Review of effective iron-containing tablets

Iron is not a cure, but doctors often prescribe it to their patients. Iron supplements are especially often prescribed to women during pregnancy. But iron deficiency occurs not only during pregnancy. In the vast majority of cases, the deficiency is easily restored with the help of an iron-rich diet, but if the deficiency is severe, iron supplements are prescribed. If such treatment is insufficient, special circumstances or diseases are determined in which it is necessary to administer iron intravenously, that is, directly into the blood vessels. How to take iron supplements correctly will help you understand the answers to the most common questions regarding the use of these products at home.

What causes iron deficiency in the body?

The following reasons lead to the development of iron deficiency anemia:

• Chronic blood loss. This includes regular nosebleeds, heavy and prolonged menstrual bleeding, and bleeding from the gastrointestinal tract.
• A condition of the body in which iron is consumed more than usual. These include: pregnancy, breastfeeding, periods of intensive growth in childhood and adolescence. Many chronic diseases also cause the body to use up its iron stores.
• Sometimes the gastrointestinal tract is simply unable to absorb iron. For example, similar situations are observed in inflammatory bowel diseases.
• Adherence to dietary patterns that do not contain meat or other animal products. For this reason, vegetarians and people whose menu is not balanced in composition often suffer from anemia.

Side effects

During treatment, the patient's general condition may unexpectedly worsen. This is due to a systematic violation of daily dosages, or the body does not tolerate such active components of the prescribed medication. Side effects are temporary and require immediate adjustment of daily dosages. If you ignore such valuable recommendations, the clinical picture only worsens, and the symptoms of the pathology become more pronounced:

• problems with the gastrointestinal tract, represented by indigestion, bloating, chronic constipation;
• pathology of tooth enamel, which becomes faded and brittle, and teeth may even begin to decay;
• On the part of the skin, doctors do not rule out allergic reactions in the form of rash, urticaria, and itchy skin.

What are the signs of iron deficiency?

Iron deficiency anemia can have a hidden course. It can be indicated by signs that make it difficult to guess about a developing problem. The body signals anemia by decreased appetite, increased weakness, deterioration of the condition of nails and hair, distortion of taste preferences (a person may start eating chalk, toothpaste, ice, etc.). The skin of people with anemia is pale, and shortness of breath and tachycardia may periodically bother them.

If you take blood for analysis, it will reveal a decrease in hemoglobin, red blood cells, and serum iron. The color index will be below normal.

Even a doctor cannot make a final diagnosis based only on external signs of anemia. To confirm anemia, you will need to take a blood test.

Treatment should be selected by a specialist. It is he who determines which drug should be taken in a particular case and how long the therapy should last.

Fenyuls

Release form: capsules coated with a compound that forms a semi-permeable film of a certain thickness. This ensures a gradual release of iron.

If there are current instructions on the drug’s website, then it seems that this is the only iron supplement that can be dispensed without a doctor’s prescription.

But I wouldn't do it, and here's why.

Fenyuls contains ferrous sulfate and a number of vitamins (B1, B2, B6, PP, ascorbic acid, calcium pantothenate). All this, as the manufacturer claims, improves iron absorption and prevents the formation of free radicals.

But there are more side effects, since in addition to the side effects for iron, side effects for vitamins have been added: allergic reactions, dizziness, tachycardia, sweating, numbness of the extremities, an increase in the number of platelets, leukocytes, increased blood sugar levels, etc.

Maybe that's why the manufacturer is so careful with the recommended dosage? Pure iron in 1 capsule - 55 mg. Take 1-2 capsules per day. This dosage is more suitable for the prevention of anemia or the treatment of latent iron deficiency.

Contraindicated for children, allowed for pregnant and lactating women.

How anemia drugs work

To treat iron deficiency anemia, you will need to take ferrous or ferric iron supplements. Medicines containing ferrous iron are absorbed by the body faster than ferric iron preparations. They are almost 100% absorbed in the intestines, which can sometimes be dangerous. The cost of ferric iron preparations exceeds the cost of divalent iron preparations.

