 4 g.
6. In case of severe intoxication: in a state of shock and / or coma and in case of an increase in serum iron concentration (> 90 mmol / L in children,> 142 mmol / L in adults), intensive supportive therapy should be started immediately. Blood or plasma transfusion is performed with shock, oxygen therapy is prescribed for respiratory failure.
7. After elimination of intoxication, it is recommended to monitor the concentration of iron in the blood serum.

Overdose

A relatively low dose of iron can cause symptoms of intoxication.An iron dose equivalent to 20 mg / kg can already cause some symptoms of intoxication, and with an iron content exceeding 60 mg / kg, manifestations of intoxication are expected to develop. Iron content equivalent to 200-250 mg / kg can be fatal.
Symptoms
Determination of serum iron concentration may assist in assessing the severity of poisoning. Although the concentration of iron does not always correlate well with symptoms, its concentration, determined 4 hours after ingestion, indicates the severity of poisoning as follows:
– less than 3 μg / ml – mild poisoning,
– 3-5 μg / ml – moderate poisoning,
>, 5 μg / ml – severe poisoning.
The maximum concentration of iron is determined 4-6 hours after the ingestion of iron.
Mild to moderate poisoning: Vomiting and diarrhea may develop within 6 hours of swallowing.
SEVERE POISONING: severe vomiting and diarrhea, lethargy, metabolic acidosis, shock, gastrointestinal bleeding, coma, convulsions, hepatotoxicity, later gastrointestinal stenosis. Severe toxicity also causes liver necrosis and jaundice, hypoglycemia, bleeding disorders, oliguria, renal failure, and pulmonary edema.

