ferrous sulfate (30% elemental iron)

Contraindicated in:

Anemia not due to iron deficiency;
Hemochromatosis;
Hemosiderosis;
Hypersensitivity to iron products.

Use Cautiously in:

Peptic ulcer disease;
Ulcerative colitis or regional enteritis (condition may be aggravated);
Alcoholism;
Severe hepatic impairment;
Severe renal impairment.

Adv. Reactions/Side Effects ⬆ ⬇

GI: constipation, dark stools, epigastric pain, nausea, GI bleeding, vomiting

Neuro: dizziness, headache, syncope

Misc: temporary staining of teeth (liquid preparations)

Interactions ⬆ ⬇

Drug-drug:

May ↓ absorption and effects of tetracyclines, fluoroquinolones, bisphosphonates, levodopa, levothyroxine, mycophenolate mofetil, and penicillamine (simultaneous administration should be avoided).
Concurrent administration of proton pump inhibitors, H2 antagonists, and cholestyramine may ↓ absorption of iron.
Doses of ascorbic acid≥200 mg may ↑ absorption of iron by up to 30%.
Chloramphenicol and vitamin E may ↓ hematologic response to iron therapy.

Drug-Food:

Iron absorption is ↓ 33–50% by concurrent administration of food.

Availability ⬆ ⬇

Tablets: 325 mg^OTC
Delayed-release tablets: 142 mg^OTC; 160 mg^OTC; 325 mg^OTC
Solution: 75 mg/mL^OTC; 300 mg/5 mL^OTC
Elixir: 220 mg/5 mL^OTC

Route/Dosage ⬆ ⬇

Oral iron dosages are expressed as mg of elemental iron. Multiple salt forms exist—see approximate equivalent doses below or consider % elemental iron of each salt for dose conversions.

Approximate Equivalent Doses (mg of iron salt): Ferrous fumarate: 197; Ferrous gluconate: 560; Ferrous sulfate: 324; Ferrous sulfate, exsiccated: 217.

PO (Adults ): Deficiency: 2–3 mg/kg/day in 2–4 divided doses or 60–100 mg elemental iron twice daily. Prophylaxis: 60–100 mg elemental iron daily.
PO (Infants and Children): Severe deficiency: 4–6 mg/kg/day in 3 divided doses. Mild to moderate deficiency: 3 mg/kg/day in 1–2 divided doses. Prophylaxis: 1–2 mg/kg/day in 1–2 divided dose (maximum: 15 mg/day).
PO (Neonates , premature): 2–4 mg/kg/day in 1–2 divided doses, maximum of 15 mg/day.

Action ⬆ ⬇

An essential mineral found in hemoglobin, myoglobin, and many enzymes.
Enters the bloodstream and is transported to the organs of the reticuloendothelial system (liver, spleen, bone marrow) where it becomes part of iron stores.

Therapeutic effects:

Resolution or prevention of iron deficiency anemia.

Classifications ⬆ ⬇

Therapeutic Classification: antianemics

Pharmacologic Classification: iron supplements

Pharmacokinetics ⬆ ⬇

Absorption: Approximately 5–10% of dietary iron is absorbed (up to 30% in deficiency states). Therapeutically administered PO iron is up to 60% absorbed via active and passive transport processes.

Distribution: Remains in the body for many months.

Protein Binding: ≥90%.

Metabolism/Excretion: Mostly recycled; small daily losses occurring via desquamation, sweat, urine, and bile.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(effects on erythropoiesis)

ROUTE	ONSET	PEAK	DURATION
PO	4 days	7–10 days	2–4 mo

Patient/Family Teaching ⬆ ⬇

Explain purpose of iron therapy to patient.
Encourage patient to comply with medication regimen. Take missed doses as soon as remembered within 12 hr; otherwise, return to regular dosing schedule. Do not double doses.
Advise patient that stools may become dark green or black.
Instruct patient to follow a diet high in iron (see Food Sources for Specific Nutrients).
Discuss with parents the risk of a child overdosing on iron. Medication should be stored in the original childproof container and kept out of reach of children. Do not refer to vitamins as candy. In the event of a suspected overdose, parents should contact poison control center (1-800-222-1222) or emergency medical services (911) immediately.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