Iron Preparations In The Treatment Of Anemia - A List Of Drugs

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Iron preparations for anemia

In case of anemia, iron preparations are prescribed, which make it possible to cover the lack of this trace element in the body. As a result, hemoglobin rises to normal values. Medications for the treatment of iron deficiency anemia can only be prescribed by a doctor.

Content:

• What causes iron deficiency in the body?
• How do signs of iron deficiency appear?
• How drugs work for anemia
• List of drugs for the treatment of iron deficiency anemia
• Ferric iron preparations
• Ferrous iron preparations
• Iron supplementation recommendations
• Which drugs are more effective?
• Why may treatment with iron supplements be ineffective?

What causes iron deficiency in the body?

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

• Chronic blood loss. This includes regular nosebleeds, heavy and prolonged menstrual bleeding, bleeding from the gastrointestinal tract.
• A condition of the body in which iron is consumed more than usual. These include: pregnancy, breastfeeding, periods of intense growth in childhood and adolescence. Many chronic diseases also cause the body to use up 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 diets that are free from meat and other animal products. For this reason, vegetarians and people whose menu is not balanced in composition often suffer from anemia.

How do signs of iron deficiency appear?

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

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

Relying only on the external signs of anemia, even a doctor cannot make a final diagnosis. A blood test will be required to confirm anemia.

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

How drugs work for anemia

To treat 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 preparations exceeds the cost of ferrous iron preparations.

For Fe3 to turn into Fe2, it requires 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 the absorption of iron. This is also true for drugs from the tetracycline group, Levomycetin, Maalox, Almagel and drugs containing potassium. On the other hand, iron is absorbed best from red meat and fish.

It is unacceptable to prescribe iron supplements on your own, 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 practicing doctors, the best drugs for the treatment of anemia in adult patients are:

• Maltofer and Maltofer-Fall.
• Ferlatum and Ferlatum-Fore.
• Fenuls.
• Ferro-foil.

The best drugs for the treatment of anemia in pregnant women are:

• Totem.
• Sorbifer Durules.
• Gyno-Tardiferon.
• Maltofer.
• Ferrum-Lect.

The following iron preparations are used to treat childhood anemia:

• Aktiferrin.
• Hemofer prolongatum.
• Tardiferon.
• Totem.
• Maltofer and Maltofer-Fall.
• Ferrum-Lect.
• Venofer.

Ferric iron preparations

Maltofer and Maltofer-Foul

Maltofer contains trivalent iron hydroxide polymaltose complex.

The drug has 4 release forms:

• 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 drug contains 50 mg of iron. One milliliter equals 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. One blister contains 20 plates.

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 babies from birth. The syrup is dispensed easily, there is a convenient cap for this purpose.

A distinctive feature of the Maltofer preparation is that it does not darken the tooth enamel. Therefore, its liquid form can be mixed with juices or other alcohol-free beverages.

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 Foul

Ferlatum preparation. It contains iron protein succinylate, in the form of a solution. The color of the liquid is brown and 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 bottle. Available in packs of 10 or 20 bottles. Each of them contains 40 mg of iron.

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

Ferlatum-Fol is a medicinal solution with a cherry scent. The bottle contains 40 mg of iron and 0.235 mg of folinate. Taking the drug is designed to cover the lack of iron and folate in the body.

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

Ferrum-Lect

Ferrum-Lect. This medication contains ferric polymaltose complex. Forms of medicinal product release:

• 30 chewable tablets, 100 mg.
• 100 ml of syrup. 5 ml of the drug contains 50 mg of iron.
• Solution for injection, available in 2 ml ampoules. Each ampoule contains 100 mg of iron.

The tablet is washed down with water or chewed during administration. If necessary, it is divided into several parts. In the form of a syrup, the drug is allowed to be washed down 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 using an injection solution, the needle must be inserted deep into the muscle. The procedure is carried out exclusively in a hospital setting. Injections are indicated only in severe anemia, when oral administration of iron preparations is impossible or does not give an effect. Do not combine injections of iron preparations with their ingestion.

Venofer

Venofer is a drug that is intended for injection. It contains ferric 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 digestive system.

Ferrous iron preparations

Fenuls is a preparation that, in addition to ferrous iron, contains vitamin C and B vitamins. The use of such a complex allows you to improve 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 intestinal and stomach walls.

Ferro-foil is a 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

Totema is 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 over 3 months old. After its use, darkening of the tooth enamel is possible, therefore it is recommended to dissolve the contents of the ampoule in any drink. After taking the drug, you should brush your teeth.

Gyno-Tardiferon. This drug is widely known among women in position. It contains bivalent iron in the amount of 40 mg, as well as folic acid. Gino-Tardiferon is produced in tablet form. It is approved for the treatment of anemia in children over seven years of age. In addition to replenishing iron stores in the body, this drug also eliminates folate deficiency. This is especially true for expectant mothers. The drug should be taken with water in large volumes.

Sorbifer durules is a ferrous iron preparation, 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 old. It is also often prescribed for pregnant women. Take the drug half an hour before meals, swallow the pill whole and wash it down with water. During the therapeutic course, care must be taken in driving transport, since Sorbifer durules affects concentration.

