Preparations of iron for anemia: which are better absorbed

In the human body contains various trace elements - and one of them is iron. His influence on most of the most important processes in the body is truly enormous. But the deficit of this element immediately affects the health of a person, which can cause a lot of negative consequences - for example, anemia develops, or anemia. Why is iron so important in anemia? In all cases of anemia, you need to take iron preparations?

Treatment of anemia with iron

Iron performs many tasks in the body. The basic directions are:

• Delivery of oxygen.

Iron is an important component of hemoglobin (a protein that makes up red blood cells), responsible for the transfer of oxygen to all tissues in the body. Blood cells, using the same iron, take out the produced carbon dioxide and transfer it to the respiratory organs for excretion. Therefore, the microelement that we are considering plays an important role in all respiratory processes.

• Providing exchange processes.

Iron is a part of the majority of enzymes and proteins necessary for a qualitative metabolism - for elimination of toxins, stable balance of cholesterol, energy transformation. Depends on the presence of this element and the immune system.

In a state of iron deficiency, the condition of the skin, hair, and nails deteriorates. There is a strong weakness, dyspnea, drowsiness, irritability, the memory processes are violated.

According to statistics, conducted by the World Health Organization, 60% of the world's inhabitants have a shortage of iron. At the same time, half of them have this shortage so pronounced that doctors put a confident diagnosis of "iron deficiency anemia". This is a pathology, which is accompanied by a significant decrease in the level of hemoglobin.

Iron deficiency anemia is not the only type of anemia. However, this type accounts for more than 90% of all cases of anemia.

Daily Iron Dose for Anemia

The human body contains 2.5 to 4.5 g of iron. This number is not constant, and it must be regularly replenished.

Women are particularly affected by iron deficiency. This is due to the systematic loss of a microelement with menstrual bleeding, as well as a special storehouse of hormonal processes. The average number of elements a woman needs per day is 15 mg, and in the period of gestation and breastfeeding - not less than 20 mg.

For the normal course of the processes in the body, a man needs to replenish the stock of 10 mg of iron per day.

Children up to the age of 18 should receive from 5 to 15 mg of a microelement every day (the higher the age, the greater the need).

The same statistics argue that in the modern diet of most people the level of iron does not "hold out" to the required rate. On average, a person replenishes his daily "iron" stock by only 10-20%. Therefore, for many people iron in anemia must be taken additionally, in the form of complex preparations.

In order to find out if you have enough microelements in your body, you need to pass a standard biochemical blood test. Normal indicators are:

• for men - 11.64-30.43 μmol per liter;
• for women - 8.95-30.43 μmol per liter;
• for a newborn child - 17.9-44.8 μmol per liter;
• for a one-year-old child - 7.16-17.9 μmol per liter.

[1], [2], [3], [4],

Indications Iron in anemia

Iron deficiency is diagnosed very often. In the vast majority of cases, they are provoked by unbalanced diet, or by strict monotonous diets.

Among other causes of iron deficiency should be noted the state under which there is an active consumption of trace element. For example, this happens during puberty, when the baby is born and fed, and after trauma, surgery, menstrual disorders, digestive tract diseases, parasitic infestations, thyroid disorders, vitamin deficiency ascorbic acid, and B-group vitamins.

The sharp weakening of the immune defense, provoked by anemia, gradually becomes the cause of chronic inflammation, the development of cardiac insufficiency, liver diseases.

The greatest danger is the shortage of iron in expectant mothers: in such situations, children can be born with already existing anemic conditions.

[5], [6]

Release form

The main iron preparations are divided into possible injections into the body:

• oral (for internal administration);
• parenteral (for injection).

In addition, iron-containing medicines are divided into different forms, depending on the mechanism of assimilation. Thus, two types of drugs are distinguished:

• bivalent, which are absorbed quickly and full-length (reception is done orally);
• trivalent, which are not fully digested (they are injected).

The iron-containing drug is digested in the digestive system, but for the normal course of this process, an adequate acidic environment in the stomach is needed. Therefore, under certain circumstances - for example, with reduced acidity, iron can be absorbed somewhat worse, as well as with the simultaneous use of certain drugs that neutralize the acid.

All this must be taken into account when choosing the form of the drug.

