Ferrous fumarate (Ferretts) is an iron formulation that contains 33% of elemental iron. It is used in the treatment and prevention of iron deficiency anemia.
Ferrous fumarate Uses:
-
Iron-deficiency anemia:
- It is indicated for the treatment and prevention anemia due to iron deficiency.
Ferrous fumarate (Ferretts) Dose in Adults
Note:
- Doses given here are expressed in terms of elemental iron.
- Sustained-release or slow-release iron formulations should be avoided when treating iron-deficiency anemia because of poor absorption.
Ferrous fumarate (Ferretts) Dosage for Iron-deficiency Prevention in Areas Where Anemia Prevalence Exceeds 40%:
- Non-pregnant ladies who are menstruating:
- 30–60 mg taken orally once each day for three months in a row.
Ferrous fumarate (Ferretts) Dose in the therapy of Iron-deficiency anemia:
- 65-0 mg per day orally in one to three divided doses.
Note:
- It is important to note that alternate-day dosing may result in greater absorption.
- Patients who can adhere to alternate-day dosing may be advised of the drug on alternate days.
Ferrous fumarate (Ferretts) Dose in Children
Note:
- The amounts stated below are provided in elemental iron.
- Iron elements make up 33% of it.
Ferrous fumarate (Ferretts) Dose in the prevention of Iron deficiency anemia where prevalence exceeds 40%:
-
Children and infants under the age of two:
- 10-12.5 mg taken orally three times a year for three months straight.
-
Children aged two to five:
- 30 mg used orally three times a year for three months straight.
-
Children aged 5 to 12:
- 30 to 60 milligrams taken orally in a year for three months straight.
-
Adolescent menstruation girls (females with reproductive potential who are not pregnant):
- 30 to 60 milligrams taken orally in a year for three months straight.
Ferrous fumarate (Ferretts) Dose in the treatment of Iron deficiency:
-
Children and Adolescents:
- 3-6 mg per kg per day orally in 3 divided doses.
- The suggested maximum daily dose is 200 mg per day.
Pregnancy Risk Category: A
- The iron concentration in mild to moderate iron deficiency is maintained for the fetus. However, severe maternal iron deficiency may cause the iron concentration to drop.
- Anemia of maternal iron may lead to adverse outcomes such as low birth weight, preterm delivery, and higher perinatal mortality.
- Iron deficiency is anemia can be treated in women regardless of whether they are pregnant.
- However, oral iron replacement may not be sufficient for patients suffering from gastrointestinal disorders such as malabsorption, or those suffering from severe iron deficiency, who require a rapid rise in hemoglobin, intravenous iron (or iron sucrose) may also be administered.
- Multiple pregnancy studies have shown that ferrous fumarate is safe and effective. However, enteric-coated and slow-release formulations of ferrous fumarate should be avoided.
Ferrous fumarate use during breastfeeding:
- Human breast milk contains iron. Breastfeeding can increase maternal iron needs.
- Normally, iron levels in breast milk are maintained for lactating mothers with mild to moderate iron deficiencies. However, severe iron deficiency may cause breast milk concentrations to drop.
- According to the WHO, iron salts are compatible with breastfeeding.
- The WHO recommends that postpartum women supplement with iron (with or not folic acid), for six to twelve weeks regardless of whether they are breastfeeding.
Dose in renal disease:
No dosage adjustment was mentioned in patients with kidney disease.
Dose in liver disease:
No dosage adjustment was mentioned in patients with liver disease.
Side Effects of Ferrous fumarate (Ferretts):
-
Gastrointestinal:
- Constipation
- Darkening of stools
- Nausea
- Stomach cramps
- Vomiting
Less Common Side Effects of Ferrous fumarate (Ferretts):
-
Gastrointestinal:
- Dental discoloration
- Diarrhea
- Heartburn
-
Genitourinary:
- Urine discoloration
Contraindications to Ferrous fumarate (Ferretts):
- Allergy reactions to iron salts and any component of the formulation
- Hemochromatosis
- Hemolytic anemia
Warnings and precautions
-
Gastrointestinal Disease:
- Iron salts should be avoided by patients with ulcerative colitis, enteritis, peptic ulcer disease and/or enteritis.
