Haematinincs (Drugs Used in Anaemia) 249The parenteral administration can
cause local pain at the site of injection. The
other adverse effects include headache,
fever, flushing, palpitation, dyspnoea, chest
pain, metallic taste and even disorientation
and temporary loss of taste.
IV administration can cause anaphylactic
reaction characterized by circulatory collapse
and even deaths have been reported.
Treatment of Acute Iron Poisoning
- Gastric lavage with 1% sodium
bicarbonate solution to remove any
undissolved iron tablets. - Administration of milk or egg yolk to
complex iron. - Specific iron binding chelating agent
like desferrioxamine mesylate (5-10 g
in 100 ml isotonic saline) or calcium di-
ethylene triamine pentaacetate (DTPA)
35-40 mg/kg or calcium disodium ac-
etate (35-40 mg/kg). - Electrolytes and other fluids to correct
metabolic acidosis and hypotension. - Supportive administration of various
agents e.g. anticonvulsants drugs to
control convulsions.
Table 6.2.1: Classification for iron preparations.
Ferrous sulphate (Hydrated salt 20% iron, exsiccated
salt 30% iron; FERSOLATE). 200-600 mg/day
Ferrous gluconate (12% iron; FERRONICUM). 300-1200 mg/day
Ferrous fumarate (33% iron; AUTRIN). 100-300 mg/day
Colloidal ferric hydroxide (50% iron; NEOFERUM). 200-800 mg/day
Other forms of iron which are present in different pharmaceutical preparations are ferric ammonium citrate,
ferrous succinate, iron choline citrate, ferrous amionate, iron calcium complex, carbonyl iron, ferric
glycerophosphate, haemoglobin, elemental iron, ferrous glycine sulphate, glycerinated haemoglobin, and
iron (III) hydroxide polymaltose complex (equivalent to elemental iron).
Parenteral preparations: Iron dextran (IMFERON) & Iron-sorbitol citric acid complex (JECTOFER).ERYTHROPOIETIN
It is produced primarily by peritubular
cells in the proximal tubule of the kidney.
In anaemia renal secretion of erythropoi-
etin increases rapidly manifold. Erythro-
poietin levels are always detectable in
plasma.
It exerts its action by binding to recep-
tor on surface of erythroid precursor cells.
There is increase in intracellular concentra-
tion of calcium and arachidonate and
changes in intracellular phosphorylation. It
stimulates proliferation, maturation and
haemoglobin formation by committed
erythroid progenitors.
Recombinant human erythropoietin is
available. It is given by parenteral route
(IV or SC).
It is used in the treatment of anaemia of
chronic renal failure, in anaemia of patients
with AIDS who are being treated with
zidovudine and anaemia associated with
cancer chemotherapy.
Adverse effects include exacerbation of
or new onset of hypertension and seizures
in patients with renal disease.