Aktiferrin is a preparation containing ferrous iron and D, L-serine.

The drug has several forms of release:

• In the form of capsules containing 34.5 mg iron and 129 mg 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, the 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.

Hemofer prolongatum is a preparation containing ferrous iron in the amount of 105 mg per capsule. It cannot 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 adjusted by the doctor. Take Hemofer prolongatum before or after meals, which depends on the individual characteristics of the human body.

Iron supplementation recommendations

• You can not deviate from the regimen for 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 his feces are colored dark. 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 donation, 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 a form of release that is convenient for the patient and make the therapy individually oriented. However, this does not mean that you can independently prescribe medications for yourself. Only a doctor should be involved in the selection of therapy, and only after the examination. Anemia is treated for a long time and the whole process should be under the supervision of a specialist.

Which 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 treating anemia is equivalent.

Taking ferrous iron supplements is associated with the following problems:

• The body can absorb these drugs in uncontrolled amounts, which can cause serious poisoning.
• The drugs are able to interact with food and other drugs.
• An unpleasant metal taste may appear in the mouth during treatment.
• The teeth and gums can become dark in color. Sometimes the staining is quite persistent.
• About 30-35% of patients discontinue therapy before completing the course.

Many problems can be avoided by using ferric iron preparations based on CHP.

Compared to their bivalent counterparts, they have the following advantages:

• There is no risk of overdose and body poisoning. The drugs are absolutely safe in this regard.
• Gums and teeth are not stained dark.
• The preparations taste good.
• They are well tolerated by patients.
• Most patients complete the course.
• Ferric iron preparations do not interact with other drugs and food products.
• In addition to saturating the body with iron, most of these drugs have an antioxidant effect.

Ferrous iron supplementation can cause constipation, abdominal pain, diarrhea, nausea and vomiting. As a result of these side effects, the person refuses treatment. In addition, the body is able to absorb excess iron, which sometimes leads to poisoning. Therefore, experts give preference to 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 administration of 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 impossible, or does not allow achieving the desired effect.

Indications for parenteral administration of iron preparations:

• Severe anemia. In modern practice, such a situation is rare, no more than 3% of all cases of the disease.
• Intolerance to iron preparations produced for oral administration.
• Oral drug resistance.
• Stomach and duodenal ulcers, previous operations on the organs of the digestive system. Moreover, even if peptic ulcer disease was already in the history, it will still be a contraindication to oral intake of iron supplements.
• 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. Also, parenteral iron preparations are prescribed for patients undergoing hemodialysis. This measure is aimed at preventing anemia.
• The inability to perform a transfusion of red blood cells.
• Acute 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 every 7 days. The dose should not exceed the total iron deficiency in the human body. To calculate the total iron deficiency, you should use the following formula:

Total iron deficiency in mg = Human weight in kg * (Norm of hemoglobin in g / l - patient's hemoglobin in g / l) + iron depot in mg.

Coefficient 0.24 = 0.0034 * 0.07 * 1000, where:

• The iron content in hemoglobin is equal to 0.34%;
• The volume of blood in the human body is 7% of his body weight.
• 1000 - 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 reserves of iron in the body, which make up more than 30% of all its 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 an 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:

The number of ampoules per course = total iron deficiency / 100 mg

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

• Burning, itching and flushing 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 a person needs. However, the body is capable of giving negative reactions even when treatment is carried out with a small amount of iron.

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

• Only modern medicines should be used that have minimal toxicity, do not give anaphylactic reactions and do not pose a threat to the patient's life.
• 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 prolonged.
• It is important to follow all the rules for parenteral administration of iron preparations.
• It is imperative to enter a trial dose before starting the main treatment.
• Treatment should be carried out with 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 beginning 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.
• Increase in the level of hemoglobin in the blood by day 28 by 10 g / l, and hematocrit by 3%.
• Symptoms of anemia should be completely stopped within 30-45 days from the start of treatment.
• Iron reserves in the depot should be replenished 3-6 months after the start of therapy. The specific timing of recovery depends on the severity of the anemia.

Why may treatment with iron supplements 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 not chosen correctly.
• The treatment lasted less than the prescribed period.
• The patient did not follow the doctor's recommendations.
• The patient has problems with the iron absorption phase.
• The person does not tolerate iron preparations.

If the diagnosis is beyond doubt, then the effect of taking ferric iron preparations will certainly come. Therefore, in the absence of a reticulocytic crisis and an increase in the level of hemoglobin in the blood, the diagnosis should be revised. 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 the failure of the treatment 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 administration of iron-containing drugs. Their parenteral administration gives only a partial effect. This type of anemia develops when the TMPRSS6 gene is mutated. This leads to the fact that the level of hepcidin rises in the body, which inhibits the absorption of iron in the intestine and prevents it from being released from macrophages. Until now, effective treatments for this rare type of anemia have not been found.

The author of the article: Shutov Maxim Evgenievich | Hematologist

Education: In 2013 he graduated from the Kursk State Medical University and received a diploma "General Medicine". After 2 years, completed residency in the specialty "Oncology". In 2016 completed postgraduate studies at the National Medical and Surgical Center named after N. I. Pirogov.