Interaction with other drugs

Sorbifer Durules should not be combined with the following drugs:
– ciprofloxacin: when used together, the absorption of ciprofloxacin is reduced by 50%, thus there is a danger that its plasma concentration will not reach the therapeutic level,
– levofloxacin: when used together, absorption of levofloxacin decreases ,
– moxifloxacin: when used together, the bioavailability of moxifloxacin decreases by 40%.With the simultaneous use of moxifloxacin and Sorbifer Durules, the maximum possible time interval of at least 6 hours should be maintained between taking these drugs,
– norfloxacin: when used together, the absorption of norfloxacin decreases by about 75%,
– ofloxacin: when used together absorption of ofloxacin decreases by about 30%,
– mycophenolate mofetil: a sharp decrease in absorption by 90% of mycophenolate mofetil was observed when combined with preparations containing iron.
When Sorbifer Durules is used together with the following drugs, it may be necessary to change their dose. Between taking Sorbifer Durules and any of these drugs, the maximum possible time interval of at least 2 hours should be maintained:
– Food supplements containing calcium or magnesium, as well as antacids containing aluminum, calcium or magnesium: they form complexes with iron salts, thus impairing the absorption of each other,
– Captopril: when used simultaneously with captopril, its area under the concentration-time curve (AUC) decreases by an average of 37%, probably due to a chemical reaction in the gastrointestinal tract,
– Zinc: with simultaneous use, the absorption of zinc salts decreases,
– Clodronate: in in vitro studies it was found that preparations containing iron form a complex with clodronate.Despite the fact that in vivo studies have not been carried out, it can be assumed that when used together, the absorption of clodronate decreases,
– Deferoxamine: when used together, the absorption of both deferoxamine and iron decreases due to the formation of complexes,
– Levodopa and carbidopa: when used together ferrous sulfate with levodopa and carbidopa – probably due to the formation of complexes – the bioavailability of levodopa in healthy volunteers decreases by 50%, and carbidopa – by 75%,
– Methyldopa (levorotatory): with the combined use of iron salts (ferrous sulfate and gluconate) with methyldopa – probably due to the formation of chelate complexes – the bioavailability of methyldopa decreases, which can worsen its antihypertensive effect,
– Penicillamine: when penicillamine is used together with iron salts – probably due to the formation of chelate complexes – the absorption of both penicillamine and iron salts decreases Alendrone
– : in iss In vitro studies, preparations containing iron formed complexes with alendronate, reducing the absorption of the latter.No in vivo results,
– Risedronate: In an in vitro study, preparations containing iron formed complexes with risedronate. Despite the fact that this interaction has not been studied in vivo, it can be assumed that when used together, the absorption of risedronate will decrease,
– Tetracycline: when used together, the absorption of tetracycline decreases, therefore, with combined use, the maximum possible time interval should be maintained, which is not less than 3 hours between meals.The use of iron-containing drugs worsens the enterohepatic cycle of doxycycline, both when taken orally and when administered intravenously, therefore, the combined use of these drugs should be avoided,
– Thyroid hormones: when iron-containing drugs and thyroxine are used together, the absorption of the latter may decrease, which can lead to failure replacement therapy,
– Cimetidine: when Sorbifer Durules is used together with cimetidine, the decrease in gastric acidity caused by cimetidine reduces the absorption of iron.
When using Sorbifer Durules with tea, coffee, eggs, dairy products, wholemeal bread, cereal or fiber-rich foods, iron absorption may be reduced.
Other interactions:
– With iron preparations and other drugs that include iron: possible accumulation of iron in the liver, the likelihood of iron overdose increases,
– With pancreatin, cholestyramine: there is a decrease in iron absorption from the gastrointestinal tract,
– With methyldioxyphenylalanine: a decrease absorption of methyldioxyphenylalanine in the oral cavity by 61-73%,
– With tocopherol: the activity of both drugs decreases,
– With glucocorticosteroids: it is possible to increase the stimulation of erythropoiesis,
– With allopurinol: iron accumulation in the liver is possible,
– With acetohydroxamic acid: the activity decreases both drugs,
– With chloramphenicol: reduced effectiveness of iron preparations.The formation of erythrocytes is suppressed and the concentration of Hb decreases,
– With ethanol: absorption and the risk of toxic complications increase,
– With etidronic acid: the activity of etidronic acid decreases. It should be taken no earlier than 2 hours after taking Sorbifer Durules.
Interactions associated with ascorbic acid
Increases the concentration of salicylates in the blood (increases the risk of crystalluria), ethinylestradiol, benzylpenicillin and tetracyclines.Reduces the concentration of oral contraceptives. Acetylsalicylic acid and oral contraceptives also reduce the absorption and assimilation of ascorbic acid. Increases the activity of norepinephrine. Reduces the anticoagulant effect of coumarin and heparin derivatives. Improves the absorption of iron preparations in the intestine, as well as iron from food (by translating Fe (III) → Fe (II)). Increases the total clearance of ethyl alcohol. May affect the effectiveness of disulfiram in the treatment of chronic alcoholism.The simultaneous use of ascorbic acid and deferoxamine increases the excretion of iron.
Interactions with food and beverages
When using Sorbifer Durules with tea, coffee, eggs, dairy products, wholemeal bread, cereals from grains or foods rich in fiber, the absorption of iron may decrease.
Fresh juices and alkaline drinks reduce the absorption and absorption of ascorbic acid.
The time interval between taking the drug and the use of these products should be at least 2 hours.

Special instructions

The drug is effective only for diseases accompanied by iron deficiency. An iron deficiency should be diagnosed before starting treatment. In other, non-iron-deficient types of anemia (anemia due to infection, anemia accompanying chronic diseases, thalassemia and other anemias), the administration of the drug is contraindicated (see section “Contraindications”).
Due to the risk of ulcers in the oral cavity and to prevent staining of the tooth enamel, the tablet should not be chewed, held in the mouth or sucked. The tablet should be swallowed whole and washed down with water.
Iron supplementation may cause black stools.
During treatment with oral iron preparations, an exacerbation of inflammatory or ulcerative diseases of the gastrointestinal tract may occur.
The drug should not be used for infectious and inflammatory processes (acute respiratory viral infection, tonsillitis, pneumonia, etc.), since in this case iron accumulates in the inflammation focus and is not effective for its intended purpose. According to in vitro studies, iron preparations increase the pathogenicity of some microorganisms and can negatively affect the prognosis of the course of infectious diseases.
Hyposideremia associated with inflammatory syndromes is not responsive to iron therapy.
When taking the drug, a false-positive fecal occult blood test result is possible.
Ascorbic acid in urine may distort the results in the determination of sugar in urine.
To improve the absorption of iron from the intestines, at the same time with treatment, you should eat well, eating meat products, vegetables, fruits.
The drug should not be taken with strong tea, coffee, milk.Consuming significant amounts of tea suppresses iron absorption.
Alcohol should not be consumed during treatment.
During course use, it is recommended to periodically monitor laboratory parameters of iron metabolism in blood plasma.
Treatment should not be discontinued immediately after normalization of hemoglobin concentration and red blood cell count. In order to create a “depot” of iron in the body, it is necessary to take the drug for at least 1-2 months.
Accidental inhalation of iron-containing drugs may result in irreversible bronchial necrosis.Therefore, in case of accidental inhalation of tablet fragments, you should immediately seek medical attention.
To avoid the risk of possible iron overdose, special care must be taken if other iron supplements are used.

