What are the primary uses of ferrous sulfate in treating anemia. How does ferrous sulfate work to address iron deficiency. What are the potential side effects and drug interactions associated with ferrous sulfate. When is ferrous sulfate contraindicated in patients.

Understanding Ferrous Sulfate and Its Role in Anemia Treatment

Ferrous sulfate is a crucial medication used in the treatment of iron deficiency anemia. As a generic drug, it belongs to the class of medications used to address microcytic anemia. Its primary function revolves around replenishing iron stores in the body, which are essential for the production of hemoglobin and healthy red blood cells.

Mechanism of Action

The mechanism of action of ferrous sulfate is straightforward yet vital. Iron, provided by ferrous sulfate, combines with porphyrin and globin chains to form hemoglobin. This process is critical for oxygen delivery from the lungs to other tissues throughout the body. In cases of iron deficiency, the formation of small erythrocytes with insufficient hemoglobin leads to microcytic anemia, which ferrous sulfate aims to correct.

Indications for Ferrous Sulfate Use

Ferrous sulfate is primarily indicated for various conditions related to iron deficiency. These include:

• Iron deficiency anemia
• Blood loss related to pregnancy
• Gastrointestinal bleeding (often associated with NSAID use)
• Hookworm infestation
• Excessive coffee consumption leading to iron deficiency

In these situations, ferrous sulfate supplementation can help restore iron levels and alleviate the symptoms of anemia.

Potential Side Effects and Precautions

While ferrous sulfate is generally well-tolerated, it can cause certain side effects, particularly when taken in therapeutic doses. These side effects are often dose-related and may include:

• Nausea
• Upper abdominal pain
• Constipation
• Diarrhea

It’s important to note that iron overdose can be extremely dangerous. An overdose of 1-2 grams can lead to circulatory collapse and potentially death. Non-intentional iron overdose has been a leading cause of fatal poisoning in children under 6 years old. Therefore, it’s crucial to keep ferrous sulfate out of reach of children.

Overdose Treatment

In cases of iron overdose, treatment typically involves gastric lavage with a phosphate solution and the administration of deferoxamine, an iron chelator. Prompt medical attention is essential in such situations.

Contraindications for Ferrous Sulfate Use

Ferrous sulfate is not suitable for all patients. It is contraindicated in individuals with certain conditions, including:

• Hemochromatosis
• Hemosiderosis
• Hemolytic anemia

In these cases, additional iron supplementation could exacerbate the existing condition and potentially lead to complications.

Ferrous Sulfate in Comparison to Other Iron Supplements

While ferrous sulfate is a commonly prescribed iron supplement, it’s not the only option available. Other forms of iron supplements include ferrous gluconate and ferrous fumarate. Each of these has its own absorption rate and potential side effect profile.

Ferrous sulfate is often preferred due to its high elemental iron content and relatively good absorption rate. However, the choice of iron supplement may depend on individual patient factors, such as tolerance and specific iron needs.

Proper Administration and Dosage of Ferrous Sulfate

The effectiveness of ferrous sulfate largely depends on proper administration and dosage. Typically, it’s recommended to take ferrous sulfate on an empty stomach, about an hour before meals or two hours after meals. This timing helps maximize iron absorption.

Dosage can vary based on the severity of iron deficiency and individual patient factors. A common dosage for adults might be 325 mg (65 mg of elemental iron) taken orally three times a day. However, it’s crucial to follow the prescribing physician’s instructions, as they will tailor the dosage to the individual’s needs.

Enhancing Absorption

To enhance iron absorption, ferrous sulfate can be taken with vitamin C or a small amount of orange juice. Conversely, it’s advisable to avoid taking it with calcium-rich foods, tea, coffee, or antacids, as these can interfere with iron absorption.

Monitoring and Follow-up During Ferrous Sulfate Treatment

Regular monitoring is essential when using ferrous sulfate for anemia treatment. This typically involves periodic blood tests to check hemoglobin levels and iron stores. The duration of treatment can vary, but it often continues for several months even after blood counts normalize to replenish iron stores fully.

During follow-up appointments, healthcare providers may assess:

• Improvement in anemia symptoms
• Hemoglobin and hematocrit levels
• Serum ferritin levels
• Tolerability and side effects
• Adherence to the prescribed regimen

Based on these assessments, the treatment plan may be adjusted as needed.

Potential Drug Interactions with Ferrous Sulfate

Ferrous sulfate can interact with various medications, potentially affecting their efficacy or increasing the risk of side effects. Some notable interactions include:

1. Tetracycline antibiotics: Iron can reduce the absorption of these antibiotics, potentially decreasing their effectiveness.
2. Levothyroxine: Iron may interfere with the absorption of this thyroid hormone replacement medication.
3. Proton pump inhibitors and H2 blockers: These medications can reduce stomach acid, potentially decreasing iron absorption.
4. Calcium supplements: Calcium can interfere with iron absorption when taken simultaneously.
5. Certain antacids: These can reduce iron absorption when taken concurrently.