For Fe3 to turn into Fe2, it requires an oxidizing agent, such as ascorbic acid. In the intestines, iron combines with transferritin. This protein transports iron molecules to the tissues and organs responsible for the formation of blood cells (liver and bone marrow).

Products such as tea and milk worsen the process of iron absorption. This is also true for drugs from the tetracycline group, Levomycetin, Maalox, Almagel and drugs containing potassium. On the other hand, iron is best absorbed from red meat and fish.

It is unacceptable to prescribe iron supplements on your own, since an incorrectly selected dose increases the likelihood of poisoning.

Hematopoietic stimulants

For anemia caused by abnormalities in hematopoiesis, you should take medications that can normalize this process. Iron supplements are preferably taken orally. The stimulator of hematopoiesis necessary to eliminate the pathological condition is ferrous lactate.

The drug contains divalent iron. It is taken orally 3-5 times a day, 1 g. Additionally, it is necessary to take ascorbic acid. Like other iron preparations, the drug can cause side effects if treatment recommendations are not followed.

The group of hematopoietic stimulants also includes Phytoferrolactolol tablets. They are recommended for patients who have problems with the nervous system in combination with anemia. The drug is taken one tablet three times a day. It is not recommended to exceed the indicated dosage.

Ferrocal tablets are a combined antianemic agent. Take a medicine based on ferrous sulfate for hypochromic anemia, asthenia, and general loss of strength. Any medication is prescribed only by a specialist.

List of drugs for the treatment of iron deficiency anemia

Based on WHO recommendations for the treatment of iron deficiency anemia, as well as based on feedback from practicing doctors, the best drugs for the treatment of anemia in adult patients include:

• Maltofer and Maltofer-Fol.
• Ferlatum and Ferlatum-For.
• Fenyuls.
• Ferro foil.

For the treatment of anemia in pregnant women, the best drugs are recognized:

• Totema.
• Sorbifer Durules.
• Gyno-Tardiferon.
• Maltofer.
• Ferrum-Lect.

The following iron supplements are used to treat anemia in childhood:

• Actiferrin.
• Hemophere prolongatum.
• Tardiferon.
• Totema.
• Maltofer and Maltofer-Fol.
• Ferrum-Lect.
• Venofer.

Price

The cost of drugs with a natural concentration of iron varies, but doctors strongly recommend not saving on such an important purchase, your own health. This is explained by the need for rapid positive dynamics, which will help avoid serious complications of iron deficiency anemia. Below are the prices of both cheap medications and expensive ones that meet all the stated requirements of the clinical patient and the attending physician. So:

Ferric iron preparations

Maltofer and Maltofer-Fol

Maltofer contains ferric hydroxide polymaltose complex.

The drug has 4 release forms:

• In the form of syrup with a nominal volume of 150 ml. 1 ml of the drug contains 10 mg of iron.
• In the form of drops with a nominal volume of 30 ml. 1 ml of the drug contains 50 mg of iron. One milliliter is equal to 20 drops.
• In the form of a solution of 5 ml (10 glass ampoules). Each bottle contains 100 mg of iron.
• In the form of chewable tablets of 100 mg. One blister contains 20 plates.

The drug in tablet form is not recommended for use in children under 12 years of age. While the solution and syrup can be used to treat anemia in children from birth. The syrup is easily dosed; there is a convenient cap for this purpose.

A distinctive feature of the drug Maltofer is that it does not give tooth enamel a dark color. Therefore, its liquid form can be mixed with juices or other drinks that do not contain alcohol.

The drug Maltofer-Fol is available in the form of chewable tablets, which, in addition to ferric iron, contain folic acid (0.35 mg).