Iron preparations for anemia

Iron in the form of medications is a basic remedy, which is used to treat persistent iron deficiency anemia. Such preparations consist of salts or complexes of two and trivalent iron.

To this category belong medicines that consist of thirty or more mg of the active ingredient in the form of elemental iron.

If the trace element is contained in an amount less than 30 mg, then it is allowed to be used only for preventive purposes.

By the way, the elimination of anemia is not the only use of such medications. They are appointed in the recovery period after prolonged infectious diseases, with lactose insufficiency, with enterocolitis, after extensive injuries and burns, with parasitic pathologies, etc.

Iron in anemia appoints only a doctor, after studying the results of a blood test.

Medicines with ferrous salts are produced in different dosage forms. All of them have excellent digestibility, but even with a slight excess of dosage can lead to the development of side effects.

These drugs are taken on an empty stomach, since there are some products that can worsen the absorption of the necessary trace element.

Preparations of ferrous iron differ in the content of the latter, as well as in the completeness of assimilation. For example:

• the most readily absorbed is ferrous sulfate (the content of the microelement is from 12 to 16%);
• the second on the list follows chloride iron (content - up to 6%);
• the third on the list - iron furamate (the content of the microelement - up to 16%);
• slightly absorbed iron gluconate (contains up to 22% iron) and iron lactate (up to 9% iron).

To avoid irritating effects on the intestinal mucosa, mucoproteosis is present in divalent preparations.

Preparations of ferric iron in anemia are less bioavailable and almost not absorbed in the intestines, so they do not have a mass distribution. They are used in combination with amino acid-maltose complexes to reduce toxicity.

[7], [8]

Iron tablets in anemia

To correct the level of iron in anemia, the most commonly prescribed tablets are:

• Aktiferrin is an iron-containing medication that is produced in capsules, oral solution or syrup. The drug is intended to fill the shortage of iron, and its action is potentiated by the serine present in the α-amino acid composition. Such iron in anemia is well absorbed and quickly enters the systemic circulation, which contributes to rapid regression of the signs of the disease. Adult patients take the encapsulated form of Actiferrin - one piece up to three times a day. If the patient has a poor tolerance of the drug, then the dosage is reduced to 1-2 capsules per day. Thus duration of therapy accordingly increases. Aktiferrin is allowed for use by pregnant and lactating patients.
• Ferrogradumet is a sustained release drug based on the action of ferrous sulfate. Each tablet corresponds to 105 mg of elemental iron. The agent is characterized by increased activity and helps in a short period of time to compensate for the shortage of the trace element. Ferrogradumet is suitable for the treatment and prevention of anemic conditions. People prone to anemia, it is recommended to take one tablet daily, for 2-3 months. With diagnosed iron deficiency take 1-2 tablets daily, for several months (according to individual indications it is allowed to take the drug for up to six months). Pregnancy is not a contraindication to drug therapy.
• Fenules is a combined remedy, in which iron is successfully supplemented with polyvitamins. The presence of ascorbic acid and B-group vitamins accelerates and facilitates absorption of the microelement, and also minimizes its prooxidant effect. Feniuls take as follows:
  • to support the body with abundant periods of bleeding - one capsule a day before menstruation and every day until the second day after the end of menstruation;
  • with the latent course of anemia - one capsule for 4 weeks;
  • with severe anemia with iron deficiency - one capsule in the morning and evening for twelve weeks.

Pregnant patients can take medication as early as 14 weeks. The course lasts two weeks, then stand a break in one week, and so - until the birth of the child (unless the doctor appoints another scheme of admission).

• Sorbifer - antianemic agent, which is a combination of iron with ascorbic acid. The medication is made by a unique technology that provides for the gradual absorption of iron. This avoids many side effects - including, a sharp increase in the content of trace element in the digestive system. Sorbifer take one tablet in the morning and evening, shortly before meals. Pregnant patients also can take the drug:
  • I and II trimester - per tablet daily;
  • III trimester and lactation - two tablets daily.

The general period of admission is from two to six months.

