Ranferon

Ranferon is an antianemic drug, an iron medicine. It contains various minerals with multivitamins, as well as iron.

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Indications Ranferon

It is used to eliminate anemia, which is caused by a lack of folic acid and iron in the body.

Release form

The product is released in capsules, 10 pieces in 1 blister. Inside a separate pack there are 3 blister plates.

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Pharmacodynamics

Ranferon is a balanced medicinal complex that includes zinc sulfate, iron fumarate, ascorbic and folic acid, and cyanocobalamin. All these substances are required by the body for stable hematopoiesis in the bone marrow.

Iron is a component of myoglobin with hemoglobin, as well as various enzymes. It reversibly synthesizes oxygen, and in addition, it promotes its movement within tissues, provokes erythropoiesis and is a participant in several oxidation-reduction processes. The body's need for iron increases during pregnancy, lactation, in adolescents with active growth, as well as during menstruation and other bleeding.

Folic acid in combination with cyanocobalamin causes erythropoiesis, is a participant in the processes of binding nucleotides with amino acids and nucleic acids, as well as the process of choline metabolism. During pregnancy, vitamin B9 is required for the healthy development of nerve endings in the fetus, and in addition, it protects the child from teratogenic effects and is an important element of the reactions of the cellular immune system.

Cyanocobalamin is a participant in nucleotide binding. It is very important for the stable development and growth of epithelial cells, as well as the processes of erythrocyte maturation and hematopoiesis. The component is necessary for the metabolism of vitamin B9 and the synthesis of the substance myelin. Vitamins B12 and B9 prevent the occurrence of megaloblastic anemia, as well as neurological disorders.

Ascorbic acid has a powerful restorative effect. It belongs to the category of water-soluble vitamins. It is a participant in oxidation-reduction processes, regulates carbohydrate metabolism. In addition, it affects the metabolism of amino acids (included in the category of aromatic) and thyroxine, the processes of biosynthesis of steroid hormones, as well as catecholamines and insulin (necessary for blood clotting). It also affects the binding of procollagen to collagen and helps the healing of bone and connective tissues. At the same time, it improves capillary permeability, helps the processes of iron absorption in the intestine, and promotes the binding of hemoglobin. It enhances the non-specific resistance of the body and acts as an antidote. With a lack of vitamin C in food, avitaminosis or hypovitaminosis type C develops, because this substance is not synthesized inside the body.

Zinc has structural, catalytic and regulatory properties when acting on 200+ zinc-metal-containing enzymes found within biosystems. These enzymes help in the metabolism of proteins with nucleic acids, as well as in energy production. In addition, zinc helps in the formation of "zinc fingers" (used by transcription factors - to interact with DNA when regulating gene activity).

Another structural property of zinc is the maintenance of the integrity of the membranes of biological membranes, thereby helping to protect them from acid damage. Zinc is very important in the processes of protein synthesis, as well as cell division. A deficiency of this element causes short stature, anemia, as well as geophagy and hypogonadism. In addition, problems with wound healing arise, red blood cell fragility increases, and the fluidity of their membranes changes.

Dosing and administration

The duration of the course and the doses are prescribed by the attending physician.

The standard adult dosage is 1 capsule 1-2 times a day. It is recommended to take the medicine before meals (30-40 minutes), washing it down with water or juice.

The duration of the therapeutic course is often equal to 1-3 months.

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Use Ranferon during pregnancy

Pregnant or breastfeeding women can use the drug only with a doctor's prescription and only in cases where the likelihood of benefit to the mother is higher than the risk of complications in the fetus/child.

Contraindications

Among the contraindications of the drug:

• the presence of folate-dependent tumors, as well as intolerance to the components of the drug;
• malignant pathologies (excluding megaloblastic anemia), caused by a lack of vitamin B9, as well as Marchiafava-Micheli disease;
• excess of accumulated iron in the body (the presence of hematochromatosis or hemosiderosis) or a tendency to such a disease;
• other types of anemia, in addition to conditions that do not develop due to iron deficiency (such as hemolytic, hypo- or aplastic anemia, iron-deficiency anemia and B12-deficiency anemia, as well as anemia due to lead intoxication, hemoglobinopathy and thalassemia);
• Vaquez-Osler disease or erythrocytosis;
• acute form of thromboembolism, as well as tumors, excluding those accompanied by megaloblastic form of anemia;
• late stage cutaneous porphyria and liver cirrhosis;
• acute forms of inflammatory processes inside the intestine;
• aggravated ulcerative pathology in the stomach or duodenum;
• intestinal diverticulum;
• intestinal obstruction;
• frequent blood transfusions;
• use in combination with parenteral administration of iron, thrombosis, as well as abdominal pain and vomiting with nausea of unknown origin;
• tendency to develop thrombosis;
• presence of thrombophlebitis;
• severe renal pathologies, diabetes mellitus, urolithiasis (in case of using daily doses exceeding 1 g of vitamin C).

