Preparations containing iron: differences, "chips", pharmaceuticals. custody, cheat sheets

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Thanks to the author - Marina Kuznetsova

Today we will look at popular preparations containing iron for oral administration.

Here's what we'll look at:

1. Differences between divalent and trivalent iron preparations. Their advantages and disadvantages.
2. Features of some popular products.
3. What effect do iron supplements have on teeth? How to avoid darkening?
4. What questions should a buyer ask when selling iron supplements?
5. What C.U. give to the client?
6. Why can vegetarians have normal hemoglobin?
7. What can be recommended to a buyer without a doctor’s prescription so as not to cause harm?
8. Why does hemoglobin not increase despite long-term use of iron-containing medications?
9. How long can pregnant women take iron supplements?

Well then. Let's get started.

All iron preparations can be divided into two groups: ferrous and trivalent iron preparations.

Ferrous iron preparations, their advantages and disadvantages

Representatives:

• Aktiferrin,
• Sorbifer Durules,
• Tardiferon,
• Totem,
• Fenyuls,
• Ferretab comp.

Benefits of ferrous iron supplements

1. Well absorbed through the gastrointestinal mucosa.

1. Increases hemoglobin faster than ferric iron supplements. They normalize hemoglobin after 1 - 2 months, and iron reserves return to normal after 3-4 months. For comparison: on average, ferric iron preparations normalize hemoglobin within 2-4 months, and iron reserves within 5-6 months from the start of treatment.

Disadvantages of ferrous iron preparations

• Very toxic. There is a high risk of iron overload, because the absorption of ferrous iron through the mucous membrane of the digestive tract is uncontrolled, and it may happen that all the transport proteins that should pick up iron and carry it either to the depot or to the sites of hemoglobin formation are occupied. Free iron then enters the bloodstream and causes various damage. There are many side effects from this. The risk of overdose is especially high in children. Do not recommend these drugs yourself!
• Ferrous iron promotes the formation of a large number of free radicals - harmful atoms or molecules that trigger a chain of new damage.
• Eating reduces their absorption, so ideally approximately 30-60 minutes before meals But they often cause abdominal pain, constipation, diarrhea, and patients are forced to take them during or after meals.

Some manufacturers, knowing such a sin behind their brainchild, recommend taking them before or after meals. “After” means if it is poorly tolerated. But this affects the absorption of iron and the speed of onset of the effect.

How do ferrous iron preparations differ from each other?

First of all, because they contain different iron salts: sulfate, fumarate, gluconate.

Of these, ferrous sulfate is the most toxic.

Ferrous sulfate preparations are prohibited for use in a number of countries for pregnant women, children and those with digestive tract diseases.

Remember, Ferroplex used to be in dragees? When I worked as a local pediatrician, a 9-month-old baby died in my area from Ferroplex poisoning - the adults left the package open in a visible place.

Other iron salts (fumarate, gluconate) are less toxic and safer.

The preparations also differ in the form of release and the content of “pure” iron.

The minimum effective therapeutic daily dose of iron is 100 mg, and the average daily therapeutic dosage is 100-300 mg.

The dosage of an iron supplement primarily depends on the purpose for which the drug is taken, and then on the severity of the anemia.

And the goal could be like this:

1. Raise iron reserves in the depot. This is called “latent iron deficiency,” when hemoglobin and red blood cells are normal, but ferritin and some other blood parameters are reduced. It can be suspected by sticking in the corners of the mouth, dry skin, brittle hair, and split nails.
2. Cure iron deficiency anemia.
3. Prevent anemia in pregnant women.

After reading all this, you should have questions:

• Which preparations contain less toxic iron salts?
• How much iron is contained in different preparations?

A small cheat sheet for this group will help you. The download link is at the end of the article.

Basic principles of treating anemic syndrome without drugs

Naturally, the intensity of treatment for anemic syndrome, as we have already understood, depends on the causes. If this is bleeding and decay of tumor tissue, then emergency surgery is needed; if it is helminthiasis, then this is the prescription of anthelmintic drugs, but we will leave difficult situations for specialists. Let's consider a classic example of increased iron consumption in a pregnant woman, which must first be compensated for by dietary correction.

