Drug class : Multivitamins + Minerals

Generic Name : Multivitamins plus Iron

Brand Name : MACROBEE WITH IRON Tablet

(Reformulated)

Available in : Tablets x 60’s per box

Principal Uses
Iron deficiency anemias (IDA) due to nutritional deficiencies, traumatic or endogenous hemorrhages,
old age, convalescence following surgery, excessive menstrual flow and pregnancy.

Vitamin, mineral and iron supplement during rapid growth and development as in adolescence.

How the Drug Works

Macrobee with Iron tablet provides high or therapeutic dose of iron and other blood-building
nutrients (Vitamins B9 & B12 and minerals, Copper and Manganese) to restore normal levels of these
nutrients required in the production of red blood cells and to correct the signs and symptoms of IDA.

Macrobee with Iron tablet contains the following important blood building (hematopoietic) agents
needed in the formation and maturation of red blood cells (RBC) also known as erythrocytes.

− Iron is an integral part of the hemoglobin molecule of the red blood cells (erythrocytes).
Hemoglobin is an oxygen-carrying pigment of the erythrocyte. Iron is required for the production
of red blood cells (a process known as hematopoiesis) but it is also part of hemoglobin binding to
the oxygen and thus facilitating its transport from the lungs via the arteries to all cells throughout
the body.
− Folic acid (Vitamin B9) and Cyanocobalamin (Vitamin B12) are important cofactors required
in the formation and maturation of RBCs. Vitamin B9 and B12 are important co-enzymes in the DNA
synthetic pathway. A deficiency of these important vitamins or impairment in their utilization results
in deranged or inadequate synthesis of DNA. This slows the rate of division of blood cells leading to
accumulation in the marrow of cells with large nuclei. Such cells are called megaloblasts.
Megaloblastic anemia results from either folic acid or Vitamin B12 deficiency.
− High dose folic acid is incorporated to ensure formation of healthy RBCs, promote optimum fetal
brain development and to prevent neural tube defects (NTDs). Folic acid is essential in the reduction
of hemocysteine. Elevation of hemocysteine in the blood (hyperhomocysteinemia) is an identified
risk factor for cardiovascular diseases. Also, because folic acid is essential for the synthesis of DNA,
it is important during periods of rapid cell division and growth and to ensure health of rapidly
dividing cells (eg. Blood and digestive system)
− Manganese and Copper are elements/minerals which act as components of multi enzymes
systems that participate in red blood cell formation/production.

Macrobee with Iron tablet supplies energy boosters, the B vitamins, and substantial amount of
vitamin C to enhance iron absorption. Vitamin C promotes faster wound healing and also acts as an
antioxidant. As an antioxidant, vitamin C rejuvenates the body and strengthens the body’s immune
system. Vitamin C also helps build and maintain strong tissues. It promotes wound healing because it
acts as a cofactor in the synthesis of the intercellular cement substance collagen. Vitamin C is required
for the body’s synthesis of Collagen, a major component of connective tissues that constitutes the
tendons, ligaments, and other elastic fibers), for the metabolism of a variety of body substances, and
to maintain the structural and functional integrity of small blood vessel walls.

Pharmacokinetics:
Ferrous sulfate is effectively absorbed in response to low iron stores or increased requirements in the duodenum and proximal
jejunum. When needed the more distal small intestine can absorb iron as well. It is transported in the plasma bound to
transferrin, stored primarily as ferritin, in macrophages in the liver, spleen, and bone, and in parenchymal liver cells. Small
amounts are excreted in the feces, bile, urine and sweat.

Vitamin C (ascorbic acid) is readily absorbed from the intestine via an energy-dependent process that is saturable and dose
dependent. It is present in the plasma and is ubiquitously distributed in the cells of the body.

B vitamins are water soluble vitamins. Absorption of the usual dietary amounts of thiamine from the gastrointestinal tract
occurs by carrier-mediated active transport (Said et al.,1999); at higher concentrations, passive diffusion also is significant
(Rindi and Ventura, 1972). Absorption usually is limited to a maximal daily amount of 8 to 15 mg, but this amount can be
exceeded by oral administration in divided doses with food. Cellular thiamine uptake is mediated by a specific plasma membrane
transporter, (Diaz et al., 1999; Dutta et al., 1999) In adults, approximately 1 mg of thiamine per day is completely degraded
Updated as of March 2022 1
by the tissues, and this is roughly the minimal daily requirement. When intake is at this low level, little or no thiamine is
excreted in the urine. When intake exceeds the minimal requirement, tissue stores are first saturated. Thereafter, the excess
appears quantitatively in the urine as thiamine or as pyrimidine, which arises from degradation of the thiamine molecule. As
the intake of thiamine is increased further, more of the excess is excreted unchanged.

The vitamin is stored, primarily in the liver. Only trace amounts of vitamin B12 are normally lost in urine or stool. Vitamin B12
in physiologic amounts is absorbed only after it complexes with intrinsic factor, a glycoprotein secreted by the parietal cells of
the gastric mucosa. Intrinsic factor combines with the vitamin B12 that is liberated from dietary sources in the stomach and
duodenum, and the intrinsic factor-vitamin B12 complex is subsequently absorbed in the distal ileum by a highly specific
receptor-mediated transport system. Vitamin B12 deficiency in humans most often results from malabsorption of vitamin B12
due either to lack of intrinsic factor or to loss or malfunction of the specific absorptive mechanism in the distal ileum. Nutritional
deficiency is rare but may be seen in strict vegetarians after many years without meat, eggs, or dairy products. Once absorbed,
vitamin B12 is transported to the various cells of the body bound to a plasma glycoprotein, transcobalamin II. Excess vitamin
B12 is transported to the liver for storage.
Folic acid is well absorbed in the gastrointestinal tract even in patients with malabsorption syndrome so parenteral
administration is rarely necessary. In the presence of malabsorption, folic acid from food sources may be impaired.

Folates are excreted in the urine and stool and are also destroyed by catabolism, so serum levels fall within a few days when
intake is diminished.

Folate in excess of body requirements is excreted unchanged in the urine. Folate is distributed into breast milk. Haemodialysis
removes folic acid.

Dosage:
One tablet daily or as prescribed by the physician.