• Maltofer - is available in the form of tablets for internal administration and in the form of chewable tablets, as well as in the form of syrup and solution. The composition of the preparation is iron (III) hydroxide polymaltose complex. Tablets for chewing can be swallowed whole, and chewed, washed down with water. Dosage for adults can be from 100 to 300 mg daily, for 1-2 months. The question of the use of this medication during pregnancy has not yet been finally resolved, since studies for this period have not been conducted. Maltopher's intake is allowed in the II and III trimesters.
• Heferol is represented by iron fumarate - in an amount of 350 mg, which corresponds to 115 mg of elemental iron. Heferol has an enteric-soluble coating, due to which when the drug is used, iron is not contacted with the tooth enamel and mucous tissues of the stomach. Medication is taken half an hour before meals, one capsule per day (rarely - 2 capsules, with severe anemia). The course of treatment normally lasts 1.5-3 months.
• Gino-Tardiferon is a combined medicine based on ferrous iron, folic acid and vitamin C. The drug restores the level of iron, stimulates hemopoiesis, and is especially recommended for admission to women during the period of gestation. To treat anemia in children up to the age of seven, the medication is not suitable. Gino-Tardiferone is consumed before meals, with water (at least 200 ml), in the amount of 1-2 tablets per day. Between medication should be maintained at approximately the same time intervals (12 or 24 hours).

Chelation iron in anemia

Speaking of chelating iron, we have in mind complex compounds of iron ions with amino acids. In a simpler and more accessible presentation, the chelate form is a drug that is absorbed by the body more easily than others. That is, its bioavailability is much higher, which means that the body will receive the necessary amount of iron in its entirety.

What is the essence of the effectiveness of such medicines?

Iron ions, being inside the amino acid shell, are ready for digestion without additional transformations in the body. They are immediately used for their intended purpose and quickly absorbed.

The suction mechanism is carried out in the small intestine in the following way: the free iron ion combines with the transport protein, which transfers it to the bloodstream. A similar process is called the term "organic chelation". In the absence of such a process, the body is not able to recognize the trace element as a vital substance, and does not accept it for use.

Most often, this happens with inorganic mineral salts, which for normal absorption requires to overcome several successive stages: this is the stage of splitting, dissolution, absorption.

Inorganic mineral salts after their administration become bioavailable by no more than 10-20%. This means that the rest of the salts can not be digested, and can even cause some damage to the body (with prolonged intake).

Chelates have an adequate level of acidity and do not react with the acidic environment of the stomach. This can not be said about inorganic mineral salts, alkalinizing the acid contents of the stomach after oral administration: this can lead to unpleasant sensations like increased gas formation, deterioration in the assimilation of nutrients.

Treatment of anemia with chelated forms of iron is guaranteed to satisfy the body's need for a microelement.

A strong compound with an amino acid potentiates the transport of iron ions and provides protection from the corrosive acid of gastric juice.

[9], [10], [11], [12]

Injection of iron injections in anemia

Injections of medications with iron are not prescribed to everyone, since oral administration is initially more preferable. Injections are resorted only in such cases:

• in chronic diseases of the digestive tract, which can adversely affect the absorption of iron (such cases occur in pancreatitis, enteritis, celiac disease, malabsorption syndrome, etc.);
• with nonspecific ulcerative colitis;
• with hypersensitivity to iron salts, allergies;
• in the acute stage of stomach and duodenum ulcers;
• After surgery, associated with resection of the stomach or partial resection of the intestine.

Injections are prescribed and in a situation where it is necessary to deliver in the shortest period of time the necessary trace element to the patient's body - for example, this may be actual before operations.

The following are known for such injections:

• Ferrum Lek - active components of the drug are dextran and iron hydroxide. Injections are made intramuscularly, the dosage is calculated individually, depending on the total shortage of the microelement. The maximum daily dosage for adults is 200 mg or two ampoules of the drug (4 ml).
• Jektofer is a combined iron-containing substance that restores the iron reserve without affecting the hematopoietic mechanisms. The drug is administered intramuscularly, from the proportion of 1.5 mg of iron per 1 kg of the patient's weight. Injections are repeated daily, or once every two days. During the entire treatment period, the concentration of iron in the blood plasma should be monitored.
• Venofer - the preparation contains iron hydroxide of sucrose complexes. The solution is administered only intravenously - in the form of injections or droppers. Other methods of administration are prohibited.
• Ferrelcyte - a medicine based on the action of active sodium - iron-gluconate complex. The drug is administered intravenously, slowly. The average single quantity is one ampoule, the frequency of administration is up to 2 times a day. During the infusion, the patient should be in a supine position.
• Ferkoven - consists of iron sugarate, cobalt gluconate, etc., is a stimulant for hematopoiesis. The drug is administered intravenously daily for two weeks. The first and second injections are 2 ml each, then 5 ml each. Infusions should be slow, for ten minutes, so the procedure is carried out only under stationary conditions.
• Ferbitol - is an iron-sorbitol complex drug. It is prescribed for the treatment of hypochromic iron deficiency anemia, in which the drop in hemoglobin level is associated with impaired intake, assimilation or excretion of iron. Ferbitol is administered in the form of intramuscular injections of 2 ml each day. Course treatment consists of 15-30 introductions. Among the main contraindications is hemochromatosis.

