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Iron (Ferric ammonium citrate)

Indications

1. Iron deficiency
2. Iron deficiency anaemia


Dosage

Adult: I capsule or 15ml twice daily after meals.
Children: 5 ml twice daily after meals.


Missed Dose

Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.


Overdose

Treatment includes immediate support of airway, respiration, and circulation. In conscious patients induce emesis with ipecac; if not empty stomach by gastric lavage. Follow emesis with lavage, using a 1% sodium bicarbonate solution to convert iron to less irritating poorly absorbed form. Take abdominal X-ray to determine presence of excess iron. Deferoxamine may be used for systemic chelation if serum levels of iron exceed 350mg/dl.


Storage

Store in a well closed container in a cool dry place. Protect from light.


Special Precautions

1. Prolonged use
2. Minimise gastrointestinal discomfort by taking along with meals and gradually increasing the recommended dosage
3. Discontinue if intolerance occurs
4. Higher doses are required for geriatric patients


Contraindications

1.Haemolytic anaemia unless iron deficiency anaemia is also present
2.Haemochromatosis
3.Haemosiderosis
4.Peptic ulcer
5.Regional enteritis
6.Ulcerative colitis
7.Those receiving repeated blood transfusions


Adverse Effects

1.Nausea
2.Epigasttric distress
3.Vomiting
4.Constipation
5.Diarrhoea
6.Black stools
7.Temporary staining of teeth with liquid formulations.


Action Mechanism

Ferric Ammonium Citrate contains between 16.5% and 18.5% of iron. It exerts haematinic action by being an essential constituent of haemoglobin. It is necessary for the oxidative process of living tissues. Ferric ammonium citrate is given by mouth as a source of iron for iron-deficiency anaemia.Ferric salts have not been preferred over ferrous salts as the ferric ion first requires reduction to ferrous form in the intestinal lumen. The bio-availability of iron from ferric salts is 3 to 4 times less than that of ferrous form.Ferric ammonium citrate (18% elemental iron) is the most commonly used ferric salts.


Pharmacokinetics

Absorption: Ferric is converted into Ferrous form and it is absorbed in ferrous form. It is poorly absorbed in healthy individuals (about 10%) but in patients suffering from iron deficiency anaemia up to 60% dose is absorbed. Distribution: Transported in a transferrin bound form in to bone marrow for incorporation in to haemoglobin. Metabolism: Iron liberated by destruction of haemoglobin is reused by the body. Excretion: Excretion of iron is minimal. Loss usually occurs in nails, faeces, urine, hair, sweat, and bile.


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