Storage conditions

At a temperature of 15 – 25 ° C.
Keep out of the reach of children.

Prescription

Yes

Ferrous Sulfate | Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

BProtected Pedia Iron [OTC]; Fe-Vite Iron [OTC]; Fer-In-Sol [OTC]; FeroSul [OTC]; Ferro-Bob [OTC] [DSC]; FerrouSul [OTC]; Iron Supplement Childrens [OTC]; Iron Supplement [OTC]; Slow Fe [OTC]; Slow Iron [OTC]

Trade names: Canada

PMS-Ferrous Sulfate

Warning

• Accidental overdose of iron-containing products is one of the most common causes of fatal poisoning in children under 6 years of age.Keep out of reach of children. If you accidentally take this drug, call a doctor or poison control center right away.

What is this drug used for?

• It is used to meet the needs of the body with natural supplements.
• It is used for the treatment and prevention of iron deficiency.
• This medicinal product can be used for other indications. Consult your doctor.

What do I need to tell my doctor BEFORE taking this drug?

• If you are allergic to this drug, any of its ingredients, other drugs, foods or substances.Tell your doctor about your allergy and how it manifested itself.
• If you have any of the following health conditions: excess iron in your body or anemia other than iron deficiency.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems.You need to make sure that this drug is safe for your medical conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

• Tell all healthcare providers that you are taking this drug.These are doctors, nurses, pharmacists and dentists.
• Perform blood tests as directed by your doctor. Please consult your doctor.
• This drug may interfere with some laboratory tests. Tell all healthcare providers and laboratory staff that you are taking this drug.
• If you are allergic to tartrazine (FD&C Yellow No. 5), consult your doctor. Some products contain tartrazine.
• In case of an individual allergic reaction to sulfites, it is necessary to consult a doctor. Some foods contain sulfites.
• This drug interferes with the absorption of many other drugs. If you are taking other drugs, ask your doctor or pharmacist if you should take them at a time other than the time you took this drug.
• Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding.The benefits and risks for you and your child will need to be discussed.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can have serious and sometimes deadly side effects. Call your doctor or doctor right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

• Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
• High temperature.
• Black, tarry, or bloody stools.
• Vomiting of blood or vomit in the form of coffee grounds.

What are some other side effects of this drug?

Any medicine can have side effects. However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

All forms of issue:

• Constipation, diarrhea, abdominal pain, nausea, vomiting, or decreased appetite.
• Changing the color of the stool to green.
• Stomach colic.

All liquid preparations:

• Staining of the oral mucosa, teeth or dental fillings.

This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you. Follow all instructions strictly.

All forms of issue:

• This drug works best when taken on an empty stomach.If the drug is causing stomach upset, it can be taken with food. Certain types of foods, such as eggs, whole grain bread, oatmeal, dairy products, coffee, and tea, may reduce the effectiveness of this drug. If this drug causes stomach upset, talk to your doctor about taking it with food.
• Antacids may need to be rescheduled for a different time than when this drug was taken. Ask your doctor or pharmacist for advice.

Tablets and capsules:

• Swallow whole. Do not chew, break, or crush.
• Take this drug with a full glass of water.

Liquid (drops):

• Use only the measuring container supplied with the liquid preparation.
• Shake well before use.
• This drug can be put directly into the mouth, or it can be mixed with infant formula, fruit juice, cereals or other foods, as well as water or juice.Take the whole dose.

Liquid (elixir):

• Doses of the liquid preparation should be measured with caution. Use the dispenser that comes with the medicine. If a dispenser is not included in the package, ask your pharmacist for a dosing product for this drug.
• Mix liquid with water or juice and drink through a straw to reduce stains on teeth. Rinse your mouth.

