Iron is one of the most important trace elements and is involved in many fundamental internal processes. The key functions of iron are reduced to binding oxygen with its subsequent delivery to tissues and internal organs... In addition, iron is involved in the basic processes of blood formation.

V human body the item in question comes with food. Responsible for assimilation duodenum... During some life periods, the human body begins to require a higher amount of iron, for example, during pregnancy, active growth, etc. And if it is not enough, anemia may develop.

After reading the information below, you will find out which iron-containing drugs are indicated for use in the presence of anemia and consider the features of their use.

Attention! Further information is provided strictly for informational purposes. Uncontrolled self-medication is unacceptable and is fraught with adverse complications.

The basis substitution therapy iron deficiency in treatment iron deficiency anemia are iron preparations. Currently, two groups of iron preparations are used - containing ferrous and ferric iron. Due to the fact that iron from most modern iron-containing preparations is well absorbed in the intestine, in the vast majority of cases it is possible to use drugs iron inside. Parenteral iron supplements are prescribed only for special indications.

From dosage form not more than 10-12% of the iron contained in it is absorbed. With a severe degree of iron deficiency, the rate of iron absorption can increase up to three times.

The increase in the bioavailability of iron is facilitated by the presence of ascorbic and succinic acid, fructose, cysteine and other accelerators.

The main indication for iron supplementation is iron deficiency anemia. In such conditions, first of all, actions are taken to eliminate the causes that led to the onset of the disease. After that, the main focus is on recovery normal concentration gland.

Oral preparations

Available in pill and capsule form.

Features of use

The specific dosage of iron is calculated by the doctor. Average daily dose it is recommended to maintain at the level of 2 mg of iron for each kilogram of the patient's weight. The drugs are taken with food - this is how their maximum effective effect is ensured.

Monitoring the effectiveness of therapy is an essential component of the rational use of iron-containing drugs. In the first days of treatment, an assessment of subjective sensations is carried out, on the 5-8th day, it is necessary to determine the reticulocytic crisis (a 2-10-fold increase in the number of reticulocytes compared to the initial value). At the 3rd week, the increase in hemoglobin and the number of erythrocytes is assessed. The absence of a reticulocytic crisis indicates either an erroneous prescription of the drug, or the appointment of an inadequately small dose.

Normalization of hemoglobin levels usually occurs by the end of the first month of treatment (with adequate doses of drugs). However, in order to saturate the depot, it is recommended to use a half dose of iron-containing preparations for another 4-8 weeks.

Among the possible negative side effects taking tableted and encapsulated iron-containing preparations, the following provisions can be noted:

dyspeptic disorders (anorexia, metallic taste in the mouth, a feeling of fullness in the stomach, pressure in the epigastrium, nausea, vomiting);
constipation, sometimes diarrhea;
brownish staining of tooth enamel;
dark staining of the stool.

At parenteral administration iron preparations, reactions may occur:

local - phlebitis, venous spasm, darkening of the skin at the injection site, post-injection abscesses;
general - hypotension, chest pain, paresthesia, muscle pain, arthralgia, fever;
in case of an overdose, iron oversaturation with the development of hemosiderosis is possible.

Review of popular remedies

For greater ease of perception, information on popular iron-containing tablets and capsules is presented in the form of a table.

Table. Popular iron supplements

List of drugs	Basic information
	It is made on the basis of ferrous sulfate. Sold in pill form.
	It is characterized by prolonged action. In addition to ferrous iron, the drug includes ascorbic acid and mucoproteose. The concentration of iron in one tablet is 80 mg.
	At the heart of this tool- ferrous gluconate. Each tablet contains 35 mg of ferrous iron.
	Each tablet contains 100 mg of ferrous iron.
	Fumaric acid capsules. Each capsule contains 100 mg of the required substance.
	Refers to the number of combined action drugs. In addition to iron, it contains fructose, potassium sorbate and various vitamins.
	Iron supplement with additional inclusion of thiamine, yeast, fructose, ascorbic acid and others useful components... Each capsule contains 45 mg of 2-valent iron.

Iron preparations for parenteral use

These are administered by injection.

Features of use

Appointed in the presence of the following points:

presence of intestinal pathology with malabsorption (severe enteritis, malabsorption syndrome, resection small intestine and etc.);
absolute intolerance to iron preparations when taken orally (nausea, vomiting) even when taking drugs different groups preventing further treatment;
the need for rapid saturation of the body with iron, for example, when surgical interventions are planned for patients with iron deficiency anemia;
treatment of patients with erythropoietin, in which the limiting factor of effectiveness is an insufficient amount of reserves and circulating iron.

The expediency and necessity of iron administration by means of injections in each specific case is determined by the attending physician. Maximum allowable daily dosage iron in the format of an injection - 100 mg.

Before starting therapy, it is important to exclude the presence of contraindications. With insufficient preparation, this kind of injections can provoke a whole range of various complications, namely:

heavy allergic reactions;
the formation of infiltrates and abscesses;
the occurrence of phlebitis;
iron overdose.

Review of popular remedies

List of popular parenteral drugs is given in the table.

Table. Popular parenteral iron supplements

Drugs	Basic information
	The basis of this agent is represented by trivalent iron-hydroxide sucrose complexes. Sold in 5 ml ampoules. Introduced intravenously. Each such ampoule contains 100 mg of iron.
	Preparation for intramuscular injection... Sold in 2mm ampoules. Each such ampoule contains iron in an amount similar to that described above.
	Effective iron sorbitol complex. Introduced intramuscularly. Each milliliter of the drug contains 50 mg of ferrous iron.
	This product is based on a sodium-iron gluconate complex. It is administered intramuscularly or intravenously.
	The composition of this product is represented by a carbohydrate solution, iron sucrose and cobalt gluconate. The drug is designed for intravenous administration. Each milliliter of the product contains 20 mg of ferrous iron.
	A preparation with a base in the form of iron hydroxide. Introduced intramuscularly. For every 2 ml of the drug, there is 100 mg of iron.

Features of the use of iron-containing drugs by pregnant patients

Anemia is a common complication of pregnancy. The procedure for using iron-containing products during this life span does not differ much from the treatment program under normal conditions.

Often, iron is prescribed to pregnant women for prophylaxis. Dosages in this case are determined, first of all, by indicators of the content of hemoglobin, as well as the time of diagnosis of the disease, i.e. before or during pregnancy, or the absence of a problem as such.

If a woman does not have a tendency to iron deficiency anemia, during the third trimester, she will be recommended to take combination drugs with a relatively low iron content (30-50 mg), including vitamins, including folic acid and vitamin B 12. If there is a tendency to disease, the therapy is carried out for 12-15, as well as 21-25 weeks. In the event of anemia, the treatment will hardly differ from that in situations with ordinary patients. The required dosage of drugs under any circumstances is selected by the doctor on an individual basis.

Catad_tema Iron deficiency anemia - articles

Carboxymaltose iron (Ferinject) - a new intravenous drug for the treatment of iron deficiency anemia

S.V. Moiseev
Department of Therapy and Occupational Diseases First MGMU them. I.M.Sechenov, Department of Internal Medicine of the Faculty fundamental medicine Moscow State University M.V. Lomonosov

Is being discussed new drug for intravenous administration- iron carboxymaltose, which quickly restores iron deficiency, does not induce hypersensitivity reactions characteristic of preparations containing dextran, and provides a slow release of iron, which reduces the risk toxic effects.

Keywords. Iron deficiency anemia, treatment, iron carboxymaltose, intravenous.