Ferrous fumarate: Drug Interaction
Note: Drug Interaction Categories:
- Risk Factor C: Monitor When Using Combination
- Risk Factor D: Consider Treatment Modification
- Risk Factor X: Avoid Concomitant Use
Risk Factor C (Monitor therapy) |
|
| Proton Pump Inhibitors | May decrease the absorption of Iron Salts. |
| Histamine H2 Receptor Antagonists | May decrease the absorption of Iron Salts. |
Risk Factor D (Consider therapy modification) |
|
| Alpha-Lipoic Acid | Alpha-Lipoic Acid absorption may be reduced by iron salts. Iron salts may not be absorbed as well when alpha-lipoic acid is present. |
| Antacids | Iron salts' ability to absorb water may be reduced. |
| Bictegravir | The serum concentration of bictegravir may be reduced by iron salts. Treatment: Under fed conditions, bictegravir, emtricitabine, and tenofovir alafenamide can be provided with iron salts; however, it is not advised to do so when fasting or for two hours following. |
| Bisphosphonate Derivatives | The serum concentration of bisphosphonate derivatives may be reduced by polyvalent cation-containing products. Treatment: It is best to delay taking oral drugs containing polyvalent cations for at least 2 hours before or after taking tiludronate, clodronate, or etidronate, 60 minutes after taking oral ibandronate, or 30 minutes after taking alendronate or risedronate. The exceptions are pazodronate and zoledronic acid. |
| Cefdinir | Iron salts may lower the level of cefdinir in the blood. The development of an insoluble iron-cefdinir complex can also result in the development of red-looking, non-bloody feces. Management: When feasible, avoid taking oral iron and cefdinir at the same time. Several hours between doses may help reduce interaction. Cefdinir does not appear to interact with newborn formulae that include iron. |
| Deferiprone | Items containing polyvalent cations may lower the level of deferiprone in the serum. Treatment: Provide deferiprone at least four hours apart from oral drugs or dietary supplements containing polyvalent cations. |
| Dolutegravir | Dolutegravir serum levels may be lowered by iron salts. Administration of dolutegravir should occur at least two hours before or six hours after oral iron. Give dolutegravir/rilpivirine at least 4 hours prior to or 6 hours following oral iron salts. Instead, you might take dolutegravir and oral iron with meals. |
| Eltrombopag | Eltrombopag's serum concentration may drop if you take products that include polyvalent cations. Treatment: Provide eltrombopag 4 hours after oral administration of any product containing polyvalent cations, but at least 2 hours before. |
| Entacapone | The serum level of Entacapone may drop if you take iron salts. To lessen the effects of this interaction, think about spacing out the dosages of each drug by at least two hours. If dosages cannot be separated, keep an eye out for any diminished therapeutic benefits of levodopa while receiving concurrent medication. |
| Ferric Hydroxide Polymaltose Complex | may lower the level of iron salts in the serum. Particularly, there may be a decrease in the absorption of oral iron salts. Management: Avoid combining additional oral iron salts with intravenous (IV) ferric hydroxide polymaltose complex. One week following the final dosage of an IV ferric hydroxide polymaltose complex, oral iron salt therapy should start. |
| Iron Isomaltoside | may lower the level of iron salts in the serum. Particularly, oral iron salt absorption may be diminished. Management: Avoid combining other oral iron salts with intravenous (IV) iron isomaltoside. Five days following the final IV dosage of iron isomaltoside, the patient should start oral iron salt therapy. |
| Levodopa | Levodopa serum levels may be reduced by iron salts. only applies to iron formulations used orally. To reduce the effects of this interaction, think about giving the drugs two or more hours apart. During concurrent therapy, keep an eye out for any diminished therapeutic benefits of levodopa, especially if doses cannot be separated. |