Side effects Ranferon

Taking capsules may cause the development of the following side effects:

• digestive tract: occurrence of stomach pain, vomiting, constipation or diarrhea, as well as nausea and bloating. Black stool, a feeling of fullness in the stomach, a metallic taste, loss of appetite, darkening of tooth enamel, heartburn, and irritation of the mucous membranes inside the digestive tract may be observed;
• areas of the skin and subcutaneous layer: rashes, redness, acne, itching, bullous rash and urticaria;
• immune reactions: manifestations of hypersensitivity (development of anaphylaxis or anaphylactic shock with existing sensitization, as well as bronchospasms) and angioedema;
• NS area: dizziness with headaches, sleep disorders and increased excitability;
• organs of the hematopoietic system: development of erythrocytopenia or hyperprothrombinemia, thrombocytosis, and neutrophilic leukocytosis. In individuals with G6PD and erythrocyte deficiency, erythrocytolysis may develop;
• others: feeling of general weakness, increased sweating, hot flashes, development of hyperthermia.

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Overdose

If the required doses are exceeded, an overdose may develop. A dose of 180-300 mg/kg is considered lethal. But for some individuals, even a dose of 30 mg/kg of elemental iron can be toxic. In small children, the likelihood of acute intoxication is especially high - even 1 g of iron fumarate is enough to cause life-threatening poisoning.

Signs of acute iron intoxication appear 10-60 minutes or several hours after taking the drug.

Among the manifestations: epigastric and abdominal pain, vomiting (sometimes with blood) and nausea, as well as diarrhea with green feces (later they become tarry) and melena. These symptoms may be accompanied by a feeling of weakness, drowsiness, cyanosis and acrocyanosis, pale skin and the release of sticky cold sweat. Blood pressure may also decrease, the pulse may weaken, the heartbeat may develop, hyperthermia, confusion, as well as convulsions, paresthesia and necrosis of the mucous membrane inside the digestive tract. In the absence of medical measures, after 12-48 hours, coma and shock may develop, in which a toxic form of liver failure, oliguria, as well as coagulopathy and a Cheyne-Stokes spirogram are observed.

Medicinal methods: in case of severe overdose, immediate assistance must be provided to the victim: perform gastric lavage (use water or a phosphate-buffered or soda solution). It is also necessary for the patient to consume more milk and raw eggs - this will help form insoluble iron compounds in the digestive tract and facilitate the elimination of iron from the body.

If necessary, acidosis and shock are treated. Individuals who develop anuria/oliguria require hemodialysis or peritoneal dialysis.

The most appropriate way to determine the severity of the condition is to analyze the level of iron in the serum, and along with this, to assess its iron-binding capacity. When iron levels exceed the maximum limit suitable for normal serum iron binding, systemic intoxication may develop.

Methods of special therapy:

It is necessary to check the vomit for the presence of medicinal capsules. If it is not possible to remove the required amount, the stomach should be washed with an aqueous solution of sodium carbonate (1%) or a solution of sodium chloride (0.9%), and then the patient should be given a laxative.

People who have acute intoxication need to take an iron antidote - the substance deferoxamine. Chelation treatment with its use is carried out in the following situations:

• consumption of a potentially lethal dose of 180-300 mg/kg or higher;
• with serum iron levels exceeding 400-500 mcg/dl;
• the level of iron in the serum exceeds its iron-binding capacity, or the person shows signs of severe iron poisoning: shock or coma.

In case of acute overdose, to bind the iron that was not absorbed, it is necessary to take deferoxamine orally in the amount of 5-10 g (dissolve the contents of 10-20 ampoules in plain water). When eliminating the absorbed iron, the drug is administered intramuscularly every 3-12 hours in the amount of 1-2 g. If the patient has developed a state of shock, a drip injection of 1 g of the drug is administered intravenously, and symptomatic treatment is also carried out.

