Ferrous Sulfate

Brand Name: Examples include Feosol and Feratab Generic Name: Ferrous Sulfate (FER-us SULL-fate) Classification: Iron Preparation Pregnancy Category A

Indications:
Preventing or treating low levels of iron in the blood. It also may be used for other conditions as determined by your doctor. Ferrous Sulfate is an essential body mineral. It works by replacing iron in your body if your body does not produce enough on its own.

Contraindications:
You are allergic to any ingredient in Ferrous Sulfate; hemochromatosis, hemosiderosis, hemolytic anemias. You have high levels of iron in your blood, peptic ulcer, regional enteritis, ulcerative colitis. Contact your doctor or health care provider right away if any of these apply to you.

Dosage:
Stated dose is for elemental iron. Dosage must be calculated based on salt form. Ferrous sulfate is 20% elemental iron. Ferrous sulfate, exsiccated, is approximately 32% elemental iron. Ferrous gluconate is about 12% elemental iron. Ferrous fumarate is 33% elemental iron.

Iron Replacement Therapy in Deficiency States Adults Children

PO 150 to 300 mg/day in 3 divided doses. Alternatively, 60 mg 2 to 4 times daily may lessen GI effects. PO 3 to 6 mg/kg/day in 1 to 3 divided doses.

Mechanism of Action:
Absorption Primary site of absorption is the duodenum and upper jejunum. Food decreases absorption at least 50%. Elimination Daily loss of iron from urine, sweat, and sloughing of intestinal mucosal cells equals about 0.5 to 1 mg in healthy men and about 1 to 2 mg in menstruating women.

Adverse Reactions:
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome: o Constipation; darkened or green stools; diarrhea; nausea; vomiting; anorexia; stomach upset. Seek medical attention right away if any of these SEVERE side effects occur: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black, tarry stools; blood or streaks of blood in the stool; fever; vomiting with continuing sharp stomach pain.

Nursing Responsibility:

Advice patient dose may be changed periodically to obtain max benefit and minimize adverse reactions. Caution patient receiving iron supplements in conjunction with epoetin therapy that failure to take the iron supplement as prescribed may interfere with the beneficial effects of epoetin. Caution patient not to change the dose of, or stop taking, the iron supplement unless advised by health care provider. Caution patient or caregiver who is considering self-treatment of a suspected anemic state to seek medical advice before beginning treatment. Advise patient that other conditions could mimic an anemic state and using iron supplements could be harmful if taken when not clearly needed. Caution patient each iron product has specific dosing instructions, to read package label before using, and not to exceed dose or frequency of administration instructions unless advised differently by health care provider.

Caution patient or caregiver multiple salt forms (eg, sulfate, gluconate, fumarate) containing different amounts of elemental iron are available and to check product label when purchasing replacement iron supplements to ensure proper salt form is being used and doses are the same based on elemental iron content. Advice patient with sulfite or tartrazine sensitivity to carefully read inactive ingredients listed on package to identify iron supplement that contains sulfites and/or tartrazine. Advise patients to avoid those products and consult with pharmacist if they have any questions or are not sure about the contents of the product. Advise patient to take on an empty stomach, 1 h before or 2 h after a meal. Advise patient to take in divided doses if GI upset occurs with single dose. If GI upset does not resolve with divided dose administration, advise patient to take each dose with food. Instruct patient who also is taking antacids, tetracycline antibiotic, or fluoroquinolone antibiotic to separate administration of iron supplement by at least 2 h. Advice patient using enteric-coated or timed-release tablets to swallow tablets whole and not to crush, chew, cut, or split the tablet. Advise patient using elixir to measure prescribed dose of elixir using dosing syringe, dosing spoon, or dosing cup. To reduce risk of temporary staining of teeth, advise patient to dilute prescribed dose of elixir with water or juice and drink directly or drink through a straw. Caution patient not to dilute elixir with milk or wine-based vehicles. Advise patient or caregiver using iron supplement drops to measure prescribed dose using calibrated dropper and to administer directly into mouth with dropper or mix with water or juice. Inform parent or caregiver that when iron-containing drops are given to infants, the membrane covering the teeth may darken; this is normal and of no consequence. Advise patient using suspension to shake suspension well before measuring dose and to measure and administer prescribed dose of suspension using dosing syringe, dosing spoon, or dosing cup. Advise patient or caregiver iron supplements may cause the stools to turn black and this is normal and of no consequence. Advise patient or caregiver stomach pain, constipation, diarrhea, stomach irritation, nausea, and vomiting are the most common adverse reactions. Instruct patient to notify health care provider if any occur and are intolerable. Caution parent or caregiver accidental overdose of iron-containing products is a leading cause of fatal poisoning in children and to take precautions to keep iron-containing products out of reach of children.