ANEMIA is one of the global problems modern healthcare. According to WHO experts, about 1.6 billion people, or 24.8% of the total population, suffer from anemia in the world. The incidence of anemia was high in all groups and amounted to 25.4-47.4% in preschool and school age, 41.8% in pregnant women, 30.2% in non-pregnant women reproductive age, 23.9% in the elderly and 12.7% in men. Although among the adult population, anemia most often developed during pregnancy, nevertheless, in the population, the majority of patients with anemia were non-pregnant women of reproductive age (468 million people). By at least in half of cases, iron deficiency is the cause of anemia, which can be a consequence of chronic blood loss(menstruation and other reasons), insufficient intake of iron from food (for example, with chronic alcoholism), increased need (for children and adolescence, pregnancy, postpartum period), malabsorption. Iron deficiency is not only absolute, but also functional. The latter occurs when an adequate or even increased total iron content in the body is insufficient with an increase in the need for bone marrow against the background of stimulation of erythropoiesis. An important role in the regulation of iron metabolism is played by hepcidin, a hormone that is formed in the liver, interacts with ferroportin (a protein that transports iron) and inhibits the absorption of iron in the intestine, as well as its release from depots and macrophages. Increased hepcidin levels associated with inflammation are considered the main cause of anemia chronic diseases... In addition, hepcidin levels increase in chronic kidney disease and contribute to the development of nephrogenic anemia and resistance to erythropoiesis stimulants. With the enhancement of erythropoiesis under the action of erythroepoietin, the rate of iron mobilization from the depot becomes insufficient to meet the increased requirements of the bone marrow. Proliferating erythroblasts require an increasing amount of iron, which leads to depletion of the labile iron pool and a decrease in serum ferritin levels. It takes a certain amount of time to mobilize and dissolve iron from hemosiderin. As a result, the amount of people entering the Bone marrow iron, which leads to the development of its functional deficiency.

Regardless of the cause of iron deficiency anemia, the main method of its treatment is the elimination of absolute or functional iron deficiency. For this purpose, iron preparations are used, which can be administered orally or intravenously. Although oral drugs are more convenient than parenteral drugs, they are slow acting, ineffective in malabsorption syndrome, and often cause adverse reactions from the side gastrointestinal tract(10-40% of patients) who reduce adherence to treatment. Accordingly, intravenous administration of iron preparations is justified in cases where it is necessary to quickly achieve an effect (for example, with more severe anemia, especially in patients suffering from cardiovascular diseases or undergoing chemotherapy), poor tolerance drugs for oral administration or their ineffectiveness (malabsorption syndrome, chronic iron loss, exceeding the rate of its replacement, etc.). In addition, intravenous iron administration is considered the method of choice for treatment with drugs that stimulate erythropoiesis in patients with chronic illness kidney disease (CKD), inflammatory bowel disease, malignant tumors.

Some iron supplements can be administered intramuscularly, however intramuscular injections painful, discolored, and associated with the development of sarcoma gluteus muscle... According to some authors, intramuscular administration of iron preparations should be abandoned.

Carboxymaltose iron (Ferinject®) is a new intravenous iron preparation (Fig. 1). It allows you to quickly replenish iron deficiency, rarely causes hypersensitivity reactions characteristic of drugs that contain dextran, and provides a slow release of iron, which reduces the risk of toxic effects.

Fig. 1. The structure of iron carboxymaltose

Iron preparations for intravenous administration

For intravenous administration in Russia, iron carboxymaltose (Ferinject®), iron saccharate (Venofer), iron gluconate (Ferrlecite) and iron dextran (CosmoFer) are used, which are spherical iron-carbohydrate colloids. The carbohydrate shell gives the complex stability, slows down the release of iron and maintains the formed forms in a colloidal suspension. Efficiency and safety intravenous drugs iron depend on their molecular weight, stability and composition. Complexes with low molecular weight, such as iron gluconate, are less stable and more rapidly release iron into plasma, which in free form can catalyze the formation of reactive oxygen species that cause lipid peroxidation and tissue damage. A significant portion of the dose similar drugs excreted through the kidneys in the first 4 hours after taking the drug and is not used for erythropoiesis. Although iron dextran preparations have high molecular weight and stability, their disadvantage is increased risk allergic reactions. Ferrous carboxymaltose combines the positive properties of high molecular weight iron complexes, but does not cause hypersensitivity reactions observed with the use of preparations containing dextran (Fig. 2), and, unlike saccharate and ferrous gluconate, can be administered at a higher dose.

Rice. 2. The risk of toxic effects and anaphylactic reactions with the use of intravenous iron preparations

The use of iron carboxymaltose allows the administration of up to 1000 mg of iron in one infusion (intravenously infusion over 15 minutes), while maximum dose iron in the form of saccharate is 500 mg and is administered over 3.5 hours, and the duration of the iron dextran infusion reaches 6 hours. Moreover, in the last two cases, a test dose of the drug must be administered before starting the infusion. The administration of a large dose of iron can reduce the required number of infusions and the cost of treatment. In addition to ease of use, important properties of iron carboxymaltose are low toxicity and the absence of oxidative stress, which are determined by the slow and physiological release of iron from a stable complex with a carbohydrate, which is structurally similar to ferritin.

Ferinject® is administered intravenously as a bolus (maximum dose of 4 ml, or 200 mg of iron, no more than three times a week) or drip (maximum dose of 20 ml, or 1000 mg of iron, no more than once a week). Before starting treatment, the optimal cumulative dose of the drug should be calculated, which should not be exceeded. The cumulative dose required to restore the level of hemoglobin in the blood and replenish iron stores in the body is calculated using the Ganzoni formula:
Cumulative iron deficiency (mg) = body weight [kg] x (target Hb - actual Hb) [g / dl] x 2.4 + deposited iron [mg], where the target hemoglobin (Hb) level in a person with body weight<35 и?35 кг = 13 г/дл (8,1 ммоль/л) и 15 г/дл (9,3 ммоль/л), соответственно, депо железа у человека с массой тела <35 кг и?35 кг = 15 мг/кг и 500 мг. Для перевода уровня гемоглобина из ммоль/л в г/дл показатель следует умножить на 1,61145.

Ferrokinetics of iron carboxymaltose was studied using positron emission tomography to assess the distribution of iron after administration of the drug at a dose of 100 mg. It has been shown that the drug is rapidly distributed to the liver and spleen, and then mainly enters the bone marrow. In all patients, the level of iron utilization by erythrocytes increased rapidly within 6-9 days, and then continued to increase more slowly. After 2-3 weeks, the degree of iron utilization was 91-99% in patients with iron deficiency anemia and 61-84% in patients with functional iron deficiency.

Clinical researches

R. Moore et al. conducted a meta-analysis of 14 randomized clinical trials in which 2348 patients received iron carboxymaltose at a dose of up to 1000 mg per week for various indications (nephrogenic anemia, anemia in obstetric and gynecological conditions, diseases of the gastrointestinal tract, etc.). Patients in the comparison groups were prescribed oral iron preparations (n = 832), placebo (n = 762), or intravenous iron sucrose (n = 384). The duration of treatment ranged from 1 to 24 weeks. Compared to oral drugs, intravenous iron carboxymaltose resulted in greater increases in mean levels of hemoglobin (mean difference between groups 0.48 g / dL), ferritin (difference 163 μg / L) and transferrin saturation (difference 5.3%). With the intravenous drug, it was more often possible to achieve the increase in the hemoglobin level and the target hemoglobin level provided for by the protocol. In the iron carboxymaltose group, a significant decrease in the incidence of gastrointestinal disorders (13% and 32%, respectively), including constipation (3% and 13%), nausea / vomiting (3% and 10%) and diarrhea (2% and 5%). Overall, the results of the meta-analysis confirmed the higher efficacy and improved tolerability of iron carboxymaltose compared with oral iron preparations.
Iron carboxymaltose can be used for any iron deficiency anemia, when intravenous iron administration is justified for one reason or another. The most important indications for its appointment are considered anemia in inflammatory bowel diseases and chronic heart failure, nephrogenic anemia, anemia caused by anticancer chemotherapy, since in such cases intravenous iron preparations have advantages over oral ones.