What should I do if a dose of a drug is missed?

• Take the missed dose as soon as you can.
• If it is time for your next dose, do not take the missed dose and then return to your normal dose schedule.
• Do not take 2 doses at the same time or an additional dose.

How do I store and / or discard this drug?

All forms of issue:

• Store at room temperature, protected from light. Store in a dry place. Do not store in the bathroom.
• Store all medicines in a safe place.Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

All liquid preparations:

• Do not freeze.

General information on medicinal products

• If your health does not improve or even worsens, see your doctor.
• You should not give your medicine to anyone and take other people’s medicines.
• Some medicines may have different patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• Some medicines may have different patient information sheets. Check with your pharmacist. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• If you think an overdose has occurred, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are appropriate for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient.Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a treatment guide and does not replace information provided to you by your healthcare professional. For complete information on the possible risks and benefits of taking this drug, consult your doctor.Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

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New generation ferrous iron for the prevention of anemia in pregnant women

Authors:
Doctor of Clinical Pharmacology, Professor M.Bertini, obstetrician-gynecologist of the highest category, chief researcher of the Department of Internal Pathology of Pregnant Women, State Institution “Institute of Pediatrics, Obstetrics and Gynecology named after E.M. Lukyanova of the National Academy of Medical Sciences of Ukraine “, Doctor of Medical Sciences M.Ye. Kirilchuk, Corresponding Member of the National Academy of Medical Sciences of Ukraine, Honored Doctor of Ukraine, Head of the Department of Internal Pathology of Pregnant Women, Doctor of Medical Sciences, Professor V.I. Bear

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Iron deficiency is a global medical and social problem around the world.The reason for the development of iron deficiency, in particular iron deficiency anemia in pregnant women, is an insufficient intake of iron from food, combined with an increased need for it, which is caused by the growth of the fetus. That is why the World Health Organization, in the 2017 protocols, recommends the enrichment of the diet with iron (supplementation) for all pregnant women in order to prevent the development of iron deficiency anemia. This important topic was devoted to a round table with the participation of leading Ukrainian and foreign experts, which took place on November 30, 2018 in St.Kiev.

Director of the Medical Department of Laboratori Baldacci, Doctor of Clinical Pharmacology, Professor Marco Bertini spoke about the prerequisites for creating the Teknofer product and its features.

– Iron deficiency anemia in pregnancy is a serious challenge for doctors around the world and, unfortunately, Italy is no exception. The situation is complicated by the fact that about 50% of outpatients stop taking the prescribed iron preparations without notifying the doctor, and come to the next appointment with manifestations of anemia.The reason for refusal of treatment is the poor tolerance of traditional iron salts, in particular ferrous sulfate, which under the influence of the pH of the gastric juice undergoes hydrolysis (dissociation) in the stomach with the formation of free iron (Fig. 1). In turn, free iron irritates the mucous membrane of the gastrointestinal tract and causes significant side effects: nausea, abdominal pain, diarrhea or constipation, which lead to discontinuation of the drug.

In the laboratory of the Baldacci company (Italy) a new generation iron-containing product has been developed – iron bisglycinate chelate, produced under the trade name Teknofer.

Teknofer consists of one molecule of ferrous iron and two molecules of the amino acid glycine. Two glycine molecules firmly bind the two valences of iron and protect it from hydrolysis (Fig. 2). Due to this, the iron bisglycinate chelate in transit passes through the stomach and is absorbed by the mucous membrane of the small intestine unchanged. And only after absorption, under the influence of cytoplasmic enzymes of intestinal cells, free iron is released and enters the bloodstream (Fig.1).

Thus, there is no contact of free iron with the mucous membrane of the gastrointestinal tract; therefore, the iron bisglycinate chelate is very well tolerated. Post-marketing studies have not reported any significant gastrointestinal side effects that would lead to discontinuation of the Teknofer dietary supplement. It is very important that there has not been a single case of early discontinuation of this product at home due to side effects.

The high level of safety of iron bisglycinate chelate has been confirmed by European (European Food Safety Agency, EFSA) and American (US Food and Drug Administration, FDA) regulatory authorities.