Onset of Effect:
Unknown

Duration of Action:
Depends on the body’s ability to utilize vit. B vitamins as water-soluble vitamins are required by our
body on a daily basis.

Dietary Advice:
Can be taken without food. May be taken with meals to reduce GI discomfort that may be caused by
iron.

Storage:
Store in a tightly sealed container away from heat, moisture and direct light.

If You Miss a Dose:

Take it as soon as you remember. If it is near the time for the next dose, skip the missed dose and
resume your regular dosage schedule. Do not double the next dose.

Stopping the Drug:

If the medication was prescribed, the decision to stop taking this supplement should be made by your
doctor.

Prolonged Use:
Prolonged use may result in the accumulation of iron in the tissues, the effects of which can include
liver damage, heart problems, diabetes, erectile dysfunction, and unusually bronzed skin. Do not take
iron supplements without consulting your doctor.

Precautions :

Elderly (Over 60 years old)

Problems in older adults have not been reported with intake of prescribed amounts

Infants and Children

Dosage form not recommended in infants and children. Close medical supervision is
recommended, and iron preparations should be stored out of reach of small children to avoid
accidental ingestion, which can be severely toxic. Folic acid may be used regardless of age.

Breastfeeding
No problems are expected during breast feeding; however, consult your doctor before taking
ferrous salts. Folic acid supplementation is recommended while nursing.

Pregnancy
This medication should be taken during pregnancy only if your doctor so advises.

Updated as of March 2022 2

 It is well recognized that folic acid supplement prior to conception can decrease the risk of Neural
Tube Defects (NTDs) thus doctors recommend that all women of child-bearing age should
receive at least 400 mcg/day of folic acid supplementation.

Folic acid supplementation is required to reduce risk of giving birth to babies with congenital
heart defects, NTDs, oral and orofacial clefts.

Alcohol
Avoid alcohol while taking this medication because it may cause excess absorption of iron.
Alcohol impairs the body's utilization of folic acid; avoid it completely if you are taking folic acid.

Driving and Performing Hazardous Work

No problems are expected

Overdose
Ferrous salts overdose: Lethargy, nausea, vomiting, weak and rapid pulse, dehydration, and loss of
consciousness. Early symptoms: Constipation (especially in children), diarrhea, dry mouth, increased
thirst and frequency of urination, persistent headache, loss of appetite, metallic taste, nausea and
vomiting, unusual fatigue. Advanced symptoms: Bone and muscle pain, irregular heartbeat,
persistent itching, extreme drowsiness, mental changes. Severe calcium toxicity may be fatal.

What to do Call your doctor, emergency medical services, or the nearest poison control
center immediately.

Drug Interactions
The following drugs may interact with ferrous salts and prevent their absorption: antacids, antibiotics,
fluoroquinolones, levodopa, cholestyramine, or vitamin E. Consult your doctor for specific advice.

Concomitant administration of Tetracycline and some antacids may decrease the amount of iron
absorbed and similarly, iron may retard the absorption of tetracyclines; these products therefore should
not be given together within 2 hours. Food may reduce the absorption of iron but will lessen the gastric
irritation that may be caused by iron.
Folic acid: Consult your doctor for specific advice if you are taking analgesics (pain relievers),
antibiotics, anticonvulsants, epoetin, estrogens, oral contraceptives, methotrexate, pyrimethamine,
triamterene, sulfasalazine, or zinc supplements. Folic acid may interfere with the metabolism of these
agents.

Food Interactions
Some foods can reduce the effect of this drug. The following foods should be avoided or taken in small
amounts for at least 1 hour before and 2 hours after iron is taken: Eggs, milk, spinach, cheese, yogurt,
tea, coffee, whole-grain bread, cereal, and bran.

Disease Interactions
Consult your doctor if you have any of the following: a history of alcoholism; kidney disease; liver
disease; porphyria; rheumatoid arthritis; asthma; allergies; heart disease; or a stomach ulcer, colitis,
or another intestinal problem.

Consult your doctor if you have pernicious anemia. Because folic acid may mask the hematological
abnormalities while neurological damage progresses, folic acid should not be used in the therapy of
patients with vitamin B12 deficiency of any cause, unless there is associated folate deficiency. Diagnosis
of B12 deficiency can be masked by high levels of folic acid.

Side Effects :
Gastrointestinal discomfort such as nausea, constipation or diarrhea may occur with intake of iron.

Folic acid is safe and well tolerated. Rare cases of gastrointestinal disturbances & hypersensitivity
reactions have been reported. As a water soluble vitamin, it rarely accumulates in toxic concentrations.
Excess is excreted through the urine. There has been no substantial reports of side effects even with
doses as high as 15mg/ day. Nevertheless, recommended doses should not be exceeded unnecessarily.

Serious
No serious side effects are associated with ferrous salts, except for iron overload due to
prolonged or inappropriate use of the mineral.

Updated as of March 2022 3

Folic acid: Wheezing, breathing difficulty, chest pain, swelling, tightness in throat or chest,
dizziness, rash, itching. Such symptoms may indicate a serious allergic reaction, although this
is extremely rare.

Common
Nausea, constipation, black stools due to Iron content. The are no known common side effects
associated with the use of folic acid.

FORMULATION:

Each film-coated tablet contains:

Cyanocobalamin (Vitamin B12) 50 mcg
Manganese Sulfate Monohydrate 200 mcg
Ascorbic Acid (Vitamin C) 100 mg
Ferrous Fumarate 250 mg
(equivalent to elemental Fe 82.50mg)
Folic Acid (Vitamin B9) 1 mg (1,000 mcg)
Cupric Sulfate Pentahydrate 200 mcg

PRESENTATION/ : pink, oblong, film-coated tablet, plain on both sides

AVAILABILITY : Box of 60’s in foil strips
PRICE : ₱12.28 per tablet / ₱736.81 per box of 60s

Target Doctors:

MACROBEE WITH IRON TABLET

Primary Targets Secondary Targets Other Targets
IM- Hema Other Surgical Specialties IM- Diab
OB-Gyne Ortho IM- Rheuma
Gen. Sur OB-Perinatology IM- Cardio
IM- Nephro IM- Gastro Rehab Medicine
OB- Onco IM- Pulmo Fellow Cardio
IM- Onco Fellow Gastro Fellow Diab
Geria-Geron Fellow Pulmo Fellow Pulmo
Family Med Fellow Nephro Uro
Gen. Internist Fellow Hema
General Practitioner Fellow Onco
Health Center MD Fellow Geria-Geron
Industrial Med Fellow OB-Onco
Fellow OB-Perinatology
Fellow Uro
Hospital Residents-Surg
Hospital Residents-IM
Hospital Residents-OB Gyne
Hospital Residents-Ortho
Hospital Residents-FM

Updated as of March 2022 4

 APPENDIX A
MACROBEE WITH IRON
Hematinic Multivitamins with Minerals
Who are the TARGET What Macrobee with Iron
DOCTORS? Reformulated can do?
OB-GYNE Macrobee with Iron Reformulated
(Consultants & tablet contains important blood
Residents) building (hematopoietic) agents
FAMILY PHYSICIANS needed in the formation and
HEALTH CENTER maturation of red blood cells.
MDs
GENERAL Macrobee with Iron Reformulated
PRACTITIONERS tablet provides high or
therapeutic dose of iron and other
blood-building nutrients (Vitamins
B9 & B12 and minerals) to
restore normal levels of these
nutrients required in the
production of red blood cells and
to correct the signs and
symptoms of IDA / treat IDA.
SURGEON Macrobee with Iron Reformulated
(Consultants & tablet contains important blood
Residents) building (hematopoietic) agents
OTHER SURGICAL needed in the formation and
SPECIALTIES maturation of red blood cells.
Macrobee with Iron Reformulated
tablet provides high or
therapeutic dose of iron and other
blood-building nutrients (Vitamins
B9 & B12 and minerals) to
restore normal levels of these
nutrients required in the
production of red blood cells and
to correct the signs and
symptoms of IDA / treat IDA.
INTERNISTS Macrobee with Iron Reformulated
(Consultants & tablet contains important blood
Residents) building (hematopoietic) agents
FAMILY PHYSICIANS needed in the formation and
HEALTH CENTER maturation of red blood cells.
MDs
GENERAL Macrobee with Iron Reformulated
PRACTITIONERS tablet provides high or
therapeutic dose of iron and other
blood-building nutrients (Vitamins
B9 & B12 and minerals) to
HEMATOLOGISTS / restore normal levels of these
IM – ONCOLOGISTS nutrients required in the
production of red blood cells and
to correct the signs and
symptoms of IDA / treat IDA.
Updated as of March 2022
tablet
In what CLINICAL CASES / CONDITIONS will
MACROBEE with Iron Forte tablet be
beneficial?
Iron deficiency Anemia that may be associated
with:
− Nutritional or Dietary deficiency
− Pregnancy (Dilutional Anemia)
− Profuse menstrual flow / Blood loss
during menstruation
− (DUB) Dysfunctional Uterine Bleeding
− Blood loss during childbirth / delivery
− Blood loss during post operative states
(D&C, hysterectomy, Total Abdominal
Hysterectomy with bilateral Salphingo-
Oophorectomy (TAHBSO) etc…)
Pregnancy, (Vitamin B9 prevents neural tube
defects, spina bifida, anencephaly, congenital
heart defects, oral and orofacial clefts), prevent
cervical dysplasia, B9 also promotes optimal
fetal brain development during pregnancy.
Vitamin B9 is good for patients taking oral
contraceptives, methotrexate a B9 antagonist.
Iron deficiency anemia that may result from:
− Blood loss associated with:
➢ Post-op cases/surgery with blood
loss
➢ Traumatic or endogenous
hemorrhage
➢ Post-op surgery (GIT bleeding,
peptic ulcer, etc…)
− Nutritional or Dietary deficiencies (as a
result of anorexia, deficient or
restrictive diet)
− Iron deficiency anemia which may result
from dietary deficiency, parasitism,
chronic illnesses, infections, etc…
− Iron deficiency anemia among the elderly
(due to deficient or restrictive diet, faulty
eating habits, etc…)
− Nutritional or Dietary deficiencies (as a
result of anorexia, deficient or restrictive
diet)
− Blood disorders (as adjunctive or
supportive therapy)
− Various forms of anemia, drug induced
anemia or anemia secondary to
chemotherapy, dietary deficiency, etc…
− Anemia associated with malignancies
5

GERIA – Macrobee with Iron Reformulated
GERONTOLOGISTS tablet contains important blood
GENERAL building (hematopoietic) agents
INTERNIST needed in the formation and
FAMILY PHYSICIANS maturation of red blood cells.
GENERAL
PRACTITIONERS Macrobee with Iron Reformulated
HCMDs tablet provides high or
therapeutic dose of iron and other
blood-building nutrients (Vitamins
B9 & B12 and minerals) to
restore normal levels of these
nutrients required in the
production of red blood cells and
to correct the signs and
symptoms of IDA / treat IDA.
NEPHROLOGISTS Macrobee with Iron Reformulated
tablet contains important blood
building (hematopoietic) agents
needed in the formation and
maturation of red blood cells.
Macrobee with Iron Reformulated
tablet provides high or
therapeutic dose of iron and other
blood-building nutrients (Vitamins
B9 & B12 and minerals) to
restore normal levels of these
nutrients required in the
production of red blood cells and
to correct the signs and
symptoms of IDA / treat IDA.
Updated as of March 2022
− Those taking methotrexate (B9 antagonist)
− As adjunctive agent in the preventive
management of colorectal carcinoma,
those on chemotherapy, those taking
methotrexate (B9 antagonist), patients with
anorexia deficient or restrictive diet who
are likely to suffer from B9 deficiency – to
prevent and treat B9 deficiency.
− Megaloblastic anemia, sickle cell anemia,
hemolytic anemia, hereditary
spherocytosis, as adjunctive therapy in
blood disorders
− Those taking folic acid antagonist drugs –
to prevent and treat B9 deficiencies.
− Aging, convalescing individuals with
restrictive or deficient diet
− Nutritional or Dietary deficiencies (as a
result of anorexia, deficient or restrictive
diet)
− Iron deficiency anemia resulting from
chronic illness
− Prevention and treatment of folic acid
deficiencies
− Individuals taking folic acid antagonist
agents (antibiotics, anticonvulsants, etc…)
− Chronically ill, convalescing individuals
who are likely to suffer from B9 deficiency
− Prevention of certain cancers, coronary
heart diseases and congenital deficiencies
− Nutritional deficiency, aging / elderly,
alcoholic, restrictive or deficient diet that
may result in B9 deficiency (common
among elderly)
− Anemia associated with renal failure or
advanced kidney disease
− Renal disorders with coexisting
hematologic problems / Anemia
− Patients on hemodialysis, Vitamin B9
regulates homocysteine levels in patients
undergoing dialysis and decreases
cardiovascular risk in patients with chronic
renal failure
− Patients on renal dialysis
6
 Competitors of MACROBEE with IRON (Reformulated) Tablet
(Multivitamins and Minerals + Iron)
SRP:
Macrobee with Iron (Reformulated) Tablet = P 12.28 per tablet ; P 736.81 per box of 60’s