Anemia in Inflammatory Bowel Disease

Anemia is common in patients with inflammatory bowel disease (Crohn's disease and ulcerative colitis) and is most often due to iron deficiency (up to 90% of cases), although chronic anemia is also common. Decreased serum ferritin levels are criteria for diagnosing iron deficiency in patients with inflammatory bowel disease.<30 мкг/л (у пациентов с высокой воспалительной активностью <100 мкг/л) и степени насыщения трансферрина <16% . У пациентов с уровнем ферритина >100 μg / L and inflammatory activity, a decrease in hemoglobin is probably associated with anemia of chronic diseases. Iron deficiency can be caused by chronic blood loss from ulceration of the mucous membrane, insufficient absorption of iron from damage to the duodenum and jejunum, or low iron intake. In patients with inflammatory diseases intestinal iron preparations are preferably administered intravenously, since their oral administration often does not allow to compensate for ongoing blood loss. In addition, most of the ingested iron is not absorbed and can cause local oxidative stress, an increase in inflammatory bowel changes and, accordingly, an increase in the symptoms of the disease. Intravenous drugs give a faster and more pronounced effect, are better tolerated and improve the quality of life to a greater extent. Severe anemia (hemoglobin level<10 г/дл), плохую переносимость или неэффективность пероральных препаратов железа, высокую активность основного заболевания, лечение эритроэпоэтином или желание пациента .

In a multicenter, randomized, controlled trial, the efficacy of iron carboxymaltose was studied in 200 patients with iron deficiency anemia associated with inflammatory bowel disease. The drug was administered at a dose of 1000 mg of iron once a week. Patients in the comparison group received iron sulfate orally at a dose of 100 mg twice a day. At 12 weeks, the mean hemoglobin concentration was similar in the two groups, but patients responded faster to intravenous iron supplementation. So, after 2 weeks, the proportion of patients in whom the hemoglobin level increased by at least 2 g / dl was significantly higher in the main group than in the comparison group (p = 0.0051). Similar results were obtained after 4 weeks (p = 0.0346). In addition, intravenous administration of iron supplementation made it possible to replenish iron stores much faster. Already after 2 weeks, the average serum ferritin level in the study group increased from 5.0 to 323.5 μg / L. Although it later decreased, with iron sulfate treatment, only a moderate increase in ferritin levels was noted from 6.5 to 28.5 μg / L after 12 weeks. In the iron carboxymaltose group, the proportion of patients whose ferritin level increased to the target value (100-800 μg / L) was higher at all visits than in the comparison group. The overall incidence of adverse events was comparable in the two groups, however, due to adverse reactions, treatment with iron carboxymaltose was discontinued less frequently than oral medication (1.5% and 7.9%, respectively). In addition, the frequency of gastrointestinal disorders was lower in the main group (5.8% and 14.2%), although patients with known intolerance to oral iron preparations were excluded from the study.

Thus, intravenous administration of iron carboxymaltose in patients with inflammatory bowel diseases and iron deficiency anemia caused a rapid increase in hemoglobin levels and replenishment of iron stores, and also had advantages over oral preparation in terms of tolerability.

Anemia in Chronic Kidney Disease

Anemia is one of the main complications of CKD, and its frequency increases as kidney function deteriorates. According to the PRESAM epidemiological study, anemia was detected in 69% of patients who first applied to the dialysis center. Erythropoietin deficiency plays a key role in the development of nephrogenic anemia, but iron deficiency makes an important contribution to the pathogenesis of this condition. In the NHANES population-based study, signs of iron deficiency (decreased serum ferritin or transferrin saturation) were found in 58-59% of men and 70-73% of women with CKD. Causes of iron deficiency in CKD include blood loss during dialysis or from the gastrointestinal tract, insufficient dietary iron intake, and inflammation, which is accompanied by increased hepcidin secretion by the liver. The latter blocks the absorption of iron in the intestine and its release from macrophages. The main criteria for diagnosing iron deficiency in patients with CKD are considered to be a decrease in serum ferritin levels.< 100 нг/мл (<200 нг/мл при лечении гемодиализом) и степени насыщения трансферрина <20%. При заместительной терапии препаратами железа целевые значения этих показателей составляют 200-500 нг/мл и 30-50%, соответственно . Если сывороточный уровень ферритина превышает 500 нг/мл, то введение препаратов железа не рекомендуется, хотя в исследовании DRIVE у 134 диализных пациентов с высоким уровнем ферритина (500-1200 нг/мл) и низкой степенью насыщения трансферрина (<25%), у которых сохранялась анемия несмотря на введение высоких доз эритропоэтина, внутривенное введение препарата железа привело к значительному увеличению уровня гемоглобина по сравнению с контролем . В руководстве Британского национального института здоровья (NICE) 2011 года у преддиализных пациентов с нефрогенной анемией, у которых имеются признаки абсолютного или функционального дефицита железа, рекомендуется скорректировать эти изменения перед назначением препаратов, стимулирующих эритропоэз . При лечении эритроэпоэтином необходимо поддерживать показатели обмена железа на целевых уровнях. В рекомендациях Национального почечного фонда 2006 г. указано, что больным терминальной почечной недостаточностью, получающим лечение гемодиализом, препараты железа следует вводить внутривенно, в то время как у преддиализных пациентов и больных, которым проводится перитонеальный диализ, можно выбрать как внутривенный, так и пероральный путь введения препаратов железа .

Experts from the Cochrane Collaboration group conducted a meta-analysis of 28 studies (n = 2098) comparing the results of oral and intravenous iron supplementation in patients with CKD. Intravenous iron supplementation compared to oral administration resulted in significant increases in mean hemoglobin (mean difference between groups 0.90 g / dL), serum ferritin levels (mean difference 243.25 μg / L) and transferrin saturation (mean difference 10. twenty%). With the intravenous use of iron preparations in dialysis patients, a significant decrease in the doses of erythroepoietin was revealed. The incidence of gastrointestinal side effects was higher with oral administration of iron preparations, while arterial hypotension and allergic reactions were more common with intravenous administration.

In a multicenter study, the efficacy of iron carboxymaltose was studied in 163 patients with iron deficiency anemia who received hemodialysis treatment. Erythropoietin therapy was carried out in 73.6% of patients. The response rate to treatment (increase in hemoglobin level by at least 1 g / L) was 61.7%. Due to adverse events, only 3.1% of patients discontinued treatment.
W.Qunibil et al. a randomized trial compared the efficacy of ferrous carboxymaltosate (intravenous 1000 mg over 15 minutes + two additional 500 mg doses at 2-week intervals if needed) and ferrous sulfate (325 mg three times daily by mouth for 56 days) in 255 pre-dialysis patients with CKD and iron deficiency anemia who received a stable dose of erythroepoietin. The proportion of patients whose hemoglobin level increased> 1 g / dl at any time during the study was 60.4% and 34.7% in two groups, respectively (p<0,001). Через 42 дня у больных, которым препарат железа вводили внутривенно, выявили более значительное увеличение среднего уровня гемоглобина (р=0,005), ферритина (р<0,001) и степени насыщения трансферрина (р<0,001). При применении карбоксимальтозата железа частота нежелательных явлений была достоверно ниже, чем в группе сравнения (2,7% и 26,2%, соответственно; р<0,0001).
Thus, in predialysis patients with iron deficiency anemia, ferrous carboxymaltose was significantly superior to oral ferrous sulfate in both efficacy and tolerability.