To minimize these interactions, it’s often recommended to space out the administration of ferrous sulfate and these medications by at least two hours.

Addressing Common Concerns About Ferrous Sulfate Use

Patients often have questions and concerns about using ferrous sulfate. Addressing these can improve adherence and treatment outcomes. Some common concerns include:

Gastrointestinal Side Effects

Many patients worry about stomach upset or constipation. Starting with a lower dose and gradually increasing it can help minimize these effects. Taking the supplement with food, although it may reduce absorption slightly, can also help if stomach upset is a significant issue.

Stool Discoloration

Ferrous sulfate can cause stools to appear dark or black. This is a normal effect and not a cause for concern unless accompanied by other symptoms of gastrointestinal bleeding.

Long-term Use

Some patients worry about the safety of long-term iron supplementation. While prolonged unnecessary use should be avoided, taking ferrous sulfate as prescribed under medical supervision is generally safe and essential for treating iron deficiency anemia.

Dental Staining

Liquid forms of iron supplements can temporarily stain teeth. Using a straw and rinsing the mouth after taking the supplement can help prevent this.

Alternative Approaches to Iron Supplementation

While ferrous sulfate is a primary treatment for iron deficiency anemia, there are alternative approaches that may be considered in certain situations:

Dietary Changes

Increasing dietary iron intake through foods like lean red meat, poultry, fish, beans, and fortified cereals can help mild cases of iron deficiency. However, dietary changes alone are often insufficient for treating moderate to severe anemia.

Intravenous Iron

In cases where oral iron is not tolerated or ineffective, or when rapid repletion of iron stores is necessary, intravenous iron formulations may be used. These bypass the gastrointestinal tract, potentially reducing side effects and improving absorption.

Other Oral Iron Formulations

Newer iron formulations, such as iron polysaccharide complexes or heme iron polypeptides, may offer improved tolerability for some patients. These alternatives may be considered if ferrous sulfate causes significant side effects.

Combination Therapies

In some cases, ferrous sulfate may be combined with other treatments. For instance, in patients with both iron and folate deficiency, a combination supplement might be prescribed. Similarly, in cases of severe anemia, iron supplementation might be used alongside erythropoiesis-stimulating agents under close medical supervision.

The Role of Ferrous Sulfate in Pregnancy and Postpartum Care

Ferrous sulfate plays a crucial role in pregnancy and postpartum care, as iron requirements increase significantly during these periods. Pregnant women often require iron supplementation to prevent iron deficiency anemia, which can lead to complications for both mother and baby.

Pregnancy

During pregnancy, the recommended daily allowance (RDA) for iron increases from 18 mg to 27 mg. Ferrous sulfate supplementation is often recommended, especially in the second and third trimesters when iron demands are highest. Regular monitoring of hemoglobin levels is essential to ensure adequate supplementation.

Postpartum

After childbirth, many women experience iron deficiency due to blood loss during delivery. Ferrous sulfate supplementation can help replenish iron stores and prevent postpartum anemia, which can lead to fatigue and other complications.

It’s important to note that while iron supplementation is crucial during these periods, it should always be under medical supervision to avoid potential complications from excess iron intake.

Future Directions in Iron Supplementation and Anemia Treatment

Research in the field of iron supplementation and anemia treatment continues to evolve. Some areas of ongoing investigation include:

• Development of new iron formulations with improved bioavailability and reduced side effects
• Exploration of novel delivery methods, such as transdermal iron patches
• Investigation of the role of the gut microbiome in iron absorption and metabolism
• Research into genetic factors influencing iron absorption and utilization
• Studies on the long-term effects of different iron supplementation strategies

These advancements may lead to more personalized and effective approaches to treating iron deficiency anemia in the future.

Conclusion: The Importance of Proper Iron Supplementation

Ferrous sulfate remains a cornerstone in the treatment of iron deficiency anemia. Its effectiveness, affordability, and wide availability make it a valuable tool in addressing this common nutritional deficiency. However, its use requires careful consideration of individual patient factors, potential side effects, and drug interactions.

Proper administration, regular monitoring, and patient education are crucial for maximizing the benefits of ferrous sulfate supplementation while minimizing potential risks. As research continues to advance our understanding of iron metabolism and anemia treatment, we can expect to see even more refined and personalized approaches to iron supplementation in the future.

Ultimately, the goal of ferrous sulfate treatment is not just to correct anemia, but to improve overall health and quality of life for patients suffering from iron deficiency. With proper use and medical supervision, ferrous sulfate can effectively achieve this goal for many individuals struggling with iron deficiency anemia.

antianemia_drugs [TUSOM | Pharmwiki]

Erythropoietin (Epoetin alpha)

• Trade Names: erythropoietin, Epo, Epogen, Procrit ®

• Drug Class: Drug Used in Anemia (normocytic)

• Mechanism of Action:

  • a glycoprotein that stimulates red blood cell production. Epoetin alfa is a 165 amino acid glycoprotein manufactured by recombinant DNA technology, and has the same biological effects as endogenous erythropoietin

  • Hypoxia is the primary physiological stimulus for erythropoietin production in the body

• Indications:

  • treatment of anemia in:

    1. chronic renal failure patients

    2. zidovudine-treated HIV-infected patients

    3. cancer patients on chemotherapy

    4. reduction of allogeneic blood transfusion in surgery patients. Erythropoietin deficiency can result from compromised renal function (it’s primary site of production). Erythropoietin deficiency results in a normocytic anemia.

• Contraindications:

  • Uncontrolled hypertension or known hypersensitivity to either mammalian cell-derived products or to human albumin.

• Pharmacokinetics:

  • given i.v. or s.c. Half life of 4-13 hrs in patients with chronic renal failure. It is measured in international units (IU).

• Side Effects:

  • a rapid increase in hematocrit & hemoglobin may cause hypertension & thrombotic complications. These can be minimized by raising the hematocrit slowly and treating the hypertension.

Black Box Warnings:

• INCREASED DEATH, SERIOUS CARDIOVASCULAR and THROMBOEMBOLIC EVENTS, and INCREASED RISK OF TUMOR PROGRESSION OR RECURRENCE.

Renal Failure Patients

• Patients experienced greater risks for death and serious cardiovascular events when administered erythropoiesis-stimulating agents (ESAs) to target higher versus lower hemoglobin levels (13.5 vs. 11.3 g/dL; 14 vs. 10 g/dL) in two clinical studies. Physicians should individualize dosing to maintain hemoglobin levels within the range of 10 to 12 g/dL.

Cancer Patients

• Erythropoiesis-stimulating agents shortened overall survival and/or increased the risk of tumor progression in some clinical studies in patients with breast, head and neck, lymphoid, non-small cell lung, and cervical cancers. Use the lowest dose needed to avoid RBC transfusions.

• Use only for treatment of anemia due to cocomitant myelosuppressive chemotherapy.

• Erythropoietin is not indicated for patients receiving myelosuppressive therapy when the anticipated outcome is cure.

Perisurgery

• Erythropoietin increased the risk of deep vein thrombosis in patients not receiving prophylactic anticoagulation.

• Notes:

  • Epo is one of the drugs banned by the International Olympic Committee

  • Darbopoetin alpha (Aranesp ®) is a glycosylated form of erythropoietin that differs only in having a 2-3 fold longer half-life.

• Pronunciation: e rith ro POE e tin

• References:

  • Zehnder JL (2021): Agents Used in Cytopenias; Hematopoietic Growth Factors. (Chapter 33). In: Basic & Clinical Pharmacology. 15e. Katzung BG, Vanderah TW (Editors). McGraw-Hill / Lange. (Access-Medicine)

  • rxlist.com (Procrit ®)

Keywords

Ferrous Sulfate

• Trade Name: generic

• Drug Class: Drug Used in Anemia (microcytic)

• Mechanism of Action:

  • Iron combines with porphyrin and globin chains to form hemoglobin, which is critical for oxygen delivery from the lungs to other tissues.

  • Iron deficiency causes a microcytic anemia due to the formation of small erythrocytes with insufficient hemoglobin.

• Indications:

  • Iron deficiency anemia, blood loss related to pregnancy or GI bleeding (NSAIDs), hookworm infestation, or excess coffee

• Contraindications:

  • Patients with hemochromatosis, hemosiderosis or hemolytic anemia

• Pharmacokinetics:

• Side Effects:

  • Therapeutic doses – dose related nausea, upper abdominal pain, constipation or diarrhea

  • Iron overdose (1-2 g) can lead to circulatory collapse and death. Non-intentional iron overdose has been a leading cause of fatal poisoning in children <6 years old. Keep out of reach of children.

  • Iron overdose can be treated by gastric lavage with a phosphate solution and deferoxamine (iron chelator).

• Drug interactions:

• Notes:

• Pronunciation: Fair us SUL fate

• Reference:

  • Zehnder JL (2021): Agents Used in Cytopenias; Hematopoietic Growth Factors. (Chapter 33). In: Basic & Clinical Pharmacology. 15e. Katzung BG, Vanderah TW (Editors). McGraw-Hill / Lange. (Access-Medicine)McGraw-Hill / Lange. (Access-Medicine)

Keywords

Deferoxamine

• Trade Name: Desferal ®

• Drug Class: Iron Chelator

• Mechanism of Action:

  • Binds iron avidly, but poorly binds other essential trace metals

  • It competes in binding loosely bound iron, but fails to bind iron that is biologically chelated, such as in microsomal and mitrochondrial cytochromes and hemoproteins

• Indications:

  • Iron poisoning. Used for treating both acute iron intoxication and in patients with secondary iron overload from multiple transfusions.

  • Deferoxamine plus hemodialysis may also be useful in treatment of aluminum toxicity in renal failure. (It is not indicated for the treatment of primary hemochromatosis, since phlebotomy is the method of choice for removing excess iron in this disorder.)

• Contraindications:

  • Patients with severe renal disease or anuria, since the drug and the iron chelate are excreted primarily by the kidney

• Pharmacokinetics:

  • Given parentally (i.m., s.c. or i.v.)

  • It is poorly absorbed if taken orally, and may actually increase iron absorption if given orally

  • Iron-chelator complexes are excreted in the urine, often turning the urine an orange-red color

• Side Effects:

  • Rapid i. v. administration may cause hypotension

  • Idiosyncratic responses such as flushing, rash, abdominal discomfort may occur

• Pronunciation: de fer OX a meen

• References:

  • Olson KR (2007): Poisoning & Drug Overdose. 5th Edition. McGraw-Hill (Lange). (ISBN: 978-0-07-144333-3).

  • Zehnder JL (2021): Agents Used in Cytopenias; Hematopoietic Growth Factors. (Chapter 33). In: Basic & Clinical Pharmacology. 15e. Katzung BG, Vanderah TW (Editors). McGraw-Hill / Lange. (Access-Medicine)

Keywords

Folic acid

• Trade Name: Folvite ®

• Drug Class: Drug used in anemia (megaloblastic)

• Mechanism of Action:

  • Essential cofactor for synthesis of amino acids, purines and DNA

• Indications:

  • Treatment of megaloblastic anemias due to a deficiency of folic acid as may be seen in tropical or non-tropical sprue, in anemias of nutritional origin, pregnancy, infancy, or childhood

  • A reduced form of folic acid known as citrovorum factor (or leucovorin) is given to replenish endogenous folic acid in patients on methotrexate (which inhibits dihydrofolate reductase). Citrovorin (leucovorin) is better absorbed compared to folic acid.

• Contraindications:

  • Folic acid should not be given alone in patients with pernicioius anemia without knowing whether they also have a Vit B12 deficiency. The danger is that folic acid supplements can mask the signs of Vit B 12 deficiency, yet not prevent the development of irreversible neurological disease due to Vit B12 deficiency.

  • The Shilling test can be used to test for abnormalities in Vit B12 absorption.

• Pharmacokinetics:

  • 1 mg of folic acid orally daily is typically sufficient to reverse megaloblastic anemia & restore normal folate levels.

• Side Effects:

• Notes:

  • Folate deficiency (in pregnant women) is implicated as a cause of congenital malformations in newborns

  • Folate may also play a beneficial role in preventing the development vascular disease such as ischemic heart disease & stroke.

  • Folic acid supplements may mask the signs of Vit B 12 deficiency, which can produce neurological disease if undetected

  • Folic acid deficiency is also known as Will’s disease.

• Pronunciation: FOE lik As id

• References:

  • Zehnder JL (2021): Agents Used in Cytopenias; Hematopoietic Growth Factors (Chapter 33). In: Basic & Clinical Pharmacology. 15e. Katzung BG, Vanderah TW (Editors). McGraw-Hill / Lange. (Access-Medicine)

  • www.rxlist.com (Folvite ®)

Keywords

Vitamin B12

• Generic Names: generic, cyanocobalamin, hydroxocobalamin

• Drug Class: Vitamin

• Mechanism of Action:

• Indications:

  • Used to treat or prevent deficiency of Vit B12.

  • The most common causes of Vit B12 deficiency are:

    • Pernicious anemia (results from defective secretion of intrinsic factor by the gastric mucosal cells)

    • Fish tapeworm infection

    • Partial or total gastrectomy

    • Various intestinal disorders that impair absorption of Vit B12.

• Pharmacokinetics:

  • Different formulations can be administered orally, or by parenteral injection.

• Notes:

  • Vit B12 deficiency leads to megaloblastic anemia, GI symptoms & neurological abnormalities including degeneration of myelin sheaths in axons of the spinal cord & peripheral nerves.

  • Vit B12 deficiency symptoms: paresthesias & weakness in peripheral nerves, progressing to spasticity, ataxia & other CNS dysfunctions.

  • Vit B12 deficiency in elderly patients due to abnormal absorption of dietary Vit B12 is relatively common and easily treated.

• Pronunciation: vi tah min Bee 12

• References:

  • Zehnder JL (2021): Agents Used in Cytopenias; Hematopoietic Growth Factors (Chapter 33). In: Basic & Clinical Pharmacology. 15e. Katzung BG, Vanderah TW (Editors). McGraw-Hill / Lange. (Access-Medicine)

  • rxlist.com (B12)

Keywords

Keywords

antianemia-drugs,
erythropoietin,
ferrous-sulfate,
deferxoamine,
folic-acid,
vitamin-B12,
iron

Medications for anemia: Goal, options, and dose

The medication a doctor prescribes to treat anemia depends on the type of anemia a person has. For example, a person can take supplements to treat nutrient-deficiency anemia. More severe or chronic types of anemia will require different medications.

Iron deficiency anemia is the most common type and typically responds well to treatment with medication, including iron supplements.

This article looks at the goals of medication for anemia, which medications a person may require, how to take them, and how the medication works.

It also looks at the benefits and potential side effects of medication for anemia.

Medication treatment goals for anemia will differ depending on the type of anemia a person has and the underlying condition that is causing it.

For someone with mild anemia related to a nutrient-deficient diet or a temporary circumstance such as pregnancy, the goal may be to replenish lost nutrients and vitamins with supplements and other medication in the short term.

For others who experience chronic or severe anemia, the goals of medication can involve:

• increasing the hemoglobin level or red blood cell count to improve the blood’s ability to transport oxygen
• relieving symptoms of anemia and improving a person’s quality of life
• reducing the risks of complications of anemia, such as nerve or organ damage
• treating an underlying condition that may be the cause of the anemia

A person with iron deficiency anemia does not have enough iron in their body to produce a protein called hemoglobin.

This protein enables red blood cells to transport oxygen throughout the body, which is essential for the proper functioning of the organs.

Iron supplements are the most common treatment for anemia and can help replace iron levels in the body so that it can produce sufficient hemoglobin.

A person can typically get over-the-counter (OTC) iron supplements in oral pill form, as part of a multivitamin, or as an iron-only supplement. Types of iron supplements include:

• ferrous sulfate
• ferric sulfate
• ferrous gluconate
• ferric citrate

Dosage

A doctor may recommend a specific dosage.

In cases where anemia is not chronic, a person may require several supplements a day for 3–6 months to replenish their iron levels.

Individuals should take iron supplements exactly as the doctor directs, as too much iron may cause harmful side effects.

Benefits

Iron supplements can help replenish the body’s iron levels, which can relieve symptoms of anemia such as:

• fatigue
• weakness
• gastrointestinal problems
• infection
• problems with memory and concentration

If a person does not receive treatment for anemia, they may be at risk of developing severe complications, such as heart problems.

Side effects

There are various potential side effects of iron supplements, especially if a person takes high doses. These include:

• constipation
• nausea
• vomiting
• diarrhea
• inflamed stomach lining
• ulcers

In extremely high doses, iron becomes toxic and may cause severe side effects, such as:

• convulsions
• organ failure
• coma
• death

Iron may also interact with other medications and supplements. A person should disclose any other medication they are taking with their doctor, including natural or herbal supplements.

To help mitigate the side effects associated with iron, a person may need to take a delayed or enteric-coated formulation.

If iron supplements are not adequate to replenish a person’s iron levels, they may require intravenous (IV) iron.

A doctor may prescribe administering iron into a vein to increase iron levels in the blood, especially for patients with severe anemia who have a chronic condition, such as celiac disease.

Dosage

The dosage of IV iron can differ depending on the intravenous iron formulation a doctor prescribes.

Dosages may range from 100 milligrams (mg) per dose of INFeD, the brand name for a compound called low-molecular-weight iron dextran, to 1,000mg of Monofer — the brand name for the compound iron isomaltoside.

The time it takes to administer the dose can range from 15 minutes to 6 hours.

Benefits

IV iron may deliver iron into the blood more efficiently and in higher doses than iron supplements, which can result in better management of anemia symptoms.

Side effects

Side effects may include:

• nausea and vomiting
• diarrhea
• constipation
• headache
• dizziness
• allergic reactions in rare cases

Some types of anemia, such as pernicious anemia, develop because the body is deficient in vitamin B12, which it requires to produce healthy blood cells.

A doctor can prescribe vitamin B12 in the form of an injectable shot or a nasal spray. In less severe cases, a doctor may recommend large doses of vitamin B12 in pill form.

The supplemental vitamin B12 increases levels of the vitamin, which stimulates blood cell production.

Dosage

The dosage may depend on the severity and type of anemia.

Doctors will typically prescribe administering a shot into a muscle every day for a week and once a month after a person’s levels have normalized.

Benefits

Benefits of vitamin B12 include:

• reduction of vitamin B12-deficiency anemia symptoms
• reduction of a compound called homocysteine, which scientists have linked to heart attack and stroke
• possible positive effects on cognitive function and energy, although more research is necessary

Side effects

Research has not found any harmful effects of vitamin B12, although it may interact with some medications. These include gastric acid inhibitors, and Metformin, which doctors use to treat diabetes.

It is very unlikely for a person to overdose on B12. This is because it is a water-soluble vitamin, meaning that any excess that the body does not absorb leaves the body via urine.

ESA is a synthetic form of a hormone the kidneys naturally produce, called erythropoietin (EPO). EPO helps stimulate the creation of red blood cells.

In people with certain conditions, such as chronic kidney disease, EPO levels are low, which can result in anemia. Synthetic ESA can stimulate red blood cell production in a similar way to the natural hormone.

A doctor can prescribe the medication and perform the injections themselves, or a person may be able to self-administer the injections at home.

Dosage

The dosage depends on the underlying cause of the anemia and other factors.

For a person with chronic kidney disease-associated anemia, the dose may begin at 50–100 units per kilogram, three times a week. The dosage may differ for other types of anemia.

Benefits

The medication can increase hemoglobin levels, which will reduce symptoms of anemia. This can also mean that a person with severe anemia may require fewer other types of treatment, such as blood transfusions.

Side effects

A 2023 article notes that ESA can thicken the blood, which can increase the risk of blood clotting. This could lead to ischemic stroke and heart attack.

ESA may also increase the risk of certain cancers, such as cervical, lung, neck, and breast cancer.

In people who also undergo chemotherapy, side effects can include:

• nausea and vomiting
• diarrhea
• insomnia
• fatigue
• abdominal pain
• rashes
• headache
• prickling or burning sensation
• low platelet count
• swelling in the legs or hands
• muscle pain
• stiff joints

A doctor may prescribe other medications to treat underlying conditions that may contribute to or cause anemia. Many conditions may affect the production of red blood cells and cause anemia symptoms.

Medications for these conditions may include:

• corticosteroids and other immunosuppressant drugs
• chemotherapy drugs to treat cancer
• medication such as antibiotics to treat infection

Below are the answers to some frequently asked questions about medication for anemia.

What is the best medication for anemia?

The best medication for anemia will depend on the type and severity of the condition. Iron supplements are the most common treatment for iron deficiency anemia.

What is the newest medication for anemia?

The Food and Drug Administration (FDA) approved Jesduvroq tablets in February 2023.

The medication is the first oral treatment for anemia caused by chronic kidney disease, and doctors may prescribe it for adults who have received at least 4 months of dialysis.

There are different types of anemia, each with different causes and levels of severity, that may require different types of medication.

Common medication types include iron supplements, IV iron therapy, erythropoiesis-stimulating agents (ESA), and vitamin B12. Doctors may also prescribe medication to treat underlying conditions.

There are potential benefits and side effects of medication for anemia. Common side effects include nausea, vomiting, and other gastrointestinal upsets.

Ferrous sulphate – MZHR

Ferrous sulphate wholesale

We can easily organize the production and supply anywhere in the world, any number of chemicals, to order. Mikhailovsky Plant of Chemical Reagents is one of the most experienced manufacturers of chemical products. During our centuries-old history, we have become known not only to Russian buyers, but even in the most remote corners of the world, our name is known. We have rich experience in the production and logistics of finished products. That is why, when you contact us for a particular product, you receive a quality product at a given time. It is possible to ship the largest consignments of goods by rail.

We offer the production of ferrous sulfate (II) or ferrous sulfate in small and large wholesale, in any quantity.

Ferrous sulfate is a salt of sulfuric acid and iron, an inorganic substance, water-soluble.
Non-volatile, odorless. In dehydrated form, it is colorless crystals, opaque, intensively absorbing water.

Crystal hydrates:
• greenish blue
• monohydrates without shades (tar kit)
• green tetrahydrates (rosenite).

The substance has a metallic taste.
Releases water on prolonged contact with air.
Has low toxicity. When heated above 4800C, it decomposes into oxides.
Used as a fungicide on crops. Based on the compound, mineral paints are produced.
Occurs naturally as the mineral melanterite.

Our factory provides preferential prices for large customers, as well as for regular supply contracts. We can fully provide your production with all the necessary reagents and compounds.

Quality indicators
Indicator name	FS requirements
1. Description	Pale greenish blue crystals
2. Genuine	On K – the formation of a yellow crystalline precipitate. On Cl – the formation of a white precipitate
3. Solubility	Freely soluble in water, practically insoluble in alcohol 96%.
4. Solution clarity	10% solution of the substance must be clear or comparable to reference 1
5. Color of solution	10% solution of the substance must be clear or comparable to reference Y 7
6. Acidity or alkalinity	Not more than 0.5 ml 0.01 M sodium hydroxide or 0.01 M hydrochloric acid
7. Sulphates, %, not more than	0.005
8. Iron, %, no more than	0.0003
9. Magnesium and alkaline earth metals, %, not more than	0.02 calculated as calcium
10. Sodium, %, not more than	0.1
11. Ammonium salts, %, not more than	0.004
12. Bromides, %, not more than	0.1
13. Iodides	No blue color should be observed after 5 minutes
14. Barium	After 15 minutes, the opalescence of the resulting solution should not exceed that of the reference solution
15. Weight loss on drying, %, no more than	1.0
16. Heavy metals, %, no more than	0.0005
17. Arsenic, %, no more than	0.00005
18. Microbiological purity	Category 1.2.B
19. Bacterial endotoxins, not more than	3 EU per 1 g of substance
20. Quantification, %, within	Not less than 99.0% and not more than 101.0%
Packaging	10 kg, 13 kg per bag, made of polyethylene film placed in a polypropylene bag. One label is tied together with the bag, the other label is stitched together with the outer polypropylene bag. Label from label paper, writing, offset
Marking	As per regulation
Storage	In a dry place, avoiding contact with moisture, at a temperature not exceeding 250 C
Expiry date	1 year

Our factory provides a 6 month warranty. for compliance with the requirements for storing the substance under recommended conditions, with proper transportation and storage.

Since ferrous sulfate requires special attention during transportation, it is necessary to treat its packaging with great care. In general, GOSTs have been developed for its packaging, and of course, we try to comply with them. Therefore, in our chemical plant, the finished substance is packed in strong polyethylene bags, which in turn are tied with a double knot with a thread or even sealed. At the choice of the buyer, it is also possible to pack this substance in paper five-six-layer bags.

Substance (FeSO4 7h3O), crystalline hydrate, is formed from a heated solution in water. The technical name is iron sulphate.
Ferrous iron in solution oxidizes upon contact with the external environment, turning into ferric sulfate.
Iron vitriol is also produced by treating scrap iron with sulfuric acid.
It is also obtained by pickling iron sheets, wire, and also by removing scale.
In the process of thermal treatment of pyrite.
Titanium oxide is formed as a by-product during the production of titanium oxide.
All substances are produced according to regulatory specifications, but personal conditions are also developed for specific technological chains.

Ferrous sulfate used in industry:

• in the woodworking industry as a wood preservative.

• for dyeing miscellaneous items, wool black

• in leather and fur processing

• in the manufacture of inks and paints

• as a catalyst for chemical reactions

• when processing rocks containing copper

• for wastewater treatment in municipal and industrial systems.

Use of ferrous sulfate in medicine
Used for medical purposes and as part of drugs:

• For the preparation of non-sterile dosage forms
• as a medicine for anemia (Tardiferon, Ferroplex and others). Some add vitamin C as an antioxidant.
• As a hemostatic agent (ferric sulfate for this purpose)

Iron is part of hemoglobin and other elements of the blood composition. Performs the functions and participates in the processes:

• oxygen transport
• formation of erythrocytes
• oxidation and reduction.

As part of medicines, ferrous sulfate is used for:

• treatment and prevention of anemia
• treatment of gastritis
• relief of the condition during periods of exacerbations of peptic ulcer of the stomach and duodenum
• for disorders of iron absorption in the gastrointestinal tract
• during pregnancy and lactation
• Improving the nutritional composition of a lean diet
• immunity enhancement
• other diseases and pathological conditions.

Medicines are taken strictly on the recommendation of a doctor in the prescribed dosage.

Use of ferrous sulfate in agriculture

• Plants are treated with ferrous sulfate solution against diseases and pests – it is a fungicide.
• The substance is used as a source of iron for plants.

Iron vitriol has long been known as a means of protecting agricultural crops, and it does not lose its relevance, despite the large number of new modern formulations.

Iron in sulfate is at least 53%, is included in plant nutrition, participates in redox processes.

Application of the substance:

• improves soil nutrition and fertility
• improves fruit appearance, yield quality and quantity
• is a bait for flower and fruit crops
• accelerates the growth of vegetable crops
• maintains the beauty of lawns.

The preparation is applied to the soil, and spraying is also used, avoiding the formation of large droplets on the leaves.
Plants are treated with a solution of ferrous sulfate for many diseases – they treat berry bushes and fruit trees, stone fruits and pome fruits.

Treat wounds and injuries on trunks and branches, the effect is the same as when treating with garden pitch or putty.

Vitriol has proven itself as a disinfectant and disinfectant for the treatment of fruit and vegetable warehouses, greenhouses and greenhouses.

The addition of ferrous sulfate to the whitewash mixture protects the plant from pests and diseases.
Plants are treated with the agent before the cold season – this also prevents hares and rodents from biting the bark.

Antiseptic and selective herbicidal properties of the substance block the development of the mycelium of fungal organisms, protect plants from the growth of mosses and lichens. Regular treatment helps the plant resist rot, spotting and other diseases. Stops the development of diseases in case of damage and scratches on the trunks.

Treating the soil and plants in early spring, before leaves appear, kills pests that have overwintered in the bark and upper layers of the soil.

Precautions for safe handling

Among the negative effects on humans are general toxic effects on contact with the substance without protective equipment, and can also cause psychological irritation, headache, gastrointestinal disturbance, nausea, vomiting, diarrhea. Therefore, when working with it, it is required to use gloves, overalls, eye and face protection.

May cause severe irritation in contact with skin, the same effect is expected in case of contact with mucous membranes.

In the premises where work is carried out, it is necessary to ensure the presence of a general supply and exhaust ventilation. And the places of the highest concentration of the substance should be separate from the general space of the room and should also be with local exhaust ventilation.

We invite you to cooperate

You can buy any wholesale batch of ferrous sulfate just by calling our managers. We will agree with you a convenient type of delivery and a set of documents that will be required for the transportation of the substance and its further use in your production.

It is also possible to produce chem. reagents and other types of substances according to your specifications.

New generation ferrous iron to prevent anemia in pregnant women

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New generation ferrous iron to prevent anemia in pregnant women

Author:
Doctor of Clinical Pharmacology, Professor M. Bertini, obstetrician-gynecologist of the highest category, chief researcher of the Department of Internal Pathology of Pregnant Women, E.M. Lukyanova NAMS of Ukraine”, Doctor of Medical Sciences M.E. 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

02/08/2019

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Iron deficiency is a global medical and social problem throughout the world. The reason for the development of iron deficiency, in particular iron deficiency anemia in pregnant women, is insufficient intake of iron from food in combination with an increased need for it, which is caused by the growth of the fetus. That is why the World Health Organization, in its 2017 protocols, recommends fortifying 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 was held on November 30, 2018 in 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 physicians all over 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 already with 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 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.

The laboratory of Baldacci (Italy) has developed a new generation iron-containing product – 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 two iron valences and protect it from hydrolysis (Fig. 2). Due to this, iron bisglycinate chelate passes through the stomach in transit 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 it into the blood (Fig. 1).

Thus, there is no contact of free iron with the mucous membrane of the gastrointestinal tract, so the iron bisglycinate chelate is very well tolerated. In post-marketing studies, no significant gastrointestinal side effects have been registered that would lead to discontinuation of the Teknofer dietary supplement. Most importantly, there have been no reported cases of early discontinuation of this product at home due to side effects.

The high safety level of iron bisglycinate chelate has been confirmed by European (European Food Safety Agency, EFSA) and American (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 the patient and increases adherence to therapy.

Another important benefit 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 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 composition of the Teknofer product allows the iron bisglycinate chelate to bind to this type of receptor. This significantly increases the absorption of the drug, especially given the fact that PEPT-1 receptors are located throughout the surface of the small intestine.

Currently, on the basis 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” under the guidance of Professor V.I. Medved, a study is underway on the effectiveness and safety of the Teknofer dietary supplement for enriching the diet in pregnant women in order to prevent the development of iron deficiency anemia.

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 of the 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 Mila Evgenievna Kirilchuk.

– Our clinic is interested in the possibility of using Teknofer supplement 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 an enrichment of the dietary ration with iron – Teknofer at a dose of 14-28 mg (1-2 tablets) per day. Patients in the control group did not receive an iron supplement as a prophylaxis. In 100% of the participants in the control group, depletion of iron stores (decrease in ferritin levels) was observed until the end of pregnancy, and 37.5% developed iron deficiency anemia. In patients who took Teknofer, it was possible to stabilize iron stores (ferritin) and hemoglobin levels. In 25.0% of patients, the hemoglobin level before delivery increased, and in some of them it even reached values ​​of 128-136 g/l, which are unusual for our department. At the moment, 25 people have taken part in the study (in total in both groups). All patients noted that Teknofer was well tolerated: no abdominal pain, nausea, constipation.

The research leader, 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 about the Teknofer product .

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

Prepared by Anton Vovchek

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

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

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