MDC PRICE:

Direct Competitors = 9 BRANDS

Peso Savings (%)Price
BRAND NAME COMPANY MDC PRICE
Savings

1 FORTIFER FA tablet UAP ₱ 14.75 2.47 17%

GLOBIFER Forte
2 Medi-Rx ₱ 8 N/A
Capsule

3 Hemarate Tablet Biomedis (Unilab) ₱ 24.75 12.47 50%

4 HEMOBION Capsule Merck (Zuellig) ₱ Not Available in MDC

5 IBERET 500 Film Tab Abbott (Zuellig) ₱ 30.00 16.61 55%

IBERET 500 - Folic

6 Abbott (Zuellig) ₱ 20.75 7.36 35%
Acid

7 SANGOBION Capsule Merck (Zuellig) ₱ 24.75 11.36 46%

TERRAFERRON
8 Terramedic ₱ 7.00 N/A
Capsule
Wyeth (Metro
9 TRIHEMIC Tablet ₱ 17.75 4.36 25%
Drug)

Other Competitors
A. Pure Iron Preparations/ Single Ingredient (Ferrous Sulfate) = 7

FERROUS
BRAND COMPANY
CONTENT
1. Brisofer cap Brymer Pharma 250mg
2. Feosol timed-
Inovail (Zuellig) 250 mg
release cap
3. Ferglobin cap Pharmacare 75 mg elemental

4. Fer-In-Sol Mead Johnson 75 mg

Gen. Drug & Chem
7. United Home
(United Home 375 mg
Fersulfate Iron tab
Products)

B. 2-Ingredient Iron Preparations = 10

Updated as of March 2022 7

 b.1. Ferrous Sulfate + Folic Acid

BRAND COMPANY FORMULATION

Am Europharma Fe Sulfate 300 mg,

1. Ameciron tab
(Diethelm) Folic Acid 250 mcg
Fe Sulfate 200mg
(euqiv. to elemental Fe
2. Brisofer OB Brymer Pharma
60mg), Folic Acid
400mcg
Fe Sulfate 187 mg
Gen. Drug & Chem (equiv. to elemental Fe
3. Femina tab
(Unilab) 60 mg), Folic Acid 3.5
mg
Dessicated Ferrous
Solvay Pharma Sulfate (100mg
4. Ferro-Folsan Plus
(Diethelm) elemental Fe) 333.33
mg, Folic acid 850 mcg

Fe Sulfate 200mg Folic

5. Hemiron cap Ace
Acid 400mcg

Fe Sulfate 200 mg
6. Phil Pharmawealth
Nestor (Phil. (equiv. to 60 mg
/Nestor Ferrous Sulfate +
Pharmawealth) elemental Fe), Folic
Folic Acid tab
Acid 400 mcg
7. Ritemed Iron + Fe Sulfate 60mg, folic
Ritemed (United lab)
Folic Acid acid 600mcg

b.2. Ferrous Fumarate + Folic Acid

BRAND COMPANY FORMULATION

1. Anemicon Plus Fe Fumarate 200mg

San Marino
cap Folic Acid 50mcg
Fe Fumarate 520 mg
2. Beniforte cap Pharmatechnica
Folic Acid 80 mg
Fe Fumarate 200 mg
3. Fergesol cap IAE
Folic Acid 250 mg

C. Multi Ingredient Preparations with Iron = 31

BRAND COMPANY BRAND COMPANY

1. Appetite OB cap MPSI 17. Foramefer cap Interhealthcare

2. Anixon cap Kramer 18. Harvifer cap Wescrib

Eurohealthcare
3. Ferrovit softgel cap MegalifeSciences 19. Hemovin cap
(Biolink Pharma)
Tynor/ Intermed
4. Cherifer cap 20. Heralink EuroHealthcare
Mktg. (Metro Drug)
5. Dupharon cap PMS (CNN Generics) 21. IBC cap Pacific Pharma

6. Essenfer caplet Essenpharma 22. Imefer cap Le Jumont

7. Eurofer chewable Eurodrug (Croma Wyeth [Metro

23. Incremin
tab Medic) Drug]
EuroHealthcare
8. Fer-Essence 24. Iroplex cap Wellhealth
(BVG Pharma)
9. Ferosal cap Ad-Drugstel 25. Magniferon cap Filadams
Updated as of March 2022 8
 Pharma
10. Ferro-Mar cap St. Martin 26. Micron-C cap
Dynamic
J Raalph Pharma
11. Ferroplex tab 27. Mulvitron cap Wescrib
(One Pharma)
Mega Lifesciences
12. Ferrovit 28. Nakaron cap Vamsler
[Metro Drug]
Multicare
13. Foralivit cap Anm Europharma 29. Sorbifer Durules
(Diethelm)
14. Fumiron + B softgel Metro Pharma
RP Scherer (Meyers) 30. Trev-Iron cap
cap (Metro Drug)
D.B. Manix (Drug
16. Fenamil OB cap 31. Usanatal tab Icon
well)

Updated as of March 2022 9

 b.2. Ferrous Fumarate + Folic Acid
BRAND COMPANY FORMULATION

1. Anemicon Plus cap San Marino Fe Fumarate 200mg, Folic Acid 50mcg
2. Beniforte cap Pharmatechnica Fe Fumarate 520mg, Folic Acid 80mg
3. Fergesol cap IAE Fe Fumarate 200mg, Folic Acid 250 mg