And if there are clinical, or even more so laboratory, signs of anemia, then you can no longer do without medications, but a diet can compensate for low-level iron deficiency, if we are simply talking about depletion of reserve reserves. On average, we receive about 20 mg of elemental iron every day with food, and about 10 times less is absorbed: 2 mg. And if you modify the diet, you can improve not only the supply of iron from food, but also its absorption, but not by more than 30%.

1. Non-medicinal principles for treating iron deficiency using diet therapy and balanced nutrition are as follows:
2. it is necessary to increase the intake of beef and fish liver, eggs and meat, natural products. Boiled, dietary meat is preferable rather than refined sausages;
3. you should not rely on fresh apples as a legendary “source of iron”: no more than 5% of iron is absorbed from them,
4. the presence of folic acid, vitamin C, or ascorbic acid, as well as copper in the diet increases the absorption of iron. This is precisely what the effect of complex iron-containing preparations, for example, Totems, which will be discussed later, is based on.
5. Various tannins, such as tea tannin, oxalates, phosphates and calcium, reduce the availability of iron to the intestines and reduce its absorption. Therefore, regular consumption of strong tea can contribute to the occurrence of iron deficiency;
6. If dairy products are consumed, they must be consumed separately from meat products, since milk contains calcium.

Which iron valence should you prefer? Both divalent and trivalent iron enter our body. But our body itself is well versed with these types of iron atoms, and oxidation and reduction processes occur with them in the body. As a result, the valency of the iron atoms changes. So, in order for iron to contact ferritin, it must have a valence of 3 plus, and hemoglobin contains divalent iron.

The most common side effects of drugs containing iron

1. Pain, discomfort in the abdomen.
2. Constipation or diarrhea.
3. Nausea, vomiting.
4. Darkening of tooth enamel.
5. Painting the stool black. Nothing wrong with that. Simply unabsorbed iron leaves the body naturally.

Drug interactions of ferrous iron preparations

• Calcium, magnesium, levothyroxine (Euthyrox, L-thyroxine), antacids reduce iron absorption.
• In turn, iron supplements reduce the absorption of fluoroquinolones and tetracyclines (Doxycycline, Unidox, Tetracycline, etc.).
• If you take these drugs together with drugs from the NSAID group, the risk of damage to the mucous membrane of the digestive tract increases.
• During treatment with ferrous iron preparations, you should refrain from drinking alcohol - it increases the frequency of toxic reactions.

Interaction with food of ferrous iron preparations

Milk and dairy products, cereals, egg yolks, coffee, tea and some other foods reduce iron absorption. In this regard, the interval between taking the ferrous iron preparation and consuming these products should be at least 2 hours.

What else?

Ferrous iron preparations can cause exacerbation of chronic inflammatory diseases of the stomach and intestines.

If a patient has such a problem, the drug must be chosen especially carefully.

As a last resort, as I already said, take it during or after meals.

The treatment will be longer but safer.

Now do you understand what questions you need to ask the buyer when selling these funds? What recommendations should you give, what should you warn about?

I will list it all below.

In the meantime, I’ll dwell on the features of individual ferrous iron preparations. Let me remind you once again that I will only talk about drugs for oral administration.

The main causes of iron deficiency:

Reduced intake of iron into the body due to impaired absorption due to diseases of the gastrointestinal tract, fasting, refusal, or reduced consumption of foods containing iron.

Increased iron loss during chronic, repeated blood loss (uterine, gastric, intestinal, etc.), as well as during acute massive bleeding.

Increased consumption of iron by the body in children during periods of growth, in women during pregnancy and subsequent breastfeeding of the child.

Aktiferrin

Oral dosage forms: drops, syrup.

Previously, there were also capsules, but now I don’t see them in the assortment of Russian pharmacies.

The composition contains ferrous sulfate, which, let me remind you, is characterized by maximum toxicity, and the amino acid serine. It improves iron absorption, since only 10-15% of ferrous iron is absorbed through the mucous membrane of the small intestine.