Liquid iron in anemia

Liquid preparations with iron in the composition are used primarily for the treatment of anemia in childhood. Of course, it is easier to give a child a liquid medicine or syrup than a pill or capsule. However, there is a caution: after consuming a dose of such a solution or syrup, the child should drink some water or rinse the mouth so as not to cause a darkening of the tooth enamel.

Among the most common liquid iron-containing products are:

• Aktiferrin - contains iron sulfate and α-amino acid serine, which accelerates the absorption of iron in anemia. For babies it is possible to apply a medicinal solution, and for children from the age of 2 years - the syrup Aktiferrin.
• Ferlatum is an anti-anemic agent in liquid form. The composition of the solution includes succinylate protein, which creates protection of the mucous tissues of the digestive system from the irritating effects of iron. Ferlatum is allowed to be used for the treatment of anemia, even in newborn babies.
• Maltofer is a medicine with trivalent iron (hydroxide polymaltose). The drug is used as a syrup, or in the form of a solution (you can give babies and premature babies).
• Ferrum Lek is a preparation of ferric iron, it is applied from birth. It is produced in the form of a solution and syrup.

Pharmacodynamics

Iron is an important component that is part of hemoglobin, myoglobin and other enzyme substances. The functional orientation of iron is the transfer of electrons and oxygen molecules, the provision of oxidative metabolic processes in the development of tissue structures. In the composition of enzymes, the microelement acts as a catalyst for oxidation, hydroxylation, and other important metabolic reactions.

The state of iron deficiency increases with a small intake of iron with food, with disrupted its assimilation into the digestive tract, or with hyper-requirements in the gland (for example, after heavy blood loss, during pregnancy, during puberty).

In a plasma fluid, iron is transported by β-globulin transferrin, produced in the liver. One molecule of β-globulin comes into contact with a pair of iron atoms. In combination with transferrin, iron is transported to cellular structures: there it undergoes feedback with feritin and is used to produce, in particular, hemoglobin.

[13], [14], [15], [16], [17], [18], [19], [20],

Pharmacokinetics

After injection of iron-containing preparations, the microelement is absorbed mainly through the lymphatic system, and is mixed with the blood for about three days.

Information on the bioavailability of drugs is not available, but we can say that quite a lot of active components of iron-containing drugs remain in the muscle tissue for a long time.

Iron comes into contact with feritin or hemosiderin, and in part - with transferrin, after which it is included in the processes of hemoglobin synthesis. Dextran undergoes metabolic reactions, or is excreted. The volume of iron removed from the body is insignificant.

[21], [22], [23], [24], [25]

Dosing and administration

In the overwhelming majority of situations, if the patient needs to take iron additionally with anemia, the doctor prescribes one of the oral medications. To injective introduction resorted only in separate cases.

The quantity of this or that drug, frequency and scheme of reception are determined during individual consultation. Among the general recommendations are:

• for adults, the basic dose is calculated by the formula 2 mg / kg body weight;
• most often the daily dose is defined as 100-200 mg of the drug, less often - more, for example - up to 300 mg.

With a properly selected daily amount of iron preparation, the signs of anemia recede for several days. Patients report an improvement in mood, a surge of energy, etc. If we observe the dynamics with the help of laboratory studies, we can note positive changes in the number of reticulocytes already in the first week after the beginning of the treatment of anemia. Stable stabilization of hemoglobin levels is noted during 2-3 months of treatment.

Specialists explain: iron replacement with anemia is slow enough, so taking appropriate medications should be long. If the hemoglobin level has risen to the desired level, then there is no need to stop treatment: usually the drugs take some more time to provide the micronutrient reserve. True, the dosage in this case is reduced by about half.

[36], [37], [38], [39]

Use Iron in anemia during pregnancy

Women waiting for a child, anemia often happens, because her body is twice as large should be provided with vitamin and mineral substances. But if you need to take additional medications with iron in case of anemia, only the doctor prescribes them, and the dosage is chosen to be the minimum acceptable.

It happens that pregnant women are advised to drink iron-containing drugs and for prevention - this question is also decided by the doctor.

Among the general advice regarding the reception of such drugs at the stage of bearing a baby, you can specify the following:

• with a normal pregnancy in a woman during the third trimester may be recommended taking medications with iron (dosage - about 30 mg / day);
• with an adequately taking pregnancy for a woman who is addicted to anemia, iron intake is recommended from 21 to 25 weeks of gestation (dosage - 30 mg once every three days);
• when diagnosed iron deficiency state during pregnancy, it is recommended to take 100 to 200 mg of iron in the form of various drugs (dosage varies depending on body weight);
• with diagnosed anemia, before the onset of pregnancy, the recommended intake of the drugs during the entire period of gestation and breastfeeding (dosage - 200 mg / day).

All questions concerning the intake of medications with iron or other drugs by pregnant women should be discussed with the doctor, in order to avoid a negative result.

Contraindications

Before starting taking a medicine with iron in the composition, you need to read a number of caveats, which are categorical and conditional contraindications.

The category of categorical contraindications is:

• malignant blood diseases;
• hemolytic anemia, aplastic anemia;
• chronic inflammatory processes in the kidney or liver.

Among the conditional contraindications are:

• treatment with anti-acid drugs and antibiotics of the tetracycline series;
• a diet with increased intake of products containing calcium, fiber;
• frequent use of large volumes of drinks with caffeine;
• ulcerative processes in the digestive tract, enterocolitis.

[26], [27], [28], [29], [30], [31],

Side effects Iron in anemia

Oral administration of medications with iron in anemia is sometimes accompanied by undesirable side effects:

• unpleasant sensations in the abdomen - from slight nausea to vomiting, which has nothing to do with eating;
• loss of appetite, up to complete rejection of food;
• appearance of taste of metal in the oral cavity;
• disruptions in the work of the intestine (for example, difficulties with defecation can alternate with diarrhea).

There are cases when, during the period of taking medicines with iron, the formation of grayish plaque was observed. To avoid this, doctors advise that after taking a pill or solution, rinse your mouth thoroughly.

When iron is injected with anemia, seals can form at the injection site, inflammation, abscesses, allergies, and DIC syndrome can develop.

[32], [33], [34], [35]

Overdose

If there is an overdose of drugs containing iron, then there is a symptomatology indicated in the list of side effects. In addition, the symptoms can be expressed in the form of nausea, dizziness, confusion, changes in blood pressure, weakness, hyperventilation.

If you suspect of taking an excessive dose of iron, immediately wash the affected stomach, causing vomiting. Then the patient should eat some raw eggs and / or drink milk.

Further treatment depends on the symptomatology found.

If the excess amount of iron-containing agent was injected, then acute poisoning occurs, accompanied by an overload of the body. Such patients are treated only in a hospital under the supervision of medical personnel.

[40], [41]

Interactions with other drugs

As a rule, medications with iron in anemia can not be combined with substances that can slow the assimilation of the trace element. These substances include calcium-based drugs, anti-acid drugs, Levomycetin, tetracycline antibiotics.

Do not drink medicine iron milk, alkaline mineral water, coffee and strong tea. Optimum liquid for this is considered to be ordinary clean water.

On the contrary, such drugs as vitamin C, citric or succinic acid, sorbitol promote the normal assimilation of the microelement. The hemoglobin level will recover sooner if along with the iron, the patient will take medications with copper, cobalt, group B vitamins.

[42], [43]

Storage conditions

Iron-based medications that are used to treat anemia are usually stored at room temperature, not exceeding + 25 ° C.

Do not freeze drugs and expose them to high temperatures - for example, leave them near heaters, or under direct sunlight.

Children should not have access to places where medicines are stored, including iron-containing medicines.

