1. Introduction
Ferrous fumarate is an iron supplement used to prevent and treat iron deficiency anaemia. It works by replenishing iron stores in the body, which are essential for haemoglobin production and oxygen transport. It is commonly used in conditions such as pregnancy, chronic blood loss, and malnutrition.
2. Indications
- Approved Indications:
- Treatment of iron deficiency anaemia.
- Prevention of iron deficiency in high-risk individuals (e.g., pregnant women).
- Off-Label Uses:
- Iron supplementation in malabsorptive conditions (e.g., after bariatric surgery).
3. Dosage
- Adults:
- Treatment of iron deficiency anaemia: 210 mg (containing 68 mg elemental iron) 1–3 times daily, depending on severity.
- Prevention: 210 mg once daily.
- Pregnant Women:
- 210 mg once or twice daily.
- Children (≥12 years):
- 210 mg once or twice daily.
4. Administration
- Take orally, preferably on an empty stomach (1 hour before or 2 hours after meals) for better absorption.
- If gastrointestinal upset occurs, it can be taken with food, although this may reduce absorption.
- Avoid taking with tea, coffee, dairy products, or antacids, as these can interfere with iron absorption.
5. Forms Available
- Tablets: 210 mg (containing 68 mg elemental iron).
- Capsules: Various formulations.
- Syrup or oral solution: 140 mg/5 mL.
6. Side Effects
6.1. Common Side Effects
- Nausea.
- Constipation.
- Diarrhoea.
- Dark-coloured stools.
6.2. Less Common Side Effects
- Abdominal discomfort.
- Metallic taste.
6.3. Rare but Serious Side Effects
- Allergic reactions (e.g., rash, swelling).
- Severe gastrointestinal irritation or ulceration.
7. Warnings
- Iron Overload: Avoid excessive use in patients with conditions like haemochromatosis or thalassaemia.
- Gastrointestinal Bleeding: Use cautiously in patients with a history of peptic ulcers or gastrointestinal inflammation.
8. Precautions
- Use cautiously in patients with existing gastrointestinal disorders (e.g., Crohn’s disease, ulcerative colitis).
- Store out of reach of children, as accidental overdose can be fatal in young children.
9. Interactions
- Drug-Drug Interactions:
- Antacids and proton pump inhibitors (e.g., omeprazole): Reduce iron absorption.
- Tetracyclines and fluoroquinolones (e.g., ciprofloxacin): Reduced efficacy of both drugs.
- Levothyroxine: Reduced absorption of levothyroxine. Separate doses by at least 4 hours.
- Drug-Food Interactions:
- Avoid tea, coffee, milk, and calcium-containing foods during administration, as they reduce iron absorption.
10. Monitoring Parameters
- Haemoglobin and haematocrit levels to assess response to therapy.
- Serum ferritin and transferrin saturation to monitor iron stores.
- Monitor for signs of gastrointestinal side effects or intolerance.
11. Use in Children
- Not typically recommended for children under 12 years due to high elemental iron content in standard doses. Specific paediatric formulations should be used instead.
12. Use in Pregnancy
- Category A: Safe and widely used during pregnancy for preventing and treating iron deficiency anaemia.
13. Use in Elderly
- Safe for use in elderly patients, but monitor closely for gastrointestinal side effects such as constipation.
14. Use in Kidney Disease
- Use with caution in patients with chronic kidney disease on dialysis or receiving erythropoiesis-stimulating agents, as they may require intravenous iron instead.
15. Use in Liver Disease
- Use cautiously in patients with liver conditions or iron overload syndromes, as excessive iron can worsen liver function.
16. Patient Counselling Points
- Take ferrous fumarate exactly as prescribed, ideally on an empty stomach, unless it causes stomach upset.
- Expect dark-coloured stools as a normal side effect.
- Increase fluid and fibre intake to prevent constipation.
- Avoid taking with tea, coffee, or calcium-rich foods to ensure optimal absorption.
- Report any severe abdominal pain, vomiting, or signs of an allergic reaction to your doctor immediately.
17. Table of Brand Names, Manufacturers, and Prices
Brand Name | Manufacturer | Price (USD) |
---|---|---|
Ferrograd Fumarate | Teva | $10–20 (30 tablets, 210 mg) |
Ferrous Fumarate Tablets | Various | $5–15 (30 tablets, 210 mg) |
Ferrous Fumarate Syrup | Various | $8–15 (200 mL, 140 mg/5 mL) |
18. FAQs (15 Questions)
- What is ferrous fumarate used for?
It is used to treat and prevent iron deficiency anaemia. - How does ferrous fumarate work?
It replenishes iron stores needed for haemoglobin production and oxygen transport in the blood. - Can ferrous fumarate cause black stools?
Yes, dark-coloured stools are a common and harmless side effect. - How should ferrous fumarate be taken?
Take it on an empty stomach for better absorption, or with food if it causes stomach upset. - Is ferrous fumarate safe during pregnancy?
Yes, it is commonly used to prevent and treat anaemia in pregnant women. - Can I take ferrous fumarate with milk?
No, calcium in milk can reduce the absorption of iron. Avoid taking it with dairy products. - What are the common side effects of ferrous fumarate?
Nausea, constipation, diarrhoea, and abdominal discomfort are common side effects. - Can ferrous fumarate cause constipation?
Yes, constipation is a common side effect. Increasing fluid and fibre intake can help. - How long should I take ferrous fumarate?
Treatment usually lasts 3–6 months or until iron stores are replenished. Follow your doctor’s advice. - What should I do if I miss a dose?
Take it as soon as you remember, but skip it if it’s close to the next dose. Do not double the dose. - Can children take ferrous fumarate?
It is not typically recommended for children under 12 years. Paediatric formulations should be used. - Can I take ferrous fumarate with other medications?
Some medications, like antacids or antibiotics, can interfere with iron absorption. Space doses apart. - Can ferrous fumarate cause allergic reactions?
Rarely, it can cause rash, itching, or swelling. Seek immediate medical attention if this occurs. - How should ferrous fumarate be stored?
Store at room temperature, away from moisture and heat. Keep out of reach of children. - Can I stop taking ferrous fumarate once my symptoms improve?
No, continue the treatment as prescribed to fully replenish iron stores.