Ferlatum and Ferlatum Fol

The drug Ferlatum. It contains iron protein succinylate, in the form of a solution. The color of the liquid is brown and has a specific odor. Due to the protein content in the drug, it does not irritate the walls of the stomach and intestines. This is to prevent the development of side effects.

Release form: in the form of a solution of 15 ml in a bottle. You can purchase a package of 10 or 20 bottles. Each contains 40 mg of iron.

The drug should be taken after meals, the dose is selected by the doctor. If necessary, the course of treatment can last up to six months.

Ferlatum-Fol is a medicinal solution that has a cherry scent. The bottle contains 40 mg of iron and 0.235 mg of folinate. Taking the drug is designed to overcome the lack of iron and folate in the body.

You can take Ferlatum-Fol either before meals or after meals. If a person suffers from fructose or milk protein intolerance, then this drug is prescribed to him with caution.

Ferrum-Lect

Ferrum-Lect. This drug contains polymaltose ferric iron complex. Forms of release of the drug:

• 30 chewable tablets of 100 mg.
• 100 ml syrup. 5 ml of the drug contains 50 mg of iron.
• Solution for injection, produced in ampoules of 2 ml. Each ampoule contains 100 mg of iron.

During administration, the tablet is washed down with water or chewed. If necessary, it is divided into several parts. In the form of syrup, the drug can be taken with water, and the drug can also be added to baby food. You need to measure the dose using a special spoon that comes with the kit.

If an injection solution is used, the needle must be inserted deep into the muscle. The procedure is carried out exclusively in a hospital setting. Injections are indicated only for severe anemia, when oral administration of iron supplements is impossible or does not have an effect. You cannot combine injections of iron supplements with their oral administration.

Venofer

Venofer is a drug that is intended for injection. It contains ferric iron in combination with sucrose. The drug is available in 5 ml ampoules. Venofer is used exclusively for intravenous administration and only in emergency situations. For example, against the background of acute inflammation of the digestive system.

Aktiferrin

Oral dosage forms: drops, syrup.

Previously, there were also capsules, but now I don’t see them in the assortment of Russian pharmacies.

The composition contains ferrous sulfate, which, let me remind you, is characterized by maximum toxicity, and the amino acid serine. It improves iron absorption, since only 10-15% of ferrous iron is absorbed through the mucous membrane of the small intestine.

(And trivalent without helpers is not absorbed at all).

Pregnant and lactating women can.

Children: syrup from 2 years, drops from birth.

The dose is calculated per kg of weight.

The course of treatment is at least 8 weeks.

After hemoglobin returns to normal, you need to continue taking the drug for the same amount of time to replenish iron reserves.

What I don't like about Aktiferrin

The manufacturer's instructions indicate the iron content in 100 ml of syrup or drops. This means that the doctor must calculate the daily dosage, taking into account the child’s weight and iron deficiency, which is determined by the formula. And if he is not good at mathematics, it is easy to make a mistake and either overdo the dose, or vice versa.

In the first case, this threatens with intoxication, in the second - too long a course of treatment.

Ferrous iron preparations

Fenyuls

is a drug that, in addition to ferrous iron, contains vitamin C and B vitamins. The use of such a complex allows you to improve the process of absorption of iron by the body. The main active ingredient is enclosed in a capsule and has the form of microgranules. This allows the iron and other components of the capsule to dissolve slowly, which does not irritate the walls of the intestines and stomach.

Ferro foil

is a ferrous iron supplement supplemented with cyanocobalamin and folic acid. One capsule contains 37 mg of iron. The drug gives a minimum of side effects and is quickly absorbed in the intestine, into its

Totema

– a drug for the treatment of anemia with divalent iron, copper and manganese in its composition. The drug is available in ampoules that are taken orally. Totem is prescribed to children over 3 months old. After its use, tooth enamel may darken, so it is recommended to dissolve the contents of the ampoule in a drink. After taking the drug, you should brush your teeth.

Gyno-Tardiferon.