| Levothyroxine | Levothyroxine's serum levels may drop if you take iron salts. Treatment: Provide levothyroxine and iron salts at least 4 hours apart when taking them orally. Levothyroxine or iron salts given parenterally don't require dosage separation. |
| Methyldopa | Methyldopa serum levels may be reduced by iron salts. |
| PenicillAMINE | Items containing polyvalent cations may lower the level of penicillAMINE in the serum. Treatment: Provide oral medications containing polyvalent cations and penicillamine at least an hour apart. |
| Phosphate Supplements | Iron salts may make it harder for phosphate supplements to be absorbed. To lessen the impact of this interaction, administer oral phosphate supplements as widely apart as you can from the administration of an oral iron salt. Exceptions: Pentahydrate of sodium glycerophosphate. |
| Quinolones | Quinolones' serum concentration may be lowered by iron salts. Treatment: Give oral quinolones at least a few hours before (four hours for moxi- and sparfloxacin, two hours for others) or after (eight hours for moxi-, six hours for cipro/dela-, four hours for lome-, three hours for gemi-, and two hours for levo-, nor-, oflox-, pefloxacin, or nalidixic acid) taking oral iron salts. Exception (Oral Inhalation). |
| Tetracyclines | could make it harder for iron salts to be absorbed. Tetracyclines' serum levels may drop if you take iron salts. Eravacycline is an exception. |
| Trientine | Substances with polyvalent cations may cause the blood level of trientine to decrease. Management: Avoid using trientine together with any oral drugs that include polyvalent cations. If you must take oral iron supplements, give yourself two hours between doses. If required, separate the delivery of additional oral polyvalent cations by an hour. |
Risk Factor X (Avoid combination) |
|
| BaloxavirMarboxil | Polyvalent Cation Containing Products may decrease the serum concentration of BaloxavirMarboxil. |
| Dimercaprol | May enhance the nephrotoxic effect of Iron Salts. |
Monitoring parameters:
Iron-deficiency anemia:
- Hemoglobin and hematocrit
- May also need to monitor RBC count, RBC indices, transferrin saturation, serum ferritin, total iron-binding capacity, serum iron concentration, and erythrocyte protoporphyrin concentration in some cases.
Cancer and chemotherapy-induced anemia:
- Serum iron,
- total iron-binding capacity,
- transferrin saturation,
- ferritin levels at baseline and periodically thereafter.
CKD-associated anemia in patients who are not on dialysis:
- Monitor the response to iron therapy by measuring Hemoglobin, serum ferritin, and transferrin saturation.
How to administer Ferrous fumarate (Ferretts)?
It needs to be consumed with water or juice first thing in the morning.
Mechanism of action of Ferrous fumarate (Ferretts):
- Iron is essential for oxygen transport and is an important component of hemoglobin.
- It can also be found in enzymes and muscles (myoglobin).
The beginning of action:
- After receiving iron salts or oral parenterally, it takes approximately 3-10 days to see a hemologic response.
Peak effect:
- In 5-10 days, you can see reticulocytosis. A rise in hemoglobin could be observed in 2-4 weeks.
Absorption:
- It is absorbed by the duodenum, upper part of the jejunum and the spleen. Food and achlorhydria decrease absorption.
- 10% of the drug can be absorbed normaly, but iron-deficient patients absorb 20% to 30% more.
Protein binding:
- It binds to serum transferrin
Excretion:
- It is excreted in the urine, sweat, sloughing of intestinal mucosal cells, and during menstruation.
International Brand Names of Ferrous fumarate:
- Ferretts
- Ferrimin 150
- Hemocyte
- Anschlarin
- Ercofer
- Femarate
- Feroson
- Ferrate
- Ferraton
- FerroTab
- Ferrobet
- Ferrokapsul
- Ferroklinge
- Ferronat
- Ferronil
- FerroTab
- Ferrum Hausmann
- Fersaday
- Ferumat
- Ferval
- Fumafer
- Fumiron
- Galfer
- Heferol
- Hema F
- Hierro
- Neo-Fer
- Rulofer N
Ferrous fumarate Brand Names in Pakistan:
Ferrous Fumarate Tablets 150 mg |
|
| Ferall | Nimrall Laboratories |
| Figaro | Fassgen Pharmaceuticals |
| Olifol | Olive Laboratories |
Ferrous Fumarate Tablets 200 mg |
|
| Ferovis | Global Pharmaceuticals |