Manifestations of vitamin C intoxication: in case of a single intake of the drug in a large dose, vomiting, abdominal pain, nausea, itching, flatulence, skin rash and increased excitability are observed.

Long-term use of large doses of Ranferon can lead to suppression of the insular apparatus function in the pancreas (it is necessary to monitor its work) and the appearance of cystitis, and in addition to this, accelerate the processes of formation of stones (oxalates with urates). In addition, pain in the heart may appear, blood pressure may increase, myocardial dystrophy or tachycardia may develop. Damage to the glomerular renal apparatus, formation of cystine, urate or oxalate stones inside the kidneys and urinary ducts, development of crystalluria, glucosuria or hyperglycemia, and in addition to this, a disorder of the glycogen synthesis process (up to the development of diabetes mellitus), and a violation of the metabolism of copper and zinc. Unjustified long-term use of drugs can provoke hemosiderosis.

To eliminate the disorder, it is necessary to stop taking the medication, perform gastric lavage, take activated charcoal (or other sorbents), drink alkaline drinks and treat the symptoms.

Interactions with other drugs

As a result of combining the drug with antacids containing aluminum, bismuth, and calcium with magnesium, and together with this, when combined with cimetidine or cholestyramine, there is a decrease in the absorption of Ranferon from the gastrointestinal tract.

Iron absorption is reduced when combined with coffee, black tea, bread, eggs and dairy products, as well as raw cereals and solid foods.

Tetracyclines and penicillamine in combination with Ranferon form complex compounds that reduce iron absorption and weaken the effectiveness of the drug.

GCS are capable of increasing the stimulation of erythropoiesis carried out by Ranferon.

Vitamin C increases the bioavailability of iron after internal use. Combination with tocopherol can weaken the medicinal effect of iron on the body.

Iron salts reduce the bioavailability of methyldopa with levodopa, and in addition weaken the absorption of thyroxine with zinc and sulfasalazine with DNA gyrase inhibitors (such as levofloxacin with ofloxacin, as well as ciprofloxacin with norfloxacin).

The combination of iron medications and NSAIDs increases the irritating effect of iron on the mucous membrane inside the digestive tract.

The absorption of vitamin B9 is reduced when combined with anticonvulsants, analgesics, cytostatics (methotrexate) and sulfonamides, as well as with neomycin, trimethoprim and triamterene.

The use of folic acid weakens the effectiveness of PAS, chloramphenicol, primidone with phenytoin, as well as oral hormonal contraception and sulfasalazine, as it increases the metabolism of these drugs.

The combination with chloramphenicol inhibits the absorption of iron and also reduces the hematopoietic properties of cyanocobalamin.

Cobalamin absorption decreases when combined with PAS, tetracyclines, hormonal contraception and anticonvulsants. In addition, a similar effect is produced by a combination with neomycin, ranitidine, kanamycin, as well as colchicine, polymyxins and potassium drugs.

It is prohibited to take Ranferon simultaneously with allopurinol and methotrexate, as well as pyrimethamine and disulfiram.

The absorption of vitamin C is weakened when combined with oral contraceptives, alkaline drinks, and vegetable or fruit juices.

Internal administration of ascorbic acid enhances the absorption of tetracyclines with penicillins, as well as iron. At the same time, it weakens the effect of indirect anticoagulants with heparin and increases the likelihood of crystalluria when using salicylates.

Combining ascorbic acid with deferoxamine increases the toxic properties of iron inside tissues (especially the heart muscle), which may lead to decompensation of systemic blood flow. Therefore, vitamin C should be taken at least 2 hours after deferoxamine administration.

The drug in high doses weakens the effects of tricyclics and neuroleptics (phenothiazine derivatives) and the reabsorption of amphetamine inside the tubules, and also prevents the excretion of mexiletine through the kidneys.

Vitamin C increases the total ethanol clearance rate. Quinoline drugs, salicylates, calcium chloride and corticosteroids reduce the vitamin supply in the body in case of prolonged use of these drugs.

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Storage conditions

The medicine must be kept in a place where moisture does not penetrate, and also inaccessible to children. Temperature values are a maximum of 25°C.

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Shelf life

Ranferon is permitted to be used for a period of 2 years from the date of release of the drug.