(And trivalent without helpers is not absorbed at all).

Pregnant and lactating women can.

Children: syrup from 2 years, drops from birth.

The dose is calculated per kg of weight.

The course of treatment is at least 8 weeks.

After hemoglobin returns to normal, you need to continue taking the drug for the same amount of time to replenish iron reserves.

What's not to like about Aktiferrin?

The manufacturer's instructions indicate the iron content in 100 ml of syrup or drops. This means that the doctor must calculate the daily dosage, taking into account the child’s weight and iron deficiency, which is determined by the formula. And if he is not good at mathematics, it is easy to make a mistake and either overdo the dose, or vice versa.

In the first case, this threatens with intoxication, in the second - too long a course of treatment.

What tests show iron deficiency?

• Be sure to look at a general blood test with a leukocyte formula, since iron deficiency ultimately leads to the development of anemia. Iron deficiency anemia is indicated by a decrease in hemoglobin levels, an indicator of MCV (erythrocyte hypochromia). Often, the examination begins when there are symptoms of anemia (pallor, weakness, dizziness, loss of strength, decreased performance and attention, brittle nails and hair, etc.).
• Decreased serum iron concentration
• Increasing the total iron-binding capacity of serum
• Decreased transferrin saturation coefficient with iron
• Decreased serum ferritin concentration

It is recommended to take tests in the morning, from 8 to 11 am, since the level of iron in the serum is higher in the morning. They should also be taken in the absence of inflammation, which helps lower transferrin levels and increase ferritin levels.

The iron content in the serum is checked 5-7 days after taking vitamin-mineral complexes and dietary supplements containing iron, or short-term use of iron supplements.

Sorbifer Durules

Release form: film-coated tablets.

The composition is the same ferrous sulfate (100 mg of pure iron) and ascorbic acid (60 mg).

The word “Durules” means a technology for the gradual release of the active substance, which in theory should reduce the number and frequency of adverse reactions.

The active substance is released from the tablet within 6 hours. This prevents the accumulation of high concentrations of iron on the gastrointestinal mucosa and supposedly avoids its damage. Although judging by the reviews, side effects when taking it are quite common.

Last time I asked you a question about ascorbic acid.

With its help, ferric iron turns into divalent iron, which is absorbed through the gastrointestinal mucosa. So why was it added to the ferrous iron preparation?

I told you above that ferrous iron contributes to the formation of a large number of free radicals, and I believe that ascorbic acid is added here as an antioxidant to neutralize them, although the manufacturer writes that it improves the absorption of iron.

I think that the need for ascorbic acid in the drug Sorbifer Durules is greatly exaggerated, otherwise it would be introduced into all ferrous iron preparations. But this is not the case.

Children - from 12 years old.

Pregnant and lactating women can.

How to take: 1 tablet. 1-2 times, i.e. 100-200 mg of iron per day.

Tardiferon

Release form: available in the form of film-coated tablets with prolonged release of the active substance.

The composition again contains ferrous sulfate.

Differences from the drug Sorbifer: a smaller dosage of pure iron in one tablet (80 mg versus 100 mg), so you will have to wait longer for the effect. No ascorbic acid.

Children - from 6 years old.

Pregnant and lactating women are allowed.

Standard therapeutic dosage for adults: 1-2 tablets. per day (80-160 mg of iron).

Totema

Release form: solution for oral administration. 1 ampoule - 50 mg of pure iron.

Why is the liquid form better?

The fact that the solution is more evenly distributed throughout the mucous membrane of the digestive tract, and the likelihood of irritation is reduced.

Secondly, this form is good for those who do not know how to swallow tablets, or for bedridden patients.

Another advantage of the drug Totema: it contains a safer iron salt - gluconate. The risk of side effects is less.

Fourthly, Totema contains copper and manganese, which improve iron absorption.

Children – from 3 months.

Pregnant women can.

Caution for patients with diabetes mellitus, because For taste, a lot of all sorts of chemical rubbish has been added to it. This is why I don't like liquid forms. In addition to the active and auxiliary substances necessary for stability, they contain all sorts of flavorings, dyes, sweeteners, etc., so the likelihood of allergic reactions is higher.