Note that due to the absorption of iron bisglycinate chelate in unchanged form, there is no contact of free iron not only with the gastric mucosa, but also with food inhibitors of iron absorption (dairy products, tea, coffee, etc.)). Therefore, Teknofer can be used regardless of food intake. This is very convenient for the doctor and patient and increases adherence to therapy.

Another important advantage of ferrous bisglycinate chelate is its very high bioavailability – almost 4 times that of ferrous sulfate. This can be explained by the presence of two absorption pathways – binding to two types of receptors. The first type of receptor – DMT-1 – is intended for iron salts, these receptors are located in the duodenum.The second type, PEPT-1, is used to bind peptides. The presence of the amino acid glycine in the Teknofer product allows the iron bisglycinate chelate to bind to this type of receptor. This significantly increases the absorption of the drug, especially considering the fact that the PEPT-1 receptors are located throughout the surface of the small intestine.

At present, on the basis of the Department of Internal Pathology of Pregnant Women, the State Institution “Institute of Pediatrics, Obstetrics and Gynecology named after E.M. Lukyanova of the National Academy of Medical Sciences of Ukraine “under the leadership of Professor V.I. Medveda is conducting a study of the efficacy and safety of the Teknofer dietary supplement for enriching the diet of pregnant women in order to prevent the development of iron deficiency anemia.

The preliminary results of the study were shared by obstetrician-gynecologist of the highest category, chief researcher of the Department of Internal Pathology of Pregnant Women, State Institution “Institute of Pediatrics, Obstetrics and Gynecology named after E.M. Lukyanova National Academy of Medical Sciences of Ukraine “, Doctor of Medical Sciences Mila Evgenievna Kirilchuk.

– Our clinic is interested in the possibility of using Teknofer supplements in order to prevent the development of iron deficiency anemia in high-risk pregnant women who are being examined and treated in our department. Before the start of the study, all women had normal hemoglobin levels. For 2 months, the patients of the main group were prescribed the enrichment of the diet with iron – Teknofer at a dose of 14-28 mg (1-2 tablets) per day. Patients in the control group did not receive iron supplementation as a prophylaxis.By the end of pregnancy, 100% of the participants in the control group experienced depletion of iron stores (decreased ferritin levels), and 37.5% developed iron deficiency anemia. In patients taking Teknofer, iron stores (ferritin) and hemoglobin levels were stabilized. In 25.0% of patients, the hemoglobin level before childbirth increased, and in some it even reached values ​​unusual for our department of 128-136 g / l. At the moment, the study involved 25 people (in total in both groups).All patients noted the good tolerance of the Teknofer product: no abdominal pain, nausea, and constipation.

The head of the study, Corresponding Member of the National Academy of Medical Sciences of Ukraine, Honored Doctor of Ukraine, Head of the Department of Internal Pathology of Pregnant Women, Doctor of Medical Sciences, Professor Vladimir Isaakovich Medved kindly shared his opinion on the Teknofer product.

– Convenient form, on the one hand, does not cause the development of gastrointestinal side effects, and on the other hand, due to chelating and absorption in unchanged form, it has high bioavailability.These are the indisputable advantages of the product, which make it very useful for the prevention of anemia or for the restoration of iron depot after the treatment of anemia.

Prepared by Anton Vovchek

Thematic issue “Obstetrics, Gynecology, Reproductology” No. 4 (32), chest 2018 p.

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90,000 What rules must be followed while taking iron supplements

“The doctor prescribed me to drink iron supplements, as my hemoglobin is low, but he told me to follow the rules. And which ones? ”

Alina, Vitebsk.

– In the world, 2 billion people suffer from anemia, mainly iron deficiency.It is most often found in women of reproductive age, children and pregnant women, as well as in the elderly. With a lack of iron, concentration of attention is disturbed, chronic fatigue appears, activity and performance decrease, colds occur more often, nails and hair become fragile, the skin of the face turns pale and appetite disappears.

To avoid anemia, it is necessary not only to replenish the daily iron losses associated with continuous desquamation of cells of the mucous membrane of the gastrointestinal tract, but also to consume much more of what is consumed.First, about 10% of all iron that enters the body is absorbed. Secondly, some iron is not absorbed at all. The daily requirement for iron in children is 18 mg, in pregnant women – 33, in non-pregnant women – 15 – 18, in men – 10. Women need more iron than men, because a significant amount of iron is lost during menstruation. And in a pregnant woman, this element is spent both to cover the increased needs of the body, and to ensure the fetus.