C. Multi Ingredient Preparations with high Iron = 53

BRAND COMPANY BRAND COMPANY
1. Appetite OB MPSI 27. Hemarate tab Biomeds (United Lab)
2. Aminofer FA tab Multicare 28. Hemobion caps Merck (Zuellig)
3. Anixon cap Kramer 29. Iberet 500 filmtab Abbott (Zuellig)
4. Beniforte cap Pharmatechnica 30. Iberet 500 folic acid filmtab Abbott (Zuellig)
5. Cherifer cap Gruppo Medica/Metropolitan Pharma 31. IBC cap Pacific Pharma
6. Clusivol OB (Zuellig)
Wyeth 32. Imefer cao Le Jumont
7. Dupharon cap PMS (CNN Generics) 33. Incremin Wyeth (Metro Drug)
8. Elevit Pronatal Bayer (Zuellig) 34. Irobon cap Roddensers
9. Essenfer caplet Scheele / Chiral 35. Iroplex cap Wellhealth
10. Eurofer chewable tablet Eurodrug (Croma Medic) 36. Magniferon cap Filadams
11. Fenamil OB cap D.B. Manix (Drug Well) 37. Micron-C cap Pharma Dynamic
12. Fer-Essence EuroHealthcare (Nutripharm) 38. Mulvitron cap Wescrib
13. Feronerv cap AD-Drugstel (Providencia Medica) 39. Mosvit tab Multicare (Zuellig)
14. Ferosal cap AD-Drugstel 40. Nakaron cap Vamsler
15. Ferro-Mar cap St. Martine 41. Natalac Fefol cap Gruppo Medica (Metropolitan Pharma)

16. Ferroplex tab JRalphPharma (One Pharma) 42. Natalbes Catalent Australia (Meyers)
17. Ferrovit Mega Lifesciences (Metro Drug) 43. Obimin BioFemme (United Lab)
18. Foralvit Anm Europharma 44. Odiron-C tab Medichem (United Lab)
19. Foramefer cap Foramen 45. Sangobion cap Merck (Zuellig)
20. Fortifer tab UAP 46. Sorbifer Durules Multicare (Diethelm)
21. Fortifer FA tab UAP 47. Terraferron cap Terramedic
22. Fumiron + B softgel capsule RP Scherer (Meyers) 48. TLC Vita OB Scheele (Remed)
23. Globifer Forte cap Medi-Rx 49. Trihemic tab Wyeth (Metro Drug)
24. Harvifer cap Wescrib 50. Trev-Iron Metro Pharma (Metro Drug)
25. Hemovin cap Eurohealthcare (Biolink Pharma) 51. Trev-Iron plus cap Metro Pharma (Metro Drug)
26. Heralink Eurohealthcare 52. Usanatal tab Icon
53. Vita Zinc OB cap Medlink (Metro Drug)

Comparison of Formulation
Ma c ro b e e w ith Iro n Ta b le t Ma c ro b e e w ith Iro n
(R e fo rm u la te d ) F o rte Ta b le t
F o rm u la tio n :
Vita m in A (-) 3 ,0 0 0 IU
Th ia m in e Mo n o n itra te (Vit. B 1 ) (-) 10 m g
R ib o fla v in (Vit. B 2 ) (-) 5 mg
N ia c in a m id e (Vit. B 3 ) (-) 20 m g
P y rid o x in e HC l (Vit. B 6 ) (-) 5 mg
C y a n o c o b a la m in (Vit. B 1 2 ) 50 m cg 50 m cg
A s c o rb ic A c id (Vit. C ) 100 m g 80 m g
C h o le c a lc ife ro l (Vit. D 3 ) (-) 2 0 0 IU
A lp h a -to c o p h e ry l A c e ta te (Vit. E ) (-) 1 6 IU
C a lc iu m P a n to th e n a te (-) 10 m g
F o lic A c id (Vit. B 9 ) 1 mg 5 ,0 0 0 IU
E le m e n ta l F e 8 2 .5 0 m g
Iro n 1 0 2 .3 0 m g
F e rro u s F u m a ra te = 2 5 0 m g
M a n g a n e s e S u lfa te
Ma n g a n e s e S u lfa te 1 mg
M o n o h y d ra te 2 0 0 m c g
Ma g n e s iu m S u lfa te (-) 5 mg
P o ta s s iu m Io d id e (-) 100 m cg
C o p p e r S u lfa te (-) 200 m cg
C a lc iu m La c ta te (-) 250 m g
Zin c S u lfa te (-) 10 m g
C u p ric S u lfa te P e n ta h y d ra te 200 m cg (-)

Updated as of March 2022 10

 Multivitamins + Minerals + Iron + Folic Acid
Macrobee with Iron
Macrobee with Iron Ferroplex Forte Globifer Forte Iberet 500 Folic
(Reformulated) Fortifer FA tablet Hemarate FA tablet Hemobion capsule Iberet 500 filmtab Sangobion capsule Terraferron capsule Trihemic tablet
Forte tablet Capsule capsule Acid tablet
tablet

MDC Price: ₱ 12.50 ₱ 14.40 ₱ 8.60 ₱ 13.50 ₱ 9.75 ₱ 23.00 ₱ 19.25 ₱ 18.50 ₱ 25.25 ₱ 19.75 ₱ 7.00 ₱ 13.00