How to take: the contents of the ampoule should be dissolved in plain or sweetened water and drunk before meals. To treat IDA, take 1-2 ampoules 2 times a day. This is 100-200 mg of iron per day.

Why is there a shortage?

The most common cause is blood loss, for example due to injury or bowel disease, or due to excessive menstrual bleeding.

“Iron deficiency underlies more than half of anemia,”

says Ph.D.
cardiologist and nutritionist, GMS Clinic Natalya Polenova. “The main causes of iron deficiency: unbalanced diet, malabsorption, cyclic blood loss in women of reproductive age, donation, pregnancy, lactation, rapid growth during puberty.”

The second reason is poor absorption of iron. This can occur with medications, chronic bowel disease, inflammation, or genetic disorders.

A hematologist at the Federal State Budgetary Institution “National Medical Research Center of Hematology” of the Ministry of Health of Russia clarifies that iron deficiency conditions occur in many diseases with malabsorption, ranging from serious cancer to helminthiasis and the presence of Helicobacter pylori bacteria, which absorb iron.

Fenyuls

Release form: capsules coated with a compound that forms a semi-permeable film of a certain thickness. This ensures a gradual release of iron.

If there are current instructions on the drug’s website, then it seems that this is the only iron supplement that can be dispensed without a doctor’s prescription.

But I wouldn't do it, and here's why.

Fenyuls contains ferrous sulfate and a number of vitamins (B1, B2, B6, PP, ascorbic acid, calcium pantothenate). All this, as the manufacturer claims, improves iron absorption and prevents the formation of free radicals.

But there are more side effects, since in addition to the side effects for iron, side effects for vitamins have been added: allergic reactions, dizziness, tachycardia, sweating, numbness of the extremities, an increase in the number of platelets, leukocytes, increased blood sugar levels, etc.

Maybe that's why the manufacturer is so careful with the recommended dosage? Pure iron in 1 capsule - 55 mg. Take 1-2 capsules per day. This dosage is more suitable for the prevention of anemia or the treatment of latent iron deficiency.

Contraindicated for children, allowed for pregnant and lactating women.

How is the effectiveness of treatment assessed?

During the first days of treatment with iron supplements, physical sensations are assessed.

When treating anemia, on the 5-8th day of treatment, a reticulocyte crisis is determined (an increase in the number of reticulocytes compared to the initial value, usually by 2-3% or 20-30‰).

After 4 weeks of treatment, the increase in hemoglobin is assessed. An increase in hemoglobin concentration by 10 g/l by the end of the first month of treatment with iron preparations indicates that the dose has been correctly selected and the effectiveness of therapy. After hemoglobin is restored, therapy is continued to saturate the iron depot, while the dose of the drug is reduced by 2 times.

For hidden iron deficiency, half doses of the drugs are used for 4-8 weeks. Depot saturation is determined using a comprehensive biochemical study (ferritin, transferrin, TLC).

At Lab4U you can take tests to identify iron deficiency and monitor the effectiveness of therapy with a discount of up to 50%.

Ferretab comp.

Release form: extended-release capsules.

It is interesting because each capsule contains three mini-tablets of iron (total 50 mg of pure iron) and one mini-tablet of folic acid in a good dosage (500 mcg).

See:

Abbreviation "comp." in the name of the drug means “complex”.

It is best recommended for anemia caused by deficiency of iron and folic acid, and for iron deficiency anemia in pregnant women or for the prevention of it.

Iron is represented by a safer salt than ferrous sulfate - fumarate. Gives fewer side effects.

How to take: on an empty stomach, 1 capsule (50 mg of iron) per day. If necessary, the doctor may increase the dosage to 2-3 capsules per day.

Conclusions:

ferrous preparations , I came to the following conclusions:

The safest drugs are Totema, Ferretab comp., because they do not contain ferrous sulfate, but other salts.

The most adequate dosages of iron for the treatment of IDA, in my opinion, are in the preparations Sorbifer Durules and Totema.