Iron deficiency, as a rule, is associated with malnutrition, pathological processes in the gastrointestinal system, when there is a violation of absorption and metabolic processes. But it must be remembered that it is impossible to solve the problem 100% with the help of diet therapy, although when establishing an iron deficiency state, certain products are recommended to patients. When compiling a diet, one should take into account not the total iron content in food, but its form, which determines absorption.For example, the absorption of iron from meat products is 17 – 22%, and from vegetable products – only 2 – 3%. Especially useful in this sense are buckwheat, chicken and beef meat, beef tongue, veal liver, sturgeon caviar, fish, apples, rose hips, beans, carrots, cottage cheese.

To make up for the lack of iron in the body, doctors often prescribe iron-containing drugs, the action of which is aimed at rapidly increasing the number of red cells (erythrocytes) to normal. Pills, syrups, oral solutions and only in exceptional cases, injections are used.And you need to tune in to a long course of treatment. Usually the first stage until the hemoglobin level returns to normal takes 4 to 6 weeks. The optimal therapeutic dose, according to the WHO recommendation, is 120 mg per day for mild and moderate anemia. An unjustified increase in the dose does not increase the effectiveness of treatment, but it gives side effects (pain in the heart, increased heart rate, allergic reactions, vomiting, nausea). Such drugs are contraindicated in arterial hypertension of the 2nd and 3rd degree, heart failure, liver disease.For anemia caused by infection, these drugs are ineffective. After the body is saturated with iron, it is necessary to continue supportive therapy for another 2 – 3 months at a dose of 30 – 60 mg of elemental iron per day. Thus, the full course takes 3 to 5 months. And at this time it is necessary to conduct a clinical and laboratory examination in order to monitor the increase in the level of hemoglobin, serum ferritin, iron.

Ingested iron preparations are divided into two main groups: ionic iron (ferrous salts) and nonionic (ferric complex).This division is based on the mechanism of absorption in the gastrointestinal tract. Salt preparations interact with food ingredients and medications, so they are used 1 hour before a meal. The general recommendations are as follows. Tablets and capsules must be swallowed without chewing, washed down with water. Clarified (no pulp) fruit juices are also allowed. But it is categorically impossible to drink it down with milk, kefir and other milk-based drinks because of the high calcium content. Because iron is not combined with it, as well as with magnesium and, therefore, with preparations containing these macronutrients.No need to take pills and tea, coffee. There are a number of medications that iron supplements should not be combined with. For example, some antibiotics (tetracycline, doxycycline), almagel, vicalin. Iron tablets should be taken 30 minutes before meals or 2 hours after. Then they are better tolerated and more efficiently absorbed in the gastrointestinal tract.

Olga PERESADA, Professor of the Department of Obstetrics and Gynecology, BelMAPO, Doctor of Medical Sciences.

Soviet Belarus No. 26 (25161).Wednesday, 8 February 2017

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About Fenyuls: instructions for use

¹ Optimal dosage refers to 55 mg of elemental iron, Explanation letter for composition of Fenules Capsules.Sun Pharmaceutical Industries LTD. June 2017

³ WHO recommendations on antenatal care for a positivepregnancy experience. Geneva: World Health Organization; 2017

⁴ Instructions for medical use of the drug Fenuls

⁵ Among the means of treatment and prevention of iron deficiency. According to IMS data as of October 2018

⁶ Radzinsky V.E., Ryabinkina T.S. Iron deficiency anemia in pregnant women: risks and opportunities for correction. Status Praesens. 2017.2 (38)

⁷ Bilich G.L. Anatomy and physiology: a large popular atlas. – Moscow: Eksmo Publishing House, 2017- 272s.

⁸ Mashkovsky M.D. Medicines. A guide for doctors. – 15th edition M: 2005

⁹ Spirichev V.B. Thirteen vitamins in a woman’s life (almost according to S. Zweig). M .: Valetek.-60 p., Ill.

¹⁰ Iron Shield for Reproductive Health. Therapeutic strategies for iron deficiency anemia.