[44], [45], [46], [47]

Shelf life

Each individual medicine has its own storage period, the duration of which should be specified, carefully studying the instructions to the drug. On average, iron-containing products are stored for three or five years - if the basic principles of storage of a particular medicine are observed.

[48], [49]

Reviews

Before you start taking medications with iron, you need to assess the degree of anemia by passing laboratory tests. Only after this it is possible to start treatment. According to reviews received from doctors, iron-containing drugs are relevant only in such situations:

• if the correction of nutrition did not lead to a steady increase in the level of hemoglobin;
• if a patient with an anemia is to undergo a surgical operation, during which blood loss is possible;
• Pregnant women with a tendency to anemia;
• with abundant menstrual blood loss in women;
• if the hemoglobin level in the patient falls rapidly (the indices worsen with each week);
• if there is no possibility of correction of nutrition (for example, there are contraindications to the use of most products).

Everyone should know the basic signs of iron deficiency in order to recognize anemia in time and consult a doctor. Such features are:

• constant sensation of weakness, pain in the head;
• severe fatigue, irritability, a tendency to depression;
• tachycardia, unpleasant sensations in the area of the projection of the heart;
• weak immunity, frequent inflammatory processes.

According to feedback, in order to avoid the development of anemic status, people with a tendency to anemia can take 1-2 courses of intake of iron-containing medications every year. Such a preventive technique is necessarily carried out under the control of the level of hemoglobin in the blood to prevent overdose.

Treatment with iron-containing medicines will be correct and effective if you follow such medical advice:

• It is not possible to carry out treatment with more than one preparation with the iron content simultaneously, regardless of its dosage form;
• it is better if the medicine contains additional substances that improve the absorption of iron;
• It is impossible to take iron-containing medicines without preliminary testing, and also to prescribe them yourself;
• During the whole period of treatment, one should adhere to the most healthy diet and lifestyle.

Smoking, drinking alcohol and caffeine-containing beverages adversely affect the absorption of iron: this must be taken into account when taking appropriate medicines.

Products rich in iron in anemia

If the laboratory analysis indicated a shortage of iron in the body, it should not always be immediately sent to the pharmacist and buy an iron-containing drug. First, you need to consult a doctor: it is possible that the body has a problem that prevents the normal absorption of trace elements. In a similar situation even complex preparations will not show the expected effect.

If the shortage of iron is caused by an imbalance in the diet, then this situation can be corrected by a simple correction of the daily menu.

It is necessary to include in the list of daily consumed products such that contain a sufficient amount of iron. For example, the most common and available sources are:

• beef, pork;
• liver;
• mussels, oysters;
• various nuts;
• eggs;
• beans;
• grenades;
• apples;
• dried fruits (for example, enough iron is contained in a suit, figs).

In order for the micronutrient to digest to the maximum, you need the presence of vitamins C and B ₁₂ in food  that are contained in such products:

• berries;
• rose hips fruits;
• cabbage;
• citrus fruits;
• seafood.

In many cases, it is possible to correct the situation with anemia only by adjusting the diet. Most often, the hemoglobin level stabilizes already during the first month after the introduction of changes in nutrition.

The most effective iron preparations for anemia

Almost all combined preparations containing iron, with anemia are effective. It is good, if in such means there will be components, which improve their assimilation - for example, vitamin C and amino acids.

It is worth paying attention: many iron-containing medicines have a prolonged action. That is, the output of the microelement in them is slow, which reduces the risk of side effects.

That the drug chosen in a drugstore was extremely effective, it is necessary to follow certain rules of reception:

• iron-containing remedy can not be washed down with tea, coffee, milk, jelly, mineral alkaline water (preferably - ordinary water or juice);
• the action of the drug is disrupted on the background of simultaneous or sequential intake of substances with calcium, antacids, antibiotics;
• if it is necessary to give the iron-containing complex to the baby, then it is necessary to choose a remedy in the form of a solution or syrup (do not grind the tablet or pour the contents of the capsule into food or drinks);
• Do not take a double dose of medication if one of the techniques was missed;
• During the treatment with iron-containing substances, stool can acquire a dark color: this is normal, there is no need to cancel treatment.

And remember: iron in anemia is not just a harmless vitamin preparation, it should be prescribed by a doctor. A treatment should be performed against a background of periodic laboratory monitoring.