This drug is widely known among pregnant women. It contains divalent iron in the amount of 40 mg, as well as folic acid. Gyno-Tardiferon is available in tablet form. It is approved for use in the treatment of anemia in children over seven years of age. In addition to the fact that this drug helps replenish iron reserves in the body, it also eliminates folic acid deficiency. This is especially true for expectant mothers. The drug should be taken with large volumes of water.

Sorbifer Durules

is a ferrous iron preparation, which is available in tablet form. In addition, the drug is supplemented with vitamin C. Sorbifer durules can be used to treat children over 12 years of age. It is also often prescribed to pregnant women. Take the drug half an hour before meals, swallow the tablet whole and wash it down with water. During the therapeutic course, you need to be careful when driving, as Sorbifer Durules affects concentration.

Aktiferrin

is a preparation containing divalent iron, as well as D, L-serine.

The drug has several forms of release:

• In the form of capsules containing 34.5 mg of iron and 129 mg of D,L-serine. One package contains 20 capsules.
• In the form of syrup with a nominal volume of 100 ml. At the same time, it contains 34.2 mg of iron, and 25.8 mg of D, L-serine.
• In the form of drops in a bottle with a nominal volume of 30 ml. One drop contains 9.48 mg of iron and 35.6 mg of D, L-serine.

Actiferrin is prescribed for the treatment of pregnant women. It can also be taken during lactation. However, during treatment with Actiferrin, tooth enamel may darken, so it should be diluted before use. It is important to note the date the package was opened, since after a month the drug will become unusable.

Hemophere prolongatum

is a drug containing ferrous iron in the amount of 105 mg per capsule. It should not be used to treat children under 12 years of age. Otherwise, there are no restrictions, so the drug is prescribed for therapy in lactating and pregnant women. The dosage must be selected by the doctor. Take Hemofer prolongatum before or after meals, which depends on the individual characteristics of the human body.

Features of popular tablets containing iron

Iron tablets are a classic in the treatment of iron deficiency anemia. In this case, the therapeutic dose of the microelement in them should be at least 30 mg. Tablets are prohibited for children under 3 years of age, and the capsule version is prohibited for children under 7 years of age for fear that the child may choke. Further, all the features depend on what iron the preparations are based on: divalent or trivalent. According to Federal clinical guidelines:

• tablets for relieving anemia based on ferric iron contain hydroxypolymaltase iron complex (HPC) - these are Maltofer and Ferrum-Lek;
• tableted preparations based on ferrous sulfate slowly oxidize to the trivalent version, therefore they are produced only in dry forms - these are Actiferrin, Tardiferon, Fenyuls (Actiferrin drops have a controversial reputation in terms of effectiveness);
• tablets of organic iron salts are less soluble in water than sulfates and chlorides, which are not recommended for use today, since they darken tooth enamel, but are highly soluble in the stomach - these are Ferretab, Ferlatum.

And then the features of ferrous iron tablets are that:

• they are better absorbed if you take the drug an hour before meals, on an empty stomach;
• tea, coffee, milk, bread minimize the effectiveness of medications, so consume foods a couple of hours before taking the pills or two hours after using them;
• the tablets require a course duration (up to six months with monthly blood monitoring);
• hemoglobin begins to increase three weeks after the start of therapy;
• tablets are combined with the consumption of meat and liver, poorly - with buckwheat, apples, pomegranates;
• It is better to take medications to correct iron deficiency with juice or fruit drinks, which contain a lot of vitamin C;
• To prevent tooth enamel from darkening during treatment, the tablets are swallowed whole.

If therapy is carried out with ferric iron preparations, you should only pay attention to protecting tooth enamel, since all negative reactions are minimized.