Antineoplastic chemotherapy-induced anemia

Anemia develops in 3/4 of patients with malignant tumors receiving chemotherapy. Erythroepoietin is used to treat chemotherapy-induced anemia, but about 50% of patients respond poorly to treatment. As indicated above, the main reason for the lack of effectiveness of drugs that stimulate erythropoiesis is functional iron deficiency. The European Organization for the Study and Treatment of Cancer (EORTC) guidelines indicate that iron deficiency anemia must be corrected before erythroepoietin is prescribed. Although the results of studies of iron carboxymaltosate in patients with chemotherapy-induced anemia have not been published, however, several randomized clinical trials have shown that intravenous iron supplementation increased the response rate to erythroepoietin treatment from 25-70% to 68-93% ... At the same time, oral medications in such patients were of little or no effect. For example, in one study, the response rate to erythroepoietin with concomitant placebo or oral iron supplementation was 25% and 36%, respectively, and in another, 41% and 45%. In the same studies, intravenous iron supplementation increased the response rate to erythroepoietin to 68% and 73%, respectively. The use of intravenous iron supplements can lead to lower treatment costs due to reduced doses of drugs that stimulate erythropoiesis and the need for blood transfusion.

Anemia in obstetric and gynecological conditions

Three randomized controlled trials studied the efficacy of iron carboxymaltose in women with postpartum iron deficiency anemia (hemoglobin<10 г/дл в течение 10 дней после родов) . При внутривенном введении препарата железа частота ответа на лечение (увеличение уровня гемоглобина >12 g / dl or more than 2.0 g / dl) exceeded 85%. In two studies, it was higher than with oral administration of iron, while in the third study, the average hemoglobin level after 12 weeks increased in a comparable degree with the use of iron carboxymaltose and ferrous sulfate. In all three studies, intravenous iron supplementation led to a rapid and sustained increase in serum ferritin levels, while oral ferric sulfate did not change significantly. D. Van Wyck et al. revealed a significant decrease in the incidence of gastrointestinal side effects during treatment with iron carboxymaltose (6.3% and 24.4% in the study and control groups, respectively; p<0,001). Кумулятивная доза железа при внутривенном введении была значительно меньше, чем при пероральном применении. Например, в исследовании C.Breymann и соавт. она в среднем составила 1,3 и 16,8 г, соответственно. Как отмечено выше, для введения указанной дозы (1,3 г) требуется всего две 15-минутных инфузии карбоксимальтозата железа с интервалом в одну неделю.

In another large randomized controlled trial, the efficacy of iron carboxymaltose was studied in 454 women with iron deficiency anemia that developed on the background of uterine bleeding. The patients were randomized into two groups and received intravenous iron carboxymaltosate (the dose was calculated individually) or oral iron sulfate (325 mg 3 times a day for 6 weeks). The proportion of patients whose hemoglobin level increased by at least 2 g / dl was significantly higher in the study group than in the control group (82% and 62%, respectively: p<0,001). Сходные результаты были получены при анализе частоты увеличения уровня гемоглобина по крайней мере на 3,0 г/дл (53% и 36%; р<0,001) и нормализации уровня гемоглобина (>12 g / dl; 73% vs. 50%; R<0,001). Кроме того, введение карбоксимальтозата железа привело к более выраженному улучшению качества жизни (р<0,05). У 86% пациенток основной группы для введения необходимой дозы железа потребовалось всего 2 инфузии препарата, в то время как в остальных случаях были выполнены 1 или 3 инфузии. Таким образом, как и в других исследованиях, внутривенное введение карбоксимальтозата железа было не только более эффективным, чем пероральное применение препарата железа, но и позволяло ввести необходимую дозу железа за короткий срок (у подавляющего большинства пациентов - две инфузии с интервалом в 1 неделю).

Anemia in Heart Failure

In the recommendations of the European Society of Cardiology, anemia is considered as an independent risk factor for death and other adverse outcomes in patients with chronic heart failure. Anemia in these patients may be due to iron deficiency, hemodilution, renal dysfunction, malnutrition, chronic inflammation, bone marrow dysfunction, and certain medications. Although correcting iron deficiency or iron deficiency anemia is not considered a mandatory component of the treatment of chronic heart failure, studies have been published to support this approach. The FAIR-HF study included 459 patients with chronic heart failure of II-III functional class, decreased left ventricular ejection fraction, iron deficiency (ferritin< 100 мкг/л или 100-299 мкг/л при степени насыщения трансферрина <20%) и уровнем гемоглобина от 95 до 135 г/л . Пациентов рандомизировали на две группы (2:1) и вводили карбоксимальтозат железа (200 мг железа) или физиологический раствор. Через 24 недели значительное или умеренное улучшение было отмечено у 50% и 28% пациентов двух групп, соответственно. Доля пациентов с I-II функциональным классом к этому сроку составила 47% в основной группе и 30% в группе плацебо. Внутривенное введение препарата железа привело к улучшению толерантности к физической нагрузке (проба с 6-минутной ходьбой) и качества жизни. Результаты лечения были сходными у пациентов, страдавших и не страдавших анемией.

Conclusion

Given the safety and efficacy of intravenous iron supplementation in the treatment of iron deficiency anemia of various origins, the role of oral iron supplementation in this condition needs to be reassessed. Intravenous administration of iron preparations is considered the method of choice for correcting iron deficiency not only in severe anemia or poor tolerance to oral medications, but also in treatment with drugs that stimulate erythropoiesis in patients with nephrogenic anemia or chemotherapy-induced anemia. Iron carboxymaltose (Ferinject®) is an intravenous iron preparation that is a high molecular weight and stable iron-carbohydrate complex. It does not contain dextran, which can cause serious allergic reactions. The advantage of iron carboxymaltosate over other intravenous iron preparations registered in the Russian Federation is the possibility of a single administration of a large dose of iron (1000 mg in 15 minutes), which allows you to quickly replenish iron deficiency (2-3 infusions) and avoid long-term intake of oral drugs, which often cause gastrointestinal adverse reactions.

LITERATURE

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Anker S., Comin Colet J., Filippatos G. et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N. Engl. J. Med. 2009, 361, 2436-2448.

When a patient is diagnosed with iron deficiency anemia, he is prescribed a set of various agents, which may include iron preparations in injections for intramuscular administration. And also iron preparations are recommended for preventive purposes. These funds are able to quickly and efficiently compensate for the lack of a trace element. The modern pharmaceutical industry produces a fairly large number of medicinal products that contain metal.

Iron preparations for intravenous administration

For the purpose of medical procedures, a specialist can prescribe drugs that contain iron for intravenous administration, in strict accordance with the patient's test parameters, his age, and also with the tolerance of these medicinal drugs. The dosage of the drug is calculated based on how much of this element is present in a particular medicinal drug and the volume of its packaging.

It is strictly not advised to use iron supplements uncontrollably, especially without a doctor's prescription. Intramuscular iron injections are indicated in the following cases:

After major operations on the gastrointestinal tract, after removal of part of the stomach or its extensive resection.
During an exacerbation of gastric ulcer, during enteritis, chronic pancreatitis, ulcerative colitis (since there is insufficient absorption of iron from the digestive tract).
In the case of iron deficiency anemia.
In case of an urgent need to saturate the body with metal - before extensive surgical interventions due to serious pathologies.
In case of intolerance to iron-containing drugs when taken internally.

The names of iron preparations for intravenous administration are prescribed only by a specialist, who also controls the use of these medicinal preparations. Since recently, cases of acute poisoning with iron-containing drugs have become more frequent. This list of intravenous iron preparations is most often used: Maltofer ampoules, Argeferr solution, Venofer ampoules, Likferr, Cosmofer, Ferkoven.