Pharmacotherapy of anemic syndrome

Treatment should continue under the supervision of tests, and on average, oral replenishment of iron stores with medications lasts about 3-5 months, under the supervision of a doctor. In this case, of course, it is necessary to initially make sure that the loss of iron during treatment does not exceed the norm, otherwise the treatment will be useless.

In addition, it is necessary to strictly adhere to the principles of treatment of iron deficiency anemia. If iron deficiency anemia is diagnosed, and laboratory indicators indicate this, this means that diet alone is not enough. Even with the greatest saturation of it with iron, it is unlikely that more than 3 mg can be absorbed into the body. Modern medications can absorb 10 or even 20 times more iron than with the most balanced and saturated diet.

In most cases, for anemia, oral medications are sufficient, and blood transfusion, that is, blood transfusion of red blood cells, will be needed when hemoglobin decreases to 50 or 40 g per liter. Of course, this is a very severe anemia, and patients should not be subjected to it. Therefore, you need to try to prescribe iron as early as possible, and for a fairly long period of time, in order not only to eliminate the symptoms of anemia, both laboratory and clinical, but also to create a reserve of iron in the body, which was wasted in the initial, latent stages. This means that after normalizing the hemoglobin level and obtaining quite favorable tests, there is no need to stop treatment. It usually takes another two to three months, when a reserve of iron is created in the body, and half doses of drugs that managed to cure anemia are prescribed. If the growth of iron reserves in the body occurs slowly, then it is necessary to take additional medications, for example, multivitamins.

Various iron-containing drugs also, in turn, contain either ferrous or trivalent iron. Therefore, you can take both medications containing divalent and ferric iron. It is usually believed that when it comes to organic iron compounds, they are absorbed better, and iron compounds with maltose, ferrous gluconate, are still not as harsh as inorganic compounds of this metal, such as ferrous sulfate. But that is why organic iron compounds are a little more expensive.

All the drugs listed below are over-the-counter and can be purchased over the counter at pharmacies. All of them are included in national and international clinical guidelines for the treatment of anemia and sideropenic syndrome, and all are oral, that is, prescribed by mouth. That is, we will not consider medications containing iron for intravenous use, such as Venofer and Cosmofer. They are used in specialized settings, such as in patients on dialysis.

For medicines, the INN, that is, the international nonproprietary name, will be called first, and then the commercial name. The price is valid for the end of March 2021 for pharmacies of all forms of ownership in the Russian Federation. Almost all iron preparations are imported, and they have very few or no domestic analogues.

Ferric iron preparations

Benefits of ferric iron supplements

• Low toxicity. They cannot be overdosed.
• Better tolerated.
• They can be taken before, during, and after meals, without fear of inflammation or ulceration of the gastrointestinal mucosa.
• Fewer drug interactions.
• Fewer food interactions.

Disadvantages of ferric iron preparations

They act more slowly, so the treatment time increases.

If you need to quickly increase your iron level (surgery is coming up, severe anemia, etc.), at the beginning of treatment the doctor will most likely prescribe a ferrous iron supplement. In the future, he can transfer the patient to a ferric iron preparation if he does not tolerate divalent iron.

Let's look at the features of some popular drugs in this group.

Which iron supplement is better to buy?

When choosing a medication, the severity of the pathology is taken into account, which determines the required speed of action. Iron is absorbed more quickly when administered intramuscularly or intravenously, but significant adverse reactions are noted. The therapeutic effect is provided by 80-160 mg of pure iron; exceeding the concentration will lead to deterioration of well-being. The presence of a protective shell on the capsules reduces the risk of an irritating effect on the gastrointestinal mucosa. Taking into account a number of characteristics, the best drugs in this group were identified:

• The safest composition is Maltofer;
• An inexpensive option for treating anemia is Fenyuls;
• For quick results, it is recommended to buy Ferro-foil;
• If the cause of low hemoglobin is a deficiency of vitamin B9 - Ferretab;
• If prolonged action is necessary - Tardiferon.

