lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶CosmoFer(Pharmacosmos UK Ltd)A
Iron (as Iron dextran) 50 mg per 1 mlCosmoFer 500 mg/ 10 ml
solution for injection ampoules| 2 ampouleP£ 79. 70
CosmoFer 100 mg/ 2 ml solution for injection ampoules|
5 ampouleP£ 39. 85
eiiiiF 570
Iron sucrose
lINDICATIONS AND DOSE
Iron-deficiency anaemia
▶BY SLOW INTRAVENOUS INJECTION, OR BY INTRAVENOUS
INFUSION
▶Child (body-weight up to 67 kg):Dose calculated
according to body-weight and iron deficit, each divided
dose should not exceed 3 mg/kg/dose (consult product
literature)
▶Child (body-weight 67 kg and above):Dose calculated
according to body-weight and iron deficit, each divided
dose should not exceed max. 200 mg/dose (consult
product literature)lUNLICENSED USENot licensed for use in children.
lCONTRA-INDICATIONSAnaphylaxis.asthma.eczema.
history of allergic disorders
lCAUTIONSHypersensitivity reactions can occur with
parenteral iron and facilities for cardiopulmonary
resuscitation must be available.infection (discontinue if
ongoing bacteraemia.oral iron should not be given until
5 days after last injection
lINTERACTIONS→Appendix 1 : iron (injectable)
lSIDE-EFFECTS
▶UncommonAsthenia.pain
▶Rare or very rareDrowsiness.urine discolouration
▶Frequency not knownBradycardia.cold sweat.confusion.
level of consciousness decreased
lPREGNANCYAvoid infirst trimester.
lHEPATIC IMPAIRMENTUse with caution. Avoid in
conditions where iron overload increases risk of
impairment.
lPRESCRIBING AND DISPENSING INFORMATIONA complex
of ferric hydroxide with sucrose containing 2 %( 20 mg/mL)
of iron.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Venofer(Vifor Pharma UK Ltd, Imported (United States))A
Iron (as Iron sucrose) 20 mg per 1 mlVenofer 100 mg/ 5 ml solution
for injection vials| 5 vialP£ 43. 52
Venofer 50 mg/ 2. 5 ml solution for injection vials| 5 vialPs
MINERALS AND TRACE ELEMENTS›IRON, ORAL
Iron (oral) f
lSIDE-EFFECTS
▶Common or very commonConstipation.diarrhoea.
gastrointestinal discomfort.nausea
▶UncommonVomiting
▶Frequency not knownAppetite decreased.faeces
discoloured
SIDE-EFFECTS, FURTHER INFORMATIONIron can be
constipating and occasionally lead to faecal impaction.
Oral iron, particularly modified-release preparations, can
exacerbate diarrhoea in patients with inflammatory bowel
disease; care is also needed in patients with intestinal
strictures and diverticular disease.
OverdoseFor details on the management of poisoning,
see Iron salts, under Emergency treatment of poisoning
p. 832.
Iron preparations are an important cause of accidental
overdose in children and as little as 20 mg/kg of elemental
iron can lead to symptoms of toxicity.
lMONITORING REQUIREMENTS
▶Therapeutic responseThe haemoglobin concentration
should rise by about 100 – 200 mg/ 100 mL ( 1 – 2 g/litre) per
dayor 2 g/ 100 mL ( 20 g/litre) over 3 – 4 weeks. When the
haemoglobin is in the normal range, treatment should be
continued for a further 3 months to replenish the iron
stores. Epithelial tissue changes such as atrophic glossitis
and koilonychia are usually improved, but the response is
often slow.
lPRESCRIBING AND DISPENSING INFORMATIONExpress the
dose in terms of elemental iron and iron salt and select the
most appropriate preparation; specify both the iron salt
and formulation on the prescription.
The iron content of artificial formula feeds should also
be considered.
The most common reason for lack of response in
children is poor compliance; poor absorption is rare in
children.
lPATIENT AND CARER ADVICEAlthough iron preparations
are best absorbed on an empty stomach they can be taken
after food to reduce gastro-intestinal side-effects. May
discolour stools.eiiiiFaboveFerrous fumarate
lINDICATIONS AND DOSE
Iron-deficiency anaemia (prophylactic)
▶BY MOUTH USING TABLETS
▶Child 12–17 years: 210 mg 1 – 2 times a day
▶BY MOUTH USING SYRUP
▶Child 12–17 years: 140 mg twice daily
Iron-deficiency anaemia (therapeutic)
▶BY MOUTH USING TABLETS
▶Child 12–17 years: 210 mg 2 – 3 times a day
▶BY MOUTH USING SYRUP
▶Child 12–17 years: 280 mg twice daily
FERSADAY®
Iron-deficiency anaemia (prophylactic)
▶BY MOUTH
▶Child 12–17 years: 322 mg daily
Iron-deficiency anaemia (therapeutic)
▶BY MOUTH
▶Child 12–17 years: 322 mg twice dailyGALFER®CAPSULES
Iron-deficiency anaemia (prophylactic)
▶BY MOUTH
▶Child 12–17 years: 305 mg daily
Iron-deficiency anaemia (therapeutic)
▶BY MOUTH
▶Child 12–17 years: 305 mg twice daily
GALFER®SYRUP
Iron-deficiency anaemia (prophylaxis)
▶BY MOUTH
▶Neonate up to 36 weeks corrected gestational age (body-
weight up to 3 kg): 0. 5 mL daily, prophylactic iron
supplementation may be required in babies of low birth-
weight who are solely breast-fed; supplementation is
started 4 – 6 weeks after birth and continued until mixed
feeding is established.
continued→BNFC 2018 – 2019 Iron deficiency anaemia 571
Blood and nutrition9