Venofer is an iron-containing drug that is intended for intravenous administration. Available in 5 ml ampoules. Ampoules for intravenous administration Ferkoven is a compound of iron sucrose, a solution of carbohydrates and cobalt gluconate.

Relatively recently, a new iron-containing drug for intravenous administration has appeared - Sufer. Which has long been recognized abroad. After a full course of medical therapy, gradually all clinical signs begin to subside - dizziness, fainting, muscle weakness, pallor of the skin.

Iron injections

Iron preparations in injections are used only in certain cases:

Chronic disorders of the digestive system, in which there is a decrease in the absorption of iron.
Intolerance to the salts of this trace element.
Hypersensitivity accompanied by allergic reactions.

Iron injections are prescribed and used when it is necessary to saturate the patient's body with a necessary trace element. Especially when surgery is planned. It is important to note that it is strictly forbidden to inject an iron preparation of more than 100 mg by injection, since such a dose is the daily norm of an adult.

In the case when preparations with iron are administered by injection, then in most cases, patients experience some side effects: a slight induration at the injection site, inflammation of the venous wall, abscesses, acute allergic manifestations, drug overdose. The use of drugs causes serious complications, therefore their use must be strictly controlled by a specialist.

Ferrum Lek Injection is a preparation with iron that is injected into the body. It is produced in the form of ampoules of two ml (equal to one hundred mg of iron), intramuscular injection. The main active compounds are iron hydroxide and dextran. Among other iron-containing preparations for intramuscular administration, the following are distinguished: Zhektofer (2 ml ampoules), Ferrlecite (one 5 ml ampoule), Ferbitol (1 ml ampoules).

It is very important to take iron-containing preparations for medicinal purposes, as well as to prevent the appearance of iron deficiency anemia. However, independent use and prescription of drugs is completely unacceptable - only the attending physician determines the dosage and duration of administration. Since quite a lot depends on the indicators of the tests performed and other pathologies of the patient.

Iron is essential for the human body. It is an integral component of all cells, and also participates in many cellular processes. For example, iron (as part of the protein hemoglobin) transports oxygen from the lungs to all organs. Decreased hemoglobin indicates anemia. Anemia is a condition where there are not enough healthy red blood cells. Red blood cells transport oxygen to the tissues. There are several types of anemia.

Iron deficiency anemia occurs when low levels of iron are present in the body.

is the most common type of anemia.

Healthy red blood cells are produced by the bone marrow. The organs of the body, such as the spleen, remove “old” blood cells. Iron is a key component of red blood cells. Without it, the blood will not be able to carry oxygen efficiently. A person usually gets iron through food and also sometimes reuses iron from “old” red blood cells.

Iron deficiency anemia develops when iron stores are running low.

You are losing more iron than the body can reproduce;
The body does not metabolize iron;
The body absorbs iron, but you do not get enough of it from food;
Pregnancy, breastfeeding.

Bleeding can result iron loss... The most common causes of bleeding are:

In women: prolonged or frequent menstruation;
Cancer of the esophagus, stomach, small intestine, colon;
Varicose veins of the esophagus, for example, due to cirrhosis of the liver;
Peptic ulcer disease.

Iron is not absorbed due to:

Crohn's disease;
Celiac disease (bowel disease);
Gastric bypass surgery;

While taking a large amount of antacids that contain calcium.

Ask your question to the doctor of clinical laboratory diagnostics

Anna Ponyaeva. Graduated from the Nizhny Novgorod Medical Academy (2007-2014) and the Residency in Clinical and Laboratory Diagnostics (2014-2016).

Vegetarians and seniors also are at risk.

Symptoms

Most often mild, developing slowly. May include:

Weakness, fatigue, increased fatigue;
Headache;
Concentration problems.
As the anemia progresses, symptoms worsen:
Blue eyes;
Brittle nails;
Slight dizziness;
Pale skin color;
Shortness of breath;
Dark stools or blood in your stool;
Heavy menstrual bleeding
Stomach ache;
Weight loss.

Treatment

Medication is reduced to taking iron-containing drugs.

Pregnant and lactating women should take iron supplements and supplements.

The hematocrit returns to normal after 2 months of therapy. But, as a rule, hematologists prescribe slightly longer courses of 6 to 12 months to compensate for the iron deficiency in the bone marrow.

Drugs

The most economical and effective medical treatment for this type of anemia is the oral administration of iron salts. Ferrous sulfate has received the most frequent use. Carbonyl iron medications are more commonly used during pregnancy.

Parenteral therapy is used in patients who are unable to take oral iron. And also in patients who have not responded to oral medications. This is a rather expensive method of treatment with many contraindications.

Video about which method of using drugs is more convenient in which case

Attention! Which drug to give preference, as well as which method of therapy to choose, can only be decided by your attending physician (therapist, hematologist).