When treating anemia, it is important to follow the doctor's recommendations in terms of diet and dosage of the prescribed medication. Improper use of the drug provokes the development of adverse reactions and deterioration of well-being. The choice of medication should be made by a doctor; the rating will help clarify the pros and cons of each of them.

Maltofer

Release forms for oral administration: drops, syrup, chewable tablets.

Main feature: iron hydroxide is combined with carbohydrates. This complex is called: “Iron hydroxide polymaltosate.” In articles and instructions it is referred to by the abbreviation HPC (hydroxide-polymaltose complex).

Its structure is similar to that of the natural iron compound ferritin. Thanks to this, it can connect with the transport protein, which delivers iron from the intestines to the blood.

GPC is stable. “pure” iron is not released into the gastrointestinal tract, and therefore there are significantly fewer adverse reactions when using it.

Pregnant and breastfeeding women can. Maltofer Fol will be optimal , which contains folic acid necessary for normal growth and development of the fetus.

Children: Maltofer drops, syrup - from birth, tablets - from 12 years.

Adverse reactions: nausea, constipation, diarrhea, dark stool, rash, itching, discoloration of tooth enamel.

Drug interactions - no.

There are no food interactions.

How to take: for the treatment of IDA, adults take 40-120 drops or 10-30 ml of syrup or 1-3 tablets per day. (100-300 mg pure iron) during or after meals. Chewable tablets can be swallowed as usual.

Maltofer in the form of drops or syrup can be mixed with fruit juice, vegetable puree, and milk mixture.

Important to remember

• The causes of iron deficiency are blood loss, malabsorption, unbalanced diet, pregnancy, and helminthiasis.
• To identify a deficiency, you need to take a blood test for hemoglobin level, hematocrit, mean erythrocyte volume (MCV) and mean erythrocyte hemoglobin content (MCH).
• If there is no deficiency, then you should not take iron supplements. It may be dangerous.
• It is best to obtain iron from animal foods, in which it is in heme form.
• If you do not eat animal foods, you will need foods high in vitamin C to absorb plant non-heme iron.

Ferrum Lek

Ferrum Lek used to be almost the only iron preparation for parenteral administration. There were no oral forms of it.

And now they are: syrup and chewable tablets.

Ferrum Lek is an analogue of the drug Maltofer in the form of syrup and chewable tablets. So, if something happens, they can replace Maltofer.

How to take: for adults to treat IDA, 10-30 ml of syrup (100-300 mg of iron) or 1-3 tablets per day during or after meals. After hemoglobin returns to normal, continue taking the drug 1 tablet until ferritin (iron reserves) normalizes.

Ferlatum

Release form: solution for oral administration. 1 bottle contains 40 mg of pure iron.

Features of the composition: this is also a complex, only iron is in a complex not with carbohydrates, as in the previous case, but with protein. This prevents damage to the gastric mucosa.

Iron from this complex enters the blood from the intestines only thanks to carrier proteins, so an overdose is impossible. This means that there will be significantly fewer side effects than with treatment with ferrous iron preparations.

Adverse reactions: rarely - diarrhea, constipation, nausea, epigastric pain.

Drug interactions

• Reduces the absorption of tetracyclines.
• The absorption of iron increases if the drug is taken simultaneously with 200 mg of ascorbic acid. Keep it up! They ask Ferlatum, and you ask the buyer: “Did your doctor recommend you take ascorbic acid with it?” To be more convincing, you can show the instructions.
• Antacids reduce iron absorption.

Children, pregnant and lactating women are allowed. But it is better for pregnant women to take Ferlatum Fol , which contains a folic acid compound in the dispenser cap.

You need to remove the white cap from the bottle, press the red dispenser cap with your finger, and the powder with folic acid will pour into the bottle, and now the drug is ready for use.

How to take: standard dosage: 1-2 bottles per day before or after meals. This is 40-80 mg of pure iron. In my opinion, not enough.

The manufacturer does not say anything about its dilution, which means it is usually taken: drink it and wash it down with water. Has a cherry taste.

Friends, I draw your attention: I have indicated here the MEDICAL dosