Iron supplements for anemia

With anemia, iron preparations are prescribed, which allow you to block the lack of this trace element in the body. As a result, hemoglobin rises to normal values. Drugs for the treatment of iron deficiency anemia can only be prescribed by a doctor.

What causes iron deficiency in the body?

The following reasons lead to the development of iron deficiency anemia:

• Chronic bleeding. This includes regular nosebleeds, heavy and prolonged menstrual bleeding, bleeding from the digestive tract.

• A state of the body in which iron is consumed more than usual. These include: pregnancy, the period of breastfeeding, periods of intensive growth in childhood and adolescence. Many chronic diseases also cause the body to use up its iron stores.

• Sometimes the digestive tract is simply not able to absorb iron. For example, similar situations are observed in inflammatory bowel diseases.

• Adherence to dietary food patterns that are free of meat and other animal products. For this reason, vegetarians and people whose menu is not balanced in composition often suffer from anemia.

What are the symptoms of iron deficiency?

Iron deficiency anemia can be latent. It can be indicated by signs by which it is difficult to guess about a developing problem. The body signals anemia by a decrease in appetite, increased weakness, deterioration in the condition of nails and hair, a distortion of taste preferences (a person can start eating chalk, toothpaste, ice, etc.). The skin of people with anemia is pale, shortness of breath and tachycardia may periodically disturb.

If you take blood for analysis, then it will show a decrease in hemoglobin, red blood cells, and serum iron. The color index will be below normal.

Based only on the external signs of anemia, even a doctor cannot make a final diagnosis. To confirm anemia, you will need to donate blood for analysis.

Treatment should be selected by a specialist. It is he who determines which drug should be taken in a particular case and how long the therapy should continue.

How anemia drugs work

For the treatment of iron deficiency anemia, you will need to take ferrous or ferric iron preparations. Medicines containing ferrous iron are absorbed by the body faster than ferric iron preparations. They are almost 100% absorbed in the intestines, which can sometimes be dangerous. The cost of ferric iron preparations exceeds the cost of ferrous preparations.

In order for Fe3 to become Fe2, it needs an oxidizing agent, such as ascorbic acid. In the intestine, iron combines with transferritin. This protein transports iron molecules to tissues and organs responsible for the formation of blood cells (liver and bone marrow).

Foods such as tea and milk impair iron absorption. This is also true for drugs from the tetracycline group, Levomycetin, Maalox, Almagel and medicines containing potassium. On the other hand, iron is best absorbed from red meat and fish.

It is unacceptable to self-prescribe iron preparations for yourself, since with an incorrectly selected dose, the likelihood of poisoning increases.

List of drugs for the treatment of iron deficiency anemia

Based on the WHO recommendations for the treatment of iron deficiency anemia, as well as based on the feedback from practitioners, the best drugs for the treatment of anemia in adult patients are:

• Maltofer and Maltofer-Fol.

• Ferlatum and Ferlatum-For.

• Fenuls.

• Ferro foil.

For the treatment of anemia in pregnant women, the best drugs are:

• Totem.

• Sorbifer Durules.

• Gino-Tardiferon.

• Maltofer.

• Ferrum-Lect.

For the treatment of anemia in childhood, the following iron preparations are used:

• Aktiferrin.

• Gemopher prolongatum.

• Tardiferon.

• Totem.

• Maltofer and Maltofer-Fol.

• Ferrum-Lect.

• Venofer.

Ferric iron preparations

Maltofer and Maltofer Fall

Maltofer contains trivalent iron hydroxide polymaltose complex.

The drug has 4 forms of release:

• In the form of a syrup with a nominal volume of 150 ml. 1 ml of the drug contains 10 mg of iron.

• In the form of drops with a nominal volume of 30 ml. 1 ml of the medicinal substance contains 50 mg of iron. One milliliter is equivalent to 20 drops.

• In the form of a solution of 5 ml (10 glass ampoules). Each vial contains 100 mg of iron.

• In the form of chewable tablets of 100 mg. There are 20 plates in one blister.

The drug in tablet form is not recommended for children under the age of 12 years. While the solution and syrup can be used to treat anemia in children from birth. The syrup is dosed easily, for this purpose there is a convenient cap.

A distinctive feature of the drug Maltofer is that it does not give the tooth enamel a dark color. Therefore, its liquid form can be mixed with juices or other drinks that do not contain alcohol.

The drug Maltofer-Fol is available in the form of chewable tablets, which, in addition to ferric iron, contain folic acid (0,35 mg).

Ferlatum and Ferlatum Fall

Ferlatum drug. It contains iron protein succinylate, in the form of a solution. The color of the liquid is brown, has a specific odor. Due to the protein content in the preparation, it does not irritate the walls of the stomach and intestines. This is to prevent the development of side effects.

Release form: in the form of a solution of 15 ml in a vial. You can purchase a package with 10 or 20 bottles. Each contains 40 mg of iron.

The drug should be taken after meals, the dose is selected by the doctor. If necessary, the course of treatment can be up to six months.

Ferlatum-Fol is a medicinal solution that smells like cherry. The vial contains 40 mg of iron and 0,235 mg of folinate. Taking the drug is designed to block the lack of iron and folate in the body.

You can take Ferlatum-Fol either before meals or after meals. If a person suffers from intolerance to fructose or milk protein, then this drug is prescribed to him with caution.

Ferrum-Lekt

Ferrum-Lect. This preparation contains a polymaltose complex of ferric iron. Forms of drug release:

• 30 chewable tablets of 100 mg.

• 100 ml syrup. 5 ml of the drug contains 50 mg of iron.

• Solution for injection, produced in ampoules of 2 ml. Each ampoule contains 100 mg of iron.

The tablet is taken with water or chewed. If necessary, it is divided into several parts. In the form of a syrup, the drug is allowed to be taken with water, you can also add the drug to baby food. You need to measure the dose using a special spoon that comes with the kit.

If an injection is used, the needle must be inserted deep into the muscle. The procedure is carried out exclusively in a hospital. Injections are indicated only for severe anemia, when oral iron preparations are not possible or have no effect. It is impossible to combine injections of iron preparations with their intake.

Venofer

Venofer is a drug that is intended for injection. It contains trivalent iron in combination with sucrose. The drug is produced in ampoules of 5 ml. Venofer is used exclusively for intravenous administration and only in emergency situations. For example, against the background of acute inflammation of the organs of the digestive system.

Ferrous preparations

Fenyuls – This is a drug that, in addition to ferrous iron, contains vitamin C and B vitamins. The use of such a complex improves the absorption of iron by the body. The main active ingredient is enclosed in a capsule and has the form of microgranules. This allows the iron and other components of the capsule to dissolve slowly, which does not irritate the walls of the intestines and stomach.

Ferro-foil – This is a preparation of ferrous iron, supplemented with cyanocobalamin and folic acid. One capsule contains 37 mg of iron. The drug gives a minimum of side effects and is rapidly absorbed in the intestine, in its

Totem – a drug for the treatment of anemia with ferrous iron, copper and manganese in the composition. The drug is produced in ampoules that are taken orally. Totem is prescribed for children older than 3 months. After its use, tooth enamel may darken, so it is recommended to dissolve the contents of the ampoule in a drink. After taking the drug, you should brush your teeth.

Gino-Tardiferon. This drug is widely known among pregnant women. It contains 40 mg of ferrous iron, as well as folic acid. Gino-Tardiferon is produced in tablet form. It is allowed to be used to treat anemia in children older than seven years. In addition to the fact that this drug allows you to replenish iron stores in the body, it also eliminates the deficiency of folic acid. This is especially true for expectant mothers. The drug should be washed down with water in large volumes.

Sorbifer durules is a preparation of ferrous iron, which is available in tablet form. In addition, the drug is supplemented with vitamin C. Sorbifer durules can be used to treat children over 12 years of age. It is also often prescribed to pregnant women. Take the drug half an hour before meals, swallow the tablet whole and drink it with water. During the therapeutic course, care must be taken in driving, as Sorbifer durules has an effect on concentration.

Aktiferrin is a drug containing ferrous iron, as well as D, L-serine.

The drug has several forms of release:

• In the form of capsules containing 34,5 mg of iron and 129 mg of D, L-serine. One package contains 20 capsules.

• In the form of a syrup with a nominal volume of 100 ml. At the same time, it contains 34,2 mg of iron, and 25,8 mg of D, L-serine.

• In the form of drops in a bottle with a nominal volume of 30 ml. One drop contains 9,48 mg of iron and 35,6 mg of D, L-serine.

Aktiferrin is prescribed for the treatment of women in position. It can also be taken during lactation. However, during treatment with Aktiferrin, tooth enamel may darken, so it should be diluted before use. It is important to note the date of opening the integrity of the package, since after a month the drug will become unusable.

Gemopher prolongatum is a preparation containing ferrous iron in the amount of 105 mg per capsule. It should not be used to treat children under 12 years of age. Otherwise, there are no restrictions, so the drug is prescribed for therapy for lactating and pregnant women. The dosage should be selected by the doctor. Take Hemofer prolongatum before or after meals, which depends on the individual characteristics of the human body.

Recommendations for taking iron supplements

• You can not deviate from the scheme of taking iron supplements. It is determined only by the doctor. An overdose of drugs of this group threatens with serious consequences.

• After 30-45 days from the start of treatment, the hemoglobin level should stabilize. To determine this, you will need to donate blood for analysis.

• During treatment, a person may find that their feces have turned dark in color. You should not be afraid of this, since such a phenomenon is a variant of the norm. When a doctor prescribes a fecal occult blood test, he should be warned that the patient is taking iron supplements.

• Taking iron supplements is associated with a number of complications, including: abdominal pain, nausea and vomiting, bloating, pain along the intestines.

Now there is a large selection of iron preparations on the market, which allows you to choose the form of release that is convenient for the patient and make therapy individually oriented. However, this does not mean that you can independently prescribe medicines for yourself. The selection of therapy should be done only by a doctor and only after the examination. Anemia is treated for a long time and the whole process should be under the supervision of a specialist.

What drugs are more effective?

All drugs that are used to get rid of iron deficiency can be divided into 2 large groups: ferrous iron preparations (ionic salt) and ferric iron preparations (based on HPA). As the analysis of the practical use of ferrous and ferric iron preparations shows, their therapeutic effect in terms of the treatment of anemia is equivalent.

Taking ferrous supplements is associated with the following problems:

• The body can absorb these drugs in uncontrolled amounts, which can cause serious poisoning.

• Drugs can interact with food and other drugs.

• During treatment, an unpleasant taste of metal may appear in the mouth.

• Teeth and gums may be stained dark. Sometimes the staining is quite persistent.

• About 30-35% of patients stop therapy without completing the course to the end.

If ferric iron preparations based on HPA are used, many problems can be avoided.

Compared to their divalent counterparts, they offer the following advantages:

• There is no risk of overdose and poisoning of the body. The drugs are absolutely safe in this regard.

• The gums and teeth are not stained in a dark color.

• The drugs have a pleasant taste.

• They are well tolerated by patients.

• Most patients complete the course.

• Ferric iron preparations do not interact with other drugs and foodstuffs.

• In addition to saturating the body with iron, most of these drugs have an antioxidant effect.

Ferrous iron preparations may be accompanied by constipation, abdominal pain, diarrhea, nausea, and vomiting. As a result of such side effects, a person refuses treatment. In addition, the body is able to absorb iron in excess, which sometimes leads to poisoning. Therefore, experts prefer modern preparations containing ferric iron.

The main drugs that are used to treat iron deficiency anemia are shown below in the picture:

In addition to oral iron preparations, it is possible to use iron-based drugs in the form of injections. They are administered either intramuscularly or intravenously. Such drugs are recommended for use only when oral administration is not possible, or does not achieve the desired effect.

Indications for parenteral administration of iron preparations:

• Severe anemia. In modern practice, this situation is rare, no more than 3% of all cases of the disease.

• Intolerance to iron preparations produced for oral administration.

• Resistance to treatment with oral drugs.

• Ulcer of the stomach and duodenum, surgery on the organs of the digestive system. Moreover, even if a peptic ulcer was already present in the anamnesis, it will still be a contraindication to the oral intake of iron preparations.

• Anemia that develops against the background of chronic intestinal pathologies, for example, against the background of Crohn’s disease or against the background of ulcerative colitis.

• Chronic kidney disease. Parenteral iron preparations are also prescribed to patients undergoing hemodialysis. This measure is aimed at preventing anemia.

• Inability to perform a red blood cell transfusion.

• An urgent need for immediate replenishment of iron stores in the body.

Injections into the muscle or intravenous infusions of iron preparations are performed 1-3 times in 7 days. The dose should not exceed the total iron deficiency in the human body. To calculate the total iron deficiency, use the following formula:

Total iron deficiency in mg uXNUMXd Human weight in kg * (Hemoglobin norm in g / l – patient’s hemoglobin in g / l) + iron depot in mg.

Coefficient 0,24 u0,0034d 0,07 * 1000 * XNUMX, where:

• The content of iron in hemoglobin is equal to 0,34%;

• The volume of blood in the human body is 7% of its body weight.

• 1000 is the conversion of grams to milligrams.

Thus, iron stores in patients, depending on their body weight:

• Weight below 35 kg – 15 mg / kg, target hemoglobin concentration – 30 g / l.

• Weight over 35 kg – 500 mg, target hemoglobin concentration – 150 g / l.

A distinctive characteristic of this formula is that it takes into account the iron stores in the body, which make up more than 30% of its total content in the body. With a decrease in the concentration of SF, a decrease in the concentration of iron in the depot can be detected.

By calculating the total iron deficiency in the human body in mg and knowing the total amount of iron in the ampoule of one drug (for example, 100 mg), you can calculate the number of ampoules that will be required to complete the full course of treatment. Formula for calculation:

Parenteral administration of iron preparations can be associated with a number of side effects, including:

• The occurrence of burning, itching and hyperemia of the skin at the injection site.

• Allergic reaction, up to anaphylactic shock.

Most often, shock occurs with the introduction of drugs that contain Dextran. Therefore, before the first administration of iron preparations, it is recommended to perform a test sample. It is equally important to correctly calculate the dose needed for a person. However, the body is able to give negative reactions even when the treatment is carried out with a small amount of iron.

In order for the treatment to be effective and safe, the following recommendations for parenteral administration of iron preparations must be strictly observed:

• Only modern drugs should be used that have minimal toxicity, do not give anaphylactic reactions and do not pose a threat to the life of the patient.

• Before dosing, it is necessary to calculate the total iron deficiency in the human body.

• The course should last exactly as long as necessary. It should not be extended.

• It is important to follow all the rules of parenteral administration of iron preparations.

• Be sure to enter a trial dose before starting the main treatment.

• Treatment should be carried out strictly safe doses.

Modern iron preparations for parenteral administration:

To determine whether the selected treatment regimen with iron-containing drugs was effective, it is necessary to focus on the following criteria:

• On the 7-10th day from the start of taking iron-containing drugs, the patient has an increase in the level of reticulocytes in the blood. The jump is 2-3% or 20-30% of the original amount.

• An increase in the level of hemoglobin in the blood by 28 days by 10 g / l, and hematocrit by 3%.

• Symptoms of anemia should be completely relieved after 30-45 days from the start of treatment.

• Iron stores in the depot should be replenished after 3-6 months from the start of therapy. The exact recovery time depends on the severity of the anemia.

Why treatment with iron-containing drugs may be ineffective?

Provided that the therapy does not give the desired effect, it is necessary to pay attention to the following points:

• The diagnosis was incorrect.

• The dose of the drug was chosen incorrectly.

• The treatment lasted less than the prescribed period.

• The patient did not follow the doctor’s recommendations.

• The patient has problems at the stage of iron absorption.

• The person cannot tolerate iron supplements.

If the diagnosis is not in doubt, then the effect of taking ferric iron preparations will definitely come. Therefore, in the absence of a reticulocyte crisis and an increase in the level of hemoglobin in the blood, the diagnosis should be reconsidered. With a high degree of probability, the patient does not have iron deficiency anemia, but some other type of anemia, and the treatment is chosen incorrectly.

If the cause of treatment failure has not been established, then an option such as IRIDA (iron refractory iron deficiency anemia) should be considered. This pathology is inherited and does not respond to oral intake of iron-containing preparations. Their parenteral administration gives only a partial effect. This type of anemia develops when the TMPRSS6 gene is mutated. This leads to an increase in the level of hepcidin in the body, which inhibits the absorption of iron in the intestine and prevents it from being released from macrophages. To date, effective treatments for this rare type of anemia have not been found.