Oral preparations

Sorbifer Durules (Hungary)	The combination preparation, an iron supplement, is used to treat / prevent low iron levels (for anemia, also during pregnancy). Ferrous sulfate is the most basic, most common and inexpensive drug for the treatment of patients with iron deficiency. These are tablets of 50-60 mg based on ferrous iron. Sorbifer oral solutions are available for pediatric use. Iron sulfate is best absorbed on an empty stomach (should be taken 1 hour (or half an hour) before or 2 hours after a meal). If symptoms of indigestion appear, the drug can be taken with food. Also available as liquid drops for babies. During its use, it is important to avoid taking antacids, dairy products, tea or coffee within 2 hours before or after taking it, they can reduce its effectiveness. Side effects are minimal, may include nausea, constipation, diarrhea. Price for tablets 30 pcs. 320 mg from 300 to 500 rubles.
Totema (Iron Gluconate) (France)	An iron-containing drug for the prevention / treatment of iron deficiency anemia (in pregnant women, as well as in children, adolescents, women and girls of childbearing age, the elderly). Contraindicated if there is an allergy to any component in its composition, as well as in hemochromatosis. Iron gluconate is better absorbed on an empty stomach, but can be taken with food if discomfort occurs. Certain foods (eggs, cereals, dairy products, coffee, tea) can reduce its effectiveness. Side effects often include black (sometimes green, which is rare) stools. This is normal and not a cause for concern. Allergic reactions may develop, including itching, rash, urticaria, and anaphylactic reaction may rarely develop. Price for a solution of 10 ampoules of 10 ml: 300-500 rubles.
Tardiferon (France)	A preparation with ferrous sulfate, indicated for: - reimbursement of iron losses (to restore the menstrual cycle, with bleeding as a result of gastrointestinal diseases); Increased iron levels (eg, during pregnancy, lactation, donation, puberty) Side effects are rare and include: allergies, shortness of breath, tongue swelling, upset stomach, dark stools (sometimes black), temporary staining of teeth. Avoid taking any other multivitamin or mineral product within 2 hours before or after you take Tardiferon. This can lead to mineral overdose and cause serious side effects. Avoid taking antibiotics 2 hours before or after taking Tardiferon. Price for 30 tablets: 180-230 rubles.
Ferroplex (Hungary)	An iron supplement based on ferrous iron, used to increase the level of folate and iron. Contraindications: if you are pregnant, planning to become pregnant, or while breastfeeding, consult your doctor before you start taking Ferroplex. Contraindicated in bowel diseases (colitis, Crohn's disease, intestinal obstruction, diverticulitis, diverticulosis), certain blood diseases (cutaneous porphyria, thalassemia). Side effects: constipation, black stools, nausea, diarrhea, indigestion. Price for 30 tablets: 200-350 rubles. This drug is difficult to find in pharmacies, so it is often replaced with Sorbifer Durules.
NovaFerrum (USA)	Iron supplement. NovaFerrum contains an iron polysaccharide complex. The drug effectively compensates for the lack of iron in the body. Contraindications include the age of up to 6 years (for such purposes, a special type of NovaFerrum Pediatric Drops has been released, for babies), and it is also necessary to consult a doctor before using the drug during pregnancy or breastfeeding. Iron can interfere with the absorption of some antibiotics and should not be combined with other dietary supplements. Do not exceed the recommended dosage unless otherwise directed by your doctor. Side effects have not been identified, such as constipation, nausea are rare. The price for 50 mg tablets (three-month course) will be about 700-900 rubles.
Feozol (FeoSol) (USA)	An iron-containing preparation based on carbonyl iron, used as a replacement for ferrous sulfate. It is absorbed more slowly and is more expensive. Slow absorption is especially good when ingested by children. Less toxic to the gastrointestinal tract. Contraindications: allergy to any of the components, if the patient has problems with iron absorption (eg, hemosiderosis, hemochromatosis) or high levels of iron in the blood. Price for tablets 45 mg / 60 mg 120 pcs. about 700 rubles.
Hemofer Prolangatum (Poland)	Hemofer is a natural mineral supplement. It is used for the prevention / treatment of iron deficiency anemia, improves general immunity. It can be used during pregnancy, as well as children under 6 years old, babies. Indicated for use during pregnancy and lactation, during donation, puberty. Contraindications: Hemolytic anemia, thalassemia, hemosiderosis, hemochromatosis, lead anemia Side effects are rare but may include nausea, stomach pain, bloody stool, coughing up blood or vomiting, and weak pulse, pale skin, blue lips , convulsions. Available in the form of pills or syrup. The price of tablets (dragees) 325 mg 10 pcs: 100-200 rubles.
Maltofer (Switzerland)	It is a medication that is used to treat iron deficiency in patients with ferrous iron intolerance. It contains ferric iron (polymaltose hydroxide). It is used to increase iron levels and reduce folate deficiency and is indicated for use during pregnancy and lactation. There are practically no contraindications. The drug is not absorbed while taking many medications (antibiotics, other vitamins and food supplements). Side effects are few, and also very rare, mainly nausea, constipation and diarrhea. Available as chewable tablets, drops or syrup. Prices: tablets 30 pcs .: 300-350 rubles; drops 50mg 30ml: 250-300 rubles; syrup 150 ml: 300-350 rubles.
FerreTab (Austria)	Ferrous fummarate, used to treat iron deficiency anemia, also with an unbalanced diet, severe bleeding. Possible side effects: darkening of the stool (which is harmless), staining of the teeth (in this case, you should mix each dose of the drug with water or fruit juice, or add a small amount of baking soda to the toothpaste), constipation, indigestion. Available in pill form. This medication should be taken on an empty stomach at least 1 hour before or 2 hours after a meal. There is no particular contraindication. But caution should be exercised in patients with intestinal inflammation, Crohn's disease, digestive problems, ulcers, or if you are allergic to ferrous sulfate. Safe to take during pregnancy. Prices for 30 tablets: 300-400 rubles.

Some helpful tips:

Take iron supplements on an empty stomach;
Do not take iron supplements with antacids. Medications that relieve heartburn symptoms can interfere with iron absorption;
Vitamin C improves the absorption of iron.

Parenteral therapy

Oral iron therapy more preferable and safer, but many patients experience serious side effects (for example, from the gastrointestinal tract). Patients on oral therapy often have an inadequate response to such therapy. Parenteral treatment responds quickly and is better at replenishing iron deficiency in some clinical settings. Until recently, its use was limited by the significant risk of severe allergic reactions (especially when using drugs with a high molecular weight iron dextran). The new generation of drugs currently available have a very low incidence of serious reactions.

General indications for prescribing parenteral therapy:

Iron deficiency anemia against the background of inflammatory bowel diseases, when oral therapy has shown its ineffectiveness;
It is indicated for patients on hemodialysis (with acute renal failure);
As an alternative to blood transfusion when a rapid increase in hemoglobin is required (for example, severe anemia in late pregnancy or postpartum anemia).

New generation drugs are quite expensive.

Important! Intravenous iron administration is contraindicated in the 1st trimester of pregnancy.

Preparations for injection

Venofer (Switzerland)	Ferric iron, a sucrose complex is used to treat iron deficiency anemia (in combination with erythropoietin) in patients with kidney disease. Iron deficiency in them is caused by blood loss during dialysis, as well as insufficient absorption of iron from the gastrointestinal tract. Venofer 20 mg / ml is injected intravenously for 2-5 minutes (sometimes using a dropper). There are no specific contraindications. Side effects include: muscle cramps, strange taste in the mouth, diarrhea, constipation, headache, cough, joint pain, dizziness or swelling of the hands / feet, pain, swelling or redness at the injection site. Prohibited for use in the 1st trimester. Price 20 mg / ml 5 ml ampoule: 1500-2500 rubles.
CosmoFer (Denmark)	CosmoFer is a combination of dextran and iron. Contraindications include: hypersensitivity to dextran, liver disease, hepatitis, chronic disease (administration through a vein can aggravate bacterial or viral infections), kidney disease. Cosmofer treatment during pregnancy can be carried out only in the 2nd or 3rd trimester. Side effects: nausea, stomach pain, fever, fever, convulsions, allergic reaction. Price 50 mg / ml 2 ml: 3000-4000 rubles.
Ferinject (France)	Ferinject is indicated for the treatment of iron deficiency. Contraindications: hypersensitivity to iron carboxymaltose, microcytic anemia. Contraindicated in the 1st trimester of pregnancy. Side effects include vomiting, dizziness, headache. Price for a solution in / in 50mg / ml 5 bottles: 4000-5000 rubles.
Jectofer, Ectofer (Turkey)	Jectofer - iron sorbitol citric acid, is used to prevent iron deficiency anemia. Contraindicated in hemochromatosis, heart disease, hypertension. Side effects: allergic reactions, yellowing of the skin (discoloration of the skin to brown), dizziness, metal taste in the mouth Contraindicated in the 1st trimester of pregnancy. Price for ampoules / 2 ml: 2000-2500 rubles
Ferrum Lek (Slovenia, Switzerland)	Ferric iron. Indications for use: iron deficiency anemia, also during pregnancy. Contraindicated in the following conditions and diseases: hypersensitivity to any of the ingredients of the drug, hemochromatosis, hemosiderosis, sideroblastic anemia.Side effects include black stools, pale skin, tachycardia. It can be used only from the second trimester of pregnancy (from 13-14 weeks). Also available as syrup and chewable tablets. Price for ampoules 2ml 100mg 20 pcs: 7000-8000 rubles.
Monofer (Germany)	Iron hydroxide III. It is indicated for the treatment of iron deficiency anemia. Contraindications: sensitivity to the active substance, hypersensitivity to iron products, hemolytic anemia, excess iron, hemochromatosis, hemosiderosis, liver cirrhosis, hepatitis. Side effects include nausea, rarely: abdominal pain. Price for injection solution 100 mg 2 ml: 15000-16000.
INFED (Canada)	Iron dextran (INFeD), replenishes the lack of iron in the bone marrow. Parenteral administration can cause anaphylactic shock. Side effects: loss of consciousness, difficulty breathing, hives, swelling or convulsions, low blood pressure, dizziness, fever, sweating. The daily dose of the drug should not exceed 100 mg (2 ml). Contraindicated in the treatment of non-iron deficiency anemia, as well as in kidney disease, asthma, cardiovascular diseases. The price of the drug (50 mg / 2 ml 2 ampoules) is more than 15,000 rubles per ampoule. Most often it is replaced with Monofer or Cosmofer drugs.

The effectiveness of the treatment

Taking iron supplements and getting enough iron in food symptoms go away very soon... Improvement occurs within a few days (2-3 days). But, even if the patient feels better, the course of treatment must be completed completely. Usually the course lasts up to 6 months.

Pregnancy and iron supplements

Add iron-rich foods to your daily diet;
Add foods rich in vitamin C to your diet. Vitamin C promotes the absorption and absorption of iron;
Eat lean red meat, poultry, and fish. Iron from such foods is absorbed better than iron from plant foods;
Before using any iron-containing drug, it is important to consult with a therapist, hematologist, and sometimes a gynecologist. Taking such drugs is most often not dangerous during pregnancy, while parenteral therapy should be started only if the risk to the mother is higher than the risk to the child, and only from the second trimester.

Prevention of low iron levels. Diet

It is possible to reduce the risk of anemia by choosing:

Red meat;
Pork;
Domestic bird;
Seafood;
Green leafy vegetables (spinach)
Beans;
Dried fruits (raisins, dried apricots, prunes, dates);
Iron-fortified cereals, breads and pasta.

Vegetarians will need to increase their intake of iron-rich plant foods. It:

Oatmeal;
Tofu;
Lentils;
Spinach;
Whole wheat bread;
Peanut butter;
Brown rice.

Vitamin C for iron absorption. Is in:

Broccoli;
Grapefruit;
Kiwi;
Greens;
Melons;
Oranges;
Bulgarian pepper;
Strawberry;
Tangerines;
Tomatoes.

Helpful advice: For the prevention of anemia, it is useful to drink a glass of orange or grapefruit juice a day.

Avoid excessive consumption of foods such as:

Tea and coffee;
Calcium - found in dairy products;
Whole Grains - While they are a good source of iron, they also contain phytic acid, which can slow down the absorption of iron.

Dr. Komarovsky about dietary restrictions during treatment

Facts about iron and its deficiency

Iron deficiency - the main cause of anemia;
Iron deficiency is most often associated with an increase in the body's need for iron or with a decrease in iron absorption;
The diagnosis of iron deficiency is based on;
With a balanced diet, an iron supplement diet, and the right medications, iron deficiency can be cured.

Iron preparations with low hemoglobin in adults and children are a common medical prescription. Coming to the pharmacy, a person is lost from the abundance of drugs. They differ in the valence of iron (bivalent or trivalent), in the type of iron compound (organic - gluconates, malates, succinylates, chelate forms and inorganic - sulfates, chlorides, hydroxides), in the method of administration (oral administration - tablets, drops, syrups and parenteral - intramuscular and intravenous forms).

If a doctor recommends the best iron preparation for the treatment of anemia, then in order to prevent an increase in iron stores in the blood, you often have to figure out all this ugliness of diversity on your own. We will deal with the analysis of drugs that are effective for iron deficiency.

Reasons for the development of iron deficiency

The body contains 3 to 5 grams of iron. Most of it (75-80%) is in erythrocytes, part in muscle tissue (5-10%), about 1% is part of many enzymes in the body. The bone marrow, spleen, and liver are the storage sites for reserve iron.

Iron is involved in the vital processes of our body, which is why it is so important to maintain a balance between its intake and losses. When the rate of iron excretion is higher than the rate of intake, various iron deficiency states develop.

If a person is healthy, then the removal of iron from our body is insignificant. Iron content is largely controlled by altering the level of iron absorption in the intestine. In food, iron is presented in two forms: Fe III (trivalent) and Fe II (bivalent). Upon entering the digestive tract, inorganic iron dissolves, ions and iron chelates are formed.

Chelated forms of iron are best absorbed. Ascorbic acid contributes to the formation of iron chelates. In addition, fructose, succinic and citric acids, and amino acids (for example, cysteine, lysine, histidine) help chelate iron.

Reasons for the appearance of a lack of iron:

Decrease in the efficiency of absorption of iron in the digestive tract (an increase in the rate of passage of food through the digestive tract, the presence of inflammation in the intestines, surgical interventions on the intestines and stomach, digestive disorders, etc.);
Increase in the body's need for iron (during intensive growth, pregnancy, lactation, etc.);
Decreased iron intake due to dietary habits (anorexia, vegetarianism, etc.);
Acute and chronic blood loss (stomach bleeding with ulcers, bleeding in the intestines, kidneys, nasal, uterine and other localizations);
As a consequence of tumor diseases, prolonged inflammatory processes;
Decreased synthesis of iron transport proteins (eg transferrin);
Destruction of blood cells with subsequent loss of iron (hemolytic anemias);
Increased intake of calcium into the body - more than 2 g / day;
Lack of trace elements (cobalt, copper).

The body constantly loses iron in feces, urine, sweat, hair, nails, and during menstruation.

The male body loses 0.8-1 mg of iron per day. Women lose more iron during menstruation. For a month, women lose an additional 0.5 mg of iron. With blood loss of 30 ml, the body loses 15 mg of iron. Iron consumption increases significantly in pregnant and lactating mothers.

Iron loss in excess of 2 mg / day leads to the development of iron deficiency. Since the body is not able to replenish more than 2 mg of iron per day.

Lack of iron more often occurs in women also because they store iron 3 times less than in men. And the incoming iron does not always cover the costs.

In Russia, the latent iron deficiency in some areas reaches 50%. Almost 12% of girls of childbearing age have iron deficiency states. 75-95% of all anemias of pregnant women are iron deficiency. Lack of iron in pregnant women can threaten with weakness of labor, miscarriages, excess blood loss during childbirth, decreased lactation, and a decrease in the weight of newborns.

The use of iron preparations in pregnant women to reduce the risk of developing anemia is justified in the third trimester, and the intake is continued for 2-3 months after childbirth. Additional sources of iron are not given to term infants in the first 3 months. Premature infants are given iron supplements earlier.

The required daily intake of iron in boys is 0.35-0.7 mg / day. In girls, before the onset of menstruation, 0.3-0.45 mg.

What can decrease the intake of iron from food:

Excess phosphates in food;
Oxalic acid found in some plants;
Tannin, which gives a tart taste, reduces the absorption of iron;
Tea reduces iron intake by 60%, coffee by 40%;
Phytate found in wheat bran, rice, nuts and corn;
Excessive fiber content in food;
Substances that neutralize the hydrochloric acid of the stomach - antacids;
Egg white, soy and milk protein;
Some preservatives like EDTA.

Rules for taking iron supplements

Iron preparations are used to reduce the risk of iron deficiency states, as well as in the complex therapy of anemia.

Traditionally, treatment begins with oral tablets. Preference is given to drugs that can give a rapid rise in hemoglobin in the blood with a low risk of side effects.

Usually they start with the appointment of high doses of iron: 100-200 mg / day. A similar amount of iron is able to compensate for the costs of the body for the formation of the required amount of hemoglobin. When the dosage is exceeded in 200 mg / day, side effects are much more often observed.

If the drug is selected correctly, hemoglobin returns to normal within 15-30 days. When the blood counts reach the desired values, the iron supplement is continued for at least 2 months to replenish iron stores (in the bone marrow, liver, spleen).

How to take iron supplements correctly:

Before meals or during meals. Bioavailability does not depend on the time of day, but there are recommendations to take in the evening;
It is recommended to drink it with clean water;
You can not drink milk, coffee, tea due to a decrease in absorption;
Do not combine the intake of oral iron preparations with drugs that block the production or neutralize the effect of hydrochloric acid: antacids (baking soda, phosphalugel, almagel, gastal, rennie, etc.), proton pump inhibitors (omeprazole, lansoprazole, esomeprazole, etc.);
Iron preparations affect the action of some antibiotics, therefore, the intake of these drugs should be separated in time by 2 hours;
The intake of iron supplements is not compatible with the use of alcohol. Alcohol enhances iron absorption and increases the risk of developing iron intoxication;
Iron absorption will not be affected by magnesium (Magne B6, Magnelis, Cardiomagnyl, Magnesium Chelate), but extreme dosages of 2 grams or more of calcium may reduce it.

Features of iron preparations

In the case of iron deficiency anemia, preparations of two (Fe II) and trivalent (Fe III) iron are taken. Preparations with Fe II have a higher bioavailability than trivalent. Molecular iron in these preparations is enclosed in organic and inorganic compounds, which also differ in their bioavailability and tolerability (frequency of side effects).

I. Inorganic salts of ferrous iron

The most common representative of an inorganic iron compound in preparations with Fe II is iron sulfate. It is characterized by a relatively low bioavailability (up to 10%) and frequent side effects associated with irritation of the mucous membrane of the digestive tract.

Such iron preparations are usually cheaper than their counterparts in cost. The most popular representatives that can be found in pharmacies: Sorbifer Durules, Aktiferrin, Aktiferrin compositum, Ferro-Folgamma, Fenuls, Tardiferon, Feroplekt... To increase the bioavailability of iron, ascorbic and folic acid are often included in the composition.

Pharmacies will give you a fairly modest choice if you want to buy an iron supplement with ferric chloride. Ferrous iron, which is part of the inorganic salt, will not please with a bioavailability of 4%, and does not guarantee the absence of side effects. Representative: Hemofer.

II. Organic ferrous salts

They combine a higher bidavailability of Fe II and organic salts, bioavailability can reach 30-40%. Less common side effects associated with the use of iron supplementation. Medication is well tolerated during pregnancy and lactation. In the cons, you can write down the higher cost of these drugs.

The combination of organic salts of iron, copper and manganese gluconates is presented in the French preparation Totem, which is available in the form of a solution.
The combination of ferrous fumarate and folic acid is hidden in a capsule of Austrian origin - Ferretab.
A complex composition of chelated forms of iron gluconate, ascorbic acid, herbal synergists can be found in - American-made dietary supplement. It is not a drug, but it is an excellent source of easily digestible iron with virtually no side effects.

III. Inorganic ferric compounds

They are characterized by low bioavailability of these forms of iron (up to 10%). The most common forms of release are injectable.

This form of drugs solves the problem of side effects associated with irritation of the gastrointestinal mucosa. But it adds a number of conditions necessary for the fulfillment of the drug administration and the associated side effects and complications. They are the drugs of choice for severe forms of anemia, for pathologies of the digestive tract, leading to a decrease in iron absorption.

The route of administration (parenteral - intravenous or intramuscular injections, oral - tablets, drops, syrup or solution) does not in any way affect the availability of iron itself. Safer - oral, parenteral is prescribed according to indications.

The active ingredient is complexes with iron hydroxide. Folic acid is used as an excipient. Popular representatives: Ferrum Lek, Maltofer, Maltofer Fol, Biofer, Ferinject, Ferroxide, Ferropol, Venofer, CosmoFer, Likferr, Monofer.

IV. Organic ferric compounds

They are represented by the Spanish drug Ferlatum in two modifications: with and without folic acid. Available in the form of an oral solution.

List of iron supplements for low hemoglobin for adults and children

Name / Manufacturer	The form release	Prices ($)	Compound gland	Quantity gland	Subsidiary substances
Inorganic Fe II salts
Sorbifer Durules / (Hungary)	tab. 320 mg / №30/50	4.5- 15.5	Sulfate	100 mg / tab.	Vitamin C
Aktiferrin / (Germany)	caps. 300 mg / №20/50	2.33- 8.5	Sulfate	34.5 mg / caps.	L-serine
	drops / 30 ml	3.33- 8.42		9.48 mg / ml
	syrup / 100 ml	2.33- 5.82		6.87 mg / ml
Aktiferrin compositum / (Germany)	caps / №30	5.9		34.5 mg / caps.	L-serine, folic acid, cyanocobalamin
Ferro-Foilgamma / (Germany)	caps. / №20/50	4.17- 14.82	Sulfate	37 mg / caps.	Ascorbic, folic acid, cyanocobalamin,
Fenuls / (India)	caps. / №10/30	1.67- 7.32	Sulfate	45 mg / caps.	Ascorbic, pantothenic acid, riboflavin, thiamine, pyridoxine
Ferroplex / (Germany)	dragee / №100	—	Sulfate	50 mg / dragee	Ascorbic acid
Tardiferon / (France)	tab. / №30	3.17- 7.13	Sulfate	80 mg / tab.	—
Gino-Tardiferon / (France)	tab. / №30	16.33	Sulfate	80 mg / tab.	Folic acid
Ferrogradumet / (Serbia)	tab. / №30	—	Sulfate	105 mg / tab.	—
Feroplect / (Ukraine)	tab / №50	1.46- 1.65	Sulfate	10 mg / tab.	Ascorbic acid
Hemofer / (Poland)	drops / №30	1.19- 1.63	Chloride	44 mg / ml	—
Organic Fe II salts
Totem / (France)	solution / №10	6.67- 12.81	Gluconate	50 mg / 10 ml	Copper gluconates and manganese
Ferretab / (Austria)	caps. / №30/100	4.17- 16.46	Fumarate	50 mg / caps.	Folic acid
	tab. / №180	14.52	Chelate, gluconate	25 mg / tab.	Ascorbic acid, calcium chelate, collection of synergistic herbs
Inorganic Fe III compounds
Ferrum Lek / (Slovenia)	solution for injection / №5/50	10.5- 67	Hydroxide	100 mg / 2 ml	—
	syrup / 100 ml	2.12- 9.07		50 mg / 5 ml	—
	tab. chew / №30/50/90	4.33- 14.48		100 mg / tab	—
Maltofer / (Switzerland)	tab. / №10/30	4.33- 9.3	Hydroxide	100 mg / tab.	—
	syrup / 150 ml	4.03- 9.17		10 mg / ml
	solution for injection / №5	13.33- 23.3		100 mg / 2 ml
	drops / 30 ml	3.67- 5.08		50 mg / ml
Maltofer Foul / (Switzerland)	tab. / №10/30	6.67- 14.72		100 mg / tab.	Folic acid
Biofer / (India)	tab. / №30	4.63- 7.22	Hydroxide	100 mg / tab.	Folic acid
Ferinject / (Germany)	solution for injection / 2/10 ml	20.45- 66.67	Hydroxide	50 mg / ml	—
Ferroxide / (Belarus)	solution for injection / №5/10	8.23- 16	Hydroxide	100 mg / 2 ml	—
Ferropol / (Poland)	drops / 30 ml	6.30- 7	Hydroxide	50 mg / ml	—
Venofer / (Germany)	solution for intravenous injection / №5	43.46- 58.95	Hydroxide	100 mg / 5 ml	—
CosmoFer / (Germany)	solution for injection / №5	31.67- 78.45	Hydroxide	100 mg / 2 ml	—
Likferr / (India)	solution for intravenous injection / №5	25- 58.33	Hydroxide	100 mg / 5 ml	—
Monofer / (Germany)	solution for intravenous injection / №5	180.21- 223	Hydroxide	200 mg / 2 ml	—
Organic salts of Fe III
Ferlatum / (Spain)	solution / №10	9.71- 23.37	Succinylate	40 mg / 15 ml	—
Ferlatum Foul / (Spain)	solution / №10	8.72- 17.62	Succinylate	40 mg / 15 ml	Calcium folinate