Recommendations for taking iron supplements

• You cannot deviate from the regimen of taking iron supplements. Only the doctor can determine it. An overdose of drugs in this group can have serious consequences.
• After 30-45 days from the start of treatment, the hemoglobin level should stabilize. To determine this, you will need to take a blood test.
• During treatment, a person may find that his stool is dark in color. You should not be afraid of this, since such a phenomenon is a variant of the norm. When a doctor prescribes a stool test for occult blood, he should be warned that the patient is taking iron supplements.
• Taking iron supplements is associated with a number of complications, including: abdominal pain, nausea and vomiting, bloating, and pain along the intestines.

There is now a large selection of iron preparations on the market, which allows you to choose a release form that is convenient for the patient and make therapy individually oriented. However, this does not mean that you can prescribe medications yourself. Only a doctor should select therapy and only after an examination. Anemia can be treated over a long period of time and this entire process must be supervised by a specialist.

Tardiferon

Release form: available in the form of film-coated tablets with prolonged release of the active substance.

The composition again contains ferrous sulfate.

Differences from the drug Sorbifer: a smaller dosage of pure iron in one tablet (80 mg versus 100 mg), so you will have to wait longer for the effect. No ascorbic acid.

Children - from 6 years old.

Pregnant and lactating women are allowed.

Standard therapeutic dosage for adults: 1-2 tablets. per day (80-160 mg of iron).

Which drugs are more effective?

All drugs that are used to get rid of iron deficiency can be divided into 2 large groups: ferrous iron preparations (ionic salts) and ferric iron preparations (based on HPA). As an analysis of the practical use of divalent and trivalent iron preparations shows, their therapeutic effect in terms of treating anemia is equivalent.

Taking ferrous iron supplements is associated with the following problems:

• The body can absorb these drugs in uncontrolled quantities, which can cause serious poisoning.
• The drugs can interact with food and other drugs.
• During treatment, an unpleasant metallic taste may appear in the mouth.
• The teeth and gums may become dark in color. Sometimes the coloring turns out to be quite persistent.
• About 30-35% of patients stop therapy without completing the course.

If you use ferric iron preparations based on CGP, you can avoid many problems.

Compared to their divalent analogues, they have the following advantages:

• There is no risk of overdose and poisoning of the body. The drugs are absolutely safe in this regard.
• Gums and teeth are not stained dark.
• The drugs have a pleasant taste.
• They are well tolerated by patients.
• Most patients complete the course.
• Ferric iron preparations do not interact with other medications and food products.
• In addition to saturating the body with iron, most of these drugs have an antioxidant effect.

Taking medications containing ferrous iron may be accompanied by constipation, abdominal pain, diarrhea, nausea and vomiting. As a result of the occurrence of such side effects, the person refuses treatment. In addition, the body is able to absorb iron in excess amounts, which sometimes leads to poisoning. Therefore, experts give preference to modern drugs containing ferric iron.

The main drugs that are used to treat iron deficiency anemia are presented in the picture below:

In addition to oral administration of iron supplements, it is possible to use iron-based medications in the form of injections. They are administered either intramuscularly or intravenously. Such drugs are recommended for use only when oral administration is impossible or does not achieve the desired effect.

Indications for parenteral administration of iron supplements:

• Severe anemia. In modern practice, such a situation occurs rarely, in no more than 3% of all cases of the disease.
• Intolerance to iron preparations produced for oral administration.
• Resistance to treatment with oral drugs.
• Stomach and duodenal ulcers, previous operations on the digestive system. Moreover, even if there was already a history of peptic ulcer disease, this would still be a contraindication to oral administration of iron supplements.
• Anemia that develops against the background of chronic intestinal pathologies, for example, against the background of Crohn's disease or against the background of ulcerative colitis.
• Chronic kidney diseases. Parenteral iron supplements are also prescribed to patients undergoing hemodialysis. This measure is aimed at preventing anemia.
• Inability to perform red blood cell transfusion.
• There is an urgent need to immediately replenish iron reserves in the body.

Injections into the muscle or intravenous infusions of iron preparations are performed 1-3 times every 7 days. The dose should not exceed the general iron deficiency in the human body. To calculate your total iron deficiency, use the following formula:

General iron deficiency in mg = Person’s weight in kg * (Normal hemoglobin in g/l - patient’s hemoglobin in g/l) + iron depot in mg.

Coefficient 0.24 = 0.0034*0.07*1000, where:

• The iron content in hemoglobin is equal to 0.34%;
• The volume of blood in the human body is 7% of his body weight.
• 1000 – conversion of grams to milligrams.

Thus, iron stores in patients depending on their body weight:

• Weight below 35 kg – 15 mg/kg, target hemoglobin concentration – 30 g/l.
• Weight over 35 kg – 500 mg, target hemoglobin concentration – 150 g/l.

A distinctive characteristic of this formula is that it takes into account iron reserves in the body, which account for more than 30% of its total content in the body. With a decrease in the concentration of SF, a decrease in the concentration of iron in the depot can be detected.

By calculating the total iron deficiency in the human body in mg and knowing the total amount of iron in an ampoule of one drug (for example, 100 mg), you can calculate the number of ampoules that will be required to complete the full course of treatment. Formula for calculation:

Number of ampoules per course = total iron deficiency / 100 mg

Parenteral administration of iron supplements may be associated with a number of side effects, including:

• The occurrence of burning, itching and hyperemia of the skin at the site of drug administration.
• Allergic reaction, up to anaphylactic shock.

Most often, shock occurs when administering drugs that contain Dextran. Therefore, before the first administration of iron supplements, it is recommended to perform a test sample. It is equally important to correctly calculate the dose a person needs. However, the body is capable of producing negative reactions even when treatment is carried out with a small amount of iron.

For treatment to be effective and safe, the following recommendations for parenteral administration of iron supplements must be strictly followed:

• Only modern medications should be used that have minimal toxicity, do not cause anaphylactic reactions and do not pose a threat to the patient’s life.
• Before administering a dose, it is necessary to calculate the total iron deficiency in the human body.
• The course should last exactly as long as necessary. It should not be extended.
• It is important to follow all rules for parenteral administration of iron supplements.
• It is imperative to administer a test dose before starting the main treatment.
• Treatment should be carried out in strictly safe doses.

Modern iron preparations for parenteral administration:

To determine whether the selected treatment regimen with iron-containing drugs was effective, it is necessary to focus on the following criteria:

• On days 7-10 from the start of taking iron-containing drugs, the patient experiences an increase in the level of reticulocytes in the blood. The jump is 2-3% or 20-30% of the original amount.
• An increase in the level of hemoglobin in the blood by day 28 by 10 g/l, and hematocrit by 3%.
• Symptoms of anemia should be completely relieved within 30-45 days from the start of treatment.
• Iron reserves in the depot should be replenished 3-6 months after the start of therapy. The exact recovery time depends on the severity of the anemia.

Totema

Release form: solution for oral administration. 1 ampoule - 50 mg of pure iron.

Why is the liquid form better?

The fact that the solution is more evenly distributed throughout the mucous membrane of the digestive tract, and the likelihood of irritation is reduced.

Secondly, this form is good for those who do not know how to swallow tablets, or for bedridden patients.

Another advantage of the drug Totema: it contains a safer iron salt - gluconate. The risk of side effects is less.

Fourthly, Totema contains copper and manganese, which improve iron absorption.

Children – from 3 months.

Pregnant women can.

Caution for patients with diabetes mellitus, because For taste, a lot of all sorts of chemical rubbish has been added to it. This is why I don't like liquid forms. In addition to the active and auxiliary substances necessary for stability, they contain all sorts of flavorings, dyes, sweeteners, etc., so the likelihood of allergic reactions is higher.

How to take: the contents of the ampoule should be dissolved in plain or sweetened water and drunk before meals. To treat IDA, take 1-2 ampoules 2 times a day. This is 100-200 mg of iron per day.