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Oral iron.

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VOL: 102, ISSUE: 26, PAGE NO: 40

Generic and proprietary names

- Ferrous sulphate: Ironorm drops.

- Ferrous fumarate: Fersaday, Fersamal, Galfer.

- Ferrous gluconate.

- Polysaccharide-iron complex: Niferex.

- Sodium feredetate: Sytron.

- Iron and folic acid: Fefol, Ferrograd Folic, Galfer FA, Lexpec with iron-M, Pregaday.

- Compound iron preparations are available. However, the BNF advises that there is no justification for prescribing compound iron preparations, except for preparations of iron and folic acid for prophylactic use in pregnancy.

- Modified-release preparations of iron are available but the BNF advises that these have no therapeutic advantage and should not be used.

Action

- Replaces iron stores needed for the development of red blood cells (erythrocytes).

Classification

- Nutrition and blood.

- Iron-deficiency anaemias.

Indications

- Iron-deficiency anaemia.

- Prophylaxis in: malabsorption; menorrhagia; pregnancy; after subtotal or total gastrectomy; haemodialysis patients; and the management of low birthweight infants such as preterm neonates.

Cautions

- Pregnancy.

- Any serious underlying cause for anaemia, such as gastric erosion or gastrointestinal cancer, should be excluded before starting treatment.

- Intestinal strictures and diverticular disease.

Common side-effects

- Gastrointestinal irritation.

- Nausea and epigastric pain.

- Constipation or diarrhoea.

Rare side-effects

- Constipation leading to faecal impaction in older patients.

Interactions

- Avoid concomitant use of iron with dimercaprol.

- Iron can reduce the absorption of several other drugs; the BNF should be consulted.

Administration

- Tablets.

- Capsules.

- Syrup.

Nursing considerations

- There is only a marginal difference between one ferrous salt and another in efficiency of absorption of iron. Therefore choice of preparation is normally decided by incidence of side-effects and cost.

- Iron and folic acid preparations are used during pregnancy in women who are at high risk of developing iron and folic acid deficiency. These preparations should be distinguished from those used for the prevention of neural tube defects in women planning a pregnancy.

- If side-effects occur the dose may be reduced or a different iron salt used. However, any improvement may simply be the result of a lower content of elemental iron.

Patient teaching

- Although iron preparations are best absorbed on an empty stomach, they may be taken after food to reduce gastrointestinal side-effects.

- Advise patients that they may experience discoloured stools.

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines

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