FORMULATION:
Vitamin A 3000 IU 5000 IU
Thiamine Mononitrate (Vit. B1) 10 mg 10mg 5 mg 10 mg 6 mg 6 mg 2 mg
Riboflavin (Vit. B2) 5 mg 6 mg 6 mg 2 mg
Niacinamide (Vit. B3) 20 mg 10mg 30 mg 30 mg 30 mg
Pyridoxine HCl (Vit. B6) 5 mg 5 mg 5 mg 5 mg 20 mg 5 mg 5 mg 2 mg
Cyanocobalamin (Vit. B12) 50 mcg 50 mcg 10 mcg 12 mcg 25 mcg 25 mcg 15 mcg 25 mcg 25 mcg 7.5 mcg 10 mcg 25 mcg
Ascorbic Acid (Vit. C) 100 mg 80 mg 100mg 75 mg 500 mg 500 mg 50 mg 100 mg 600 mg
Sorbitol 25 mg
Cholecalciferol (Vit. D3) 200 IU 4000 IU
Vitamin D 400 IU
Alpha-tocopheryl Acetate (Vit. E) 16 IU 100 IU 30 IU
Calcium Pantothenate 10 mg 5mg 10 mg 10 mg
Folic acid (B9) 1 mg (1000 mcg) 5,000 IU 250 mcg 500 mcg 600 mcg 1.5 mg 800 mcg 1 mg 400 mcg
Folacin 1 mg
Iron elem. Fe 82.50 mg 102.30 mg Fe Sulfate 62 mg elem. Fe 98.6 mg 105.6 mg Fe sulfate 60 mg elem. Fe 118.8 mg elem. Fe 105 mg elem. Fe 105 mg Fe gluconate 250 mg elem. Fe 65 mg elem. Fe 115 mg
Fe Fumarate 250 mg Fe Fumarate 300 mg Fe Fumarate 360 mg Fe Sulfate 525 mg Fe Sulfate 525 mg Fe Sulfate 200 mg Fe Fumarate 350 mg

Intrinsic Factor Concentrate 75 mg

Manganese Sulfate
Manganese Sulfate Monohydrate 200 mcg
1 mg 0.2 mg

Magnesium Sulfate 5 mg
Potassium Iodide 100 mcg
Copper Sulfate 200 mcg 0.2 mg
Calcium Lactate 250 mg
Zinc Sulfate 10 mg 20 mg
Cupric Sulfate Pentahydrate 200 mcg
Calcium Carbonate 200 mg
Nicotinamide 20 mg
Docusate Na 50 mg

Updated as of March 2022 11

Keywords and Phrases

Macrobee w/ Iron “Reformulated” Tablet

SET A
Probe Statements

In conditions where a hematinic formulation will be beneficial to your patients

In conditions where an anti-anemia is required
For your patients who would be needing an Iron preparation with other blood building nutrients
In conditions where a comprehensive anti-anemia preparation will benefit your patients

Support Statements

Comprehensive hematinic formulation with high dose of folic acid (at 1000 mcg)
Broad hematinic formulation ang Macrobee with Iron tablet
Iron is in the form of ferrous fumarate. Gentle sa sikmura? / less gastric irritation.
With 82.5 mg elemental iron fortified with substantial doses of less metallic taste important blood building
vitamins and minerals in just one tablet
Contains 82.5 mg elemental iron reinforced with other blood building nutrients
At mataas po ang folic acid content ng ating MACROBEE w/IRON Tablet
One tablet contains blood building nutrients with substantial amount of vitamin C
The formulation is reinforced with energy boosters, B vitamins and high amount of folic acid
Comes in easy to swallow slim film-coated
I hope you can put to test our Macrobee with Iron Tablet. Doctor, there is nothing more convincing and
credible than your own personal experience.
Hematinic preparation with most important blood building nutrients.

Closing Statements

So Doctor, when your patients require a broad/ comprehensive and high quality hematinic, please
strongly consider our MACROBEE w/ IRON Tablet
So Doctor, when patients require a comprehensive and high quality hematinic, please strongly consider
our film-coated and cost-effective MACROBEE w/ IRON Tablet

SET B
Probe Statements

In conditions where a broad hematinic with high dose folic acid will be beneficial to your patients
Should there be cases where a broad anti-anemia formulation will prove beneficial
In conditions that require a comprehensive hematinic formulation

Support Statements

One tablet of Macrobee with Iron Reformulated tablet provides broad hematinic coverage plus high dose
folic acid
Contains 82.5 mg elemental iron fortified with other important blood building nutrients
82.5 mg elemental iron plus all the other important blood building nutrients in one tablet
The formulation is reinforced with high concentration of folic acid (at 1000 mcg)
Iron is available in the form of ferrous fumarate
Comes in easy to swallow slim film-coated tablet
Provides blood-building nutrients, energy boosters, substantial concentration of vitamin C and high folic
acid, all in one tablet
Economical / affordably priced, gives your patients ___% savings
Contains 82.5 mg elemental iron fortified with all the other important blood building nutrients plus 1,000
mcg folic acid in just one easy to swallow slim tablet that is so affordably-priced.

Closing Statements

So Doctor, in conditions where a comprehensive or broad hematinic is required, with 1,000 mcg folic acid
in just one easy to swallow tablet that is so affordably priced – please consider our MACROBEE w/ IRON
Tablet.
So Doctor, in conditions where a comprehensive or broad hematinic is required please strongly consider
our affordable, sugar coated broad hematinic – MACROBEE with Iron Tablet.
Updated as of March 2022 12
Word meaning
BLOOD, IRON and ANEMIA

MOLVITE with IRON SYRUP, MACROBEE with IRON FORTE AND

REFORMULATED TABLET, MAXIFOL TABLET and MOLVITE – OB TABLET

PLASMA – the watery, straw-colored, fluid portion of the lymph and the blood in which the leukocytes, erythrocytes, and platelets are
suspended.
-fluid portion of the blood minus the RBC and WBC
PLASMA = Serum + Fibrinogen
SERUM – the remaining liquid when proteins involved in clotting have been removed from plasma
SERUM = Plasma – Fibrinogen

FIBRINOGEN is a plasma protein that is converted into fibrin by thrombin in the presence of calcium ions.

HEMATOPOIESIS - is the normal formation and development of blood cells in the bone marrow.
ERYTHROPOIESIS - is the process of erythrocyte or RBC production involving the maturation of a nucleated precursor into a hemoglobin-
filled, nucleus-free erythrocyte that s regulated by erythropoietin, a hormone produced by the kidney.
HEMATOPOIETIC SYSTEM - is the system of body organs and tissues involved in the formation of and functioning of blood elements. It
includes bone marrow and spleen
Red blood cells (erythrocytes) are produced in the bone marrow under the influence of a hormone called erythropoietin which is made
primarily in the kidneys. When you develop kidney disease, the production of erythropoietin decreases, leading to a reduced production
of RBC by the bone marrow resulting to anemia.

Erythropoietin is the hormone responsible for inducing red blood cell production by the body’s bone marrow. Erythropoietin is primarily
produced by the kidney when a drop in blood oxygen level is perceived, though 10-15% of the total erythropoietin produced comes from
the liver.

Hemoglobin is a globular molecule made up of 4 subunits. Each subunit is made of heme moiety conjugated to a polypeptide.

Heme – is an iron-containing porphyrin derivative

Globin – are polypeptides

Iron is an essential constituent of hemoglobin, cytochrome, and chief enzyme systems. Its chief functions are in the transport of oxygen
to tissues (hemoglobin) and in cellular oxidation mechanisms. Iron is used to build up the blood in anemia.

What is Anemia?

Anemia – reduction below normal in the number of red blood cells per cubic millimeter (mm3) or in the quantity of hemoglobin or in the
volume of packed red blood cells (hematocrit). Patients with anemia have a significant reduction in RBC cell mass and a corresponding
decrease in the oxygen-carrying capacity of the blood. In most instances, it results from a deficiency of red blood cells. Functionally,
anemia may result in tissue hypoxia (low oxygen content or tension) because of hemoglobin’s key role in oxygen transport.
- Present in adults if the hematocrit is < 41% (hemoglobin < 13.5 g/dl) in males or 37% (hemoglobin < 12 g/dl) in females.

What is Hemoglobin?

– is a complex of protein-iron compound in the blood that carries oxygen to the cells from the lungs and carbon dioxide away
from the cells to the lungs. It picks up oxygen in the lungs and delivers it to the peripheral tissues to maintain the viability of cells.

- Hemoglobin in the red blood cell contains the major portion of body iron (70-95% of body iron). It is a protein that has a
molecular weight of 64,658 and has approximately 0.35% iron by weight.

What is nutritional anemia?

Defined as a condition in which the hemoglobin content of the blood is lower than the normal value as a result of deficiency of essential
nutrients like iron, folic acid or vitamin B12 (ex. Iron Deficiency Anemia, Megaloblastic Anemia, Pernicious Anemia)
What is IDA – Iron Deficiency Anemia?
- Most common type of nutritional anemia caused by insufficient dietary intake and absorption of iron and/or iron loss from
intestinal bleeding.

- Commonly seen:
➢ between ages 6-24 months
➢ 0-6 months (caused by low levels of iron in the mother during pregnancy)
➢ Toddlers
➢ Pre – school
➢ Elderly
➢ Adolescent female (with profuse menstrual flow)

Updated as of March 2022 13

What is Megaloblastic anemia?

Anemia characterized by the presence of megaloblasts (large, nucleated, immature progenitor of abnormal RBC series in the
bone marrow due to deficiency in vitamin B9 ( folic acid ) and B12 ( cyanocobalamin ).
What is Pernicious Anemia?

A megaloblastic anemia occurring more commonly in later life in which the laboratory and clinical manifestations are based on
malabsorption of vitamin B12 due to a failure of the gastric mucosa to secrete adequate and potent intrinsic factor (glycoprotein secreted
by the parietal cells of the gastric mucosa). Intrinsic factor promotes B12 absorption

EXERCISE:

What are the causes of anemia?

1. Inadequate supply of iron EXERCISE: Identify the doctor(s) who will

a. lack of iron stores at birth treat the disease / causes of anemia:
1. Low birth weight, premature, twin or multiple births
2. Severe in iron deficiency in mother
_____________________________
3. Fetal blood loss before or at delivery _____________________________
- into maternal circulation _____________________________
- retroplacental bleeding
4. Bleeding in the infant during the first few days of weeks of
_____________________________
life. _____________________________
Inadequate intake – deficient dietary iron _____________________________
b. Lack of RBC production
- Diet
_____________________________
- Hormone _____________________________
2. Increased RBC destruction _____________________________
a. Sickle cell anemia
b. Thalassemia
_____________________________
c. Hemolytic anemia _____________________________
3. Impaired iron absorption _____________________________
a. Chronic recurrent diarrhea
b. Malabsorption syndrome
_____________________________
c. Gastrointestinal abnormalities _____________________________
4. Excessive demands for iron required for growth _____________________________
a. Premature or rapidly growing low birth weight infant
b. Adolescent
_____________________________
5. Blood loss – the most common cause of IDA in adults. _____________________________
a. Acute or chronic hemorrhage – frequent episodes of epistaxis _____________________________
(nose bleeding)
b. Parasitic infections e.g. hookworms
_____________________________
c. Profuse Menstruation – Menstruating women lose about 30 mg _____________________________
of iron with each menstrual period; women with heavy menstrual _____________________________
bleeding may lose much more. Thus, many premenopausal
women have low iron stores or even iron deficiency.
_____________________________
d. Gastrointestinal Bleeding – in men and postmenopausal women, _____________________________
the most common site of blood loss is the gastrointestinal tract. _____________________________
Patients with unexplained iron deficiency anemia should be
evaluated for occult gastrointestinal bleeding.
_____________________________
6. Others: _____________________________
a. Chronic disease _____________________________
b. Anemia related to kidney disease
c. Pregnancy
_____________________________
d. Poor nutrition / alcoholism _____________________________
e. Anemia due to abnormal hemoglobin molecules (sickle cell
anemia)

What are Hematinic agents?

Hematinic agents are substances or compounds which improve the quality of the blood, increasing the hemoglobin level and the number
of red blood cells

What are the different hematinic agents?

The following nutrients are needed in the formation and maturation ( erythropoiesis or production of erthrocytes) of red blood
cells (RBC) so they are called hematopoietic ( blood building ) or hematinic agents:

− Iron is an integral part of the hemoglobin molecule of the red blood cells (RBC or erythrocytes).
Hemoglobin is an oxygen - carrying pigment of the erythrocyte; it is formed by the developing erythrocyte ion bone marrow.
Hemoglobin is a conjugated protein containing four heme groups and globin (polypeptide chain of amino acids).
− Pyridoxine (Vitamin B6) acts as a co – enzyme in the metabolism (anabolism) of amino acids into various compounds and
body tissues. The hemoglobin molecule is made up of globin peptide chains consisting of amino acids.
− Folic acid (Vitamin B9) and Cyanocobalamin (Vitamin B12 ) are important in the formation and maturation of RBC.
A deficiency of these important vitamins or impairment in their utilization results in deranged or inadequate synthesis of DNA.
This slows the rate of division of blood cells leading to accumulation in the marrow of cells with large nuclei.
− Manganese and Copper are elements (minerals) which act as components of multi enzymes that participate in red blood cell
formation / production.

Updated as of March 2022 14

 What are the different types of ferrous salt?

Equivalent percentage (%) of elemental iron for each type of ferrous salt:
Ferrous Fumarate --- 33%
Ferrous Gluconate --- 12%
Ferrous Lactate --- 19%
Ferrous Sulfate ( hydrated) --- 20%
Ferrous Sulfate ( dessicated ) --- 30%

Advantages of ferrous fumarate:

- Less metallic taste
- Less gastrointestinal irritations

How is anemia treated?

The most important part of treatment is identification of the cause of anemia especially a source of occult blood loss.

Iron deficiency anemia is treated with oral or parenteral iron preparations. Oral iron corrects the anemia just as rapidly and
completely as parenteral iron in most cases if iron absorption from the gastrointestinal tract is normal. An exception is the high
requirement for iron of patients with advanced chronic kidney disease who are undergoing hemodialysis and treatment with
erythropoietin; for these patients, parenteral iron administration is preferred.

The usual adult with iron deficiency will require between 150 – 200 mg of elemental iron per day. Given an absorption
rate of 5 to 20%, in order to replete body iron completely; 3 to 6 months of continuous oral therapy are usually
required.

What are the side effects of Iron?

Gastrointestinal disturbances such as:

- Nausea
- Vomiting
- Constipation
- Diarrhea
- Darkening / blackening of stools may obscure the diagnosis of continued gastrointestinal blood loss.
- Abdominal distress, epigastric discomfort
- Chronic iron toxicity (iron overload), also known as hemochromatosis, results when excess iron is deposited in the heart, liver,
pancreas, and other organs. It can lead to organ failure and death. It most commonly occurs in patients with inherited
hemochromatosis, a disorder characterized by excessive iron absorption, and in patients who receive many red cell
transfusions over a long period of time (eg, patients with thalassemia major).

Drug interaction of Iron: Tetracyclines, Antacids

WORD MEANING
Collagen – is the main protein constituent of the white fibres of
connective tissue and cartilage and the organic substance of bone.
Hematinic agents - are substances or compounds which improve the
quality of the blood, increasing the hemoglobin level and the number of
red blood cells.
Hematopoiesis – is the normal formation and development of blood
cells in the bone marrow.
Erythropoietin – is the hormone responsible for inducing red blood cell
production by the body’s bone marrow. Erythropoietin is primarily
produced by the kidney when a drop in blood oxygen level is perceived,
though 10-15% of the total erythropoietin produced comes from the liver.
Erythropoiesis – is the process of erythrocyte or RBC production
involving the maturation of a nucleated precursor into a hemoglobin-
filled, nucleus-free erythrocyte that is regulated by erythropoietin, a
hormone produced by the kidney.
Hemoglobin is a complex of protein-iron compound in the blood that
carries oxygen to the cells from the lungs and carbon dioxide away from
the cells to the lungs. It picks up oxygen in the lungs and delivers it to
the peripheral tissues to maintain the viability of cells.
Anemia – a reduction below the normal in the number of erythrocytes
per cu. mm. in the quantity of hemoglobin or in the volume of packed red
blood cells per 100ml of blood which occurs when the equilibrium
between blood loss (through bleeding or destruction) and blood
production is disturbed.
IDA – Iron Deficiency Anemia
Megaloblastic Anemia – a rare, familial form of anemia, characterized
by selective intestinal malabsorption vitamin B12 uninfluenced by
intrinsic factor and associated with proteinuria and structural
genitourinary tract anomalies.
Pernicious Anemia – a megaloblastic anemia occurring in children but
more commonly in later life characterized in the adult by histamine-fast
achlorhydria in which the laboratory and clinical manifestations are
based on the malabsorption of vitamin B12 due to a failure of gastric
mucosa to secrete adequate and potent intrinsic factor.
Hemorrhage – the escape of blood from the vessels; bleeding.
Natal – pertaining to birth.
Pre-natal – existing or occurring before birth, with reference to the fetus
Post-natal – occurring after birth, with reference to the newborn
Lactation – the period of the secretion of milk
Updated as of March 2022
Homocystenemia or hyperhomocystenemia - (increased levels of
homocysteine in the blood) is recognized as an emerging risk factor for
the development of CHD (Coronary Heart Diseases) aside from
hypertension, smoking and hyperlipidemia.
Neural Tube defect (NTD) - A congenital defect of the central nervous
system, including the spinal cord, skull and brain, resulting from failure
of the neural tube to properly close during fetal development. Defects
may include absence of the skull, and protrusions of the brain or spinal
cord. Most such defects can be detected before birth by determination
of amniotic fluid or blood levels of alpha-fetoprotein and by ultrasonic
scanning.
Spina bifida – a development anomaly characterized by defective
closure of the bony encasement of the spinal cord, through which the
cord and meninges may or may not protrude.
Anencephaly – congenital absence of the cranial vault, with cerebral
hemispheres completely missing or reduced to small masses attached
to the base of the skull.
Hemolytic anemia – a general term for anemia, present at birth, in
which the lifespan of red blood cells is diminished.
Sprue – a chronic form of malabsorption syndrome occurring in both
tropical and nontropical forms.
Gastrectomy – excision of the whole or part of the stomach.
Dysplasia – abnormality of development; in pathology, alteration in size,
shape, and organization of adult cells.
Sickle Cell disease - Sickle cell anemia is a disease passed down
through families in which red blood cells form an abnormal crescent
shape. (Red blood cells are normally shaped like a disc.)
Hereditary spherocytosis - is a genetically-transmitted (autosomal
dominant) form of spherocytosis, an auto-
hemolytic anemia characterized by the production of red blood cells that
are sphere-shaped rather than bi-concave disk shaped (Donut-Shaped),
and therefore more prone to hemolysis
15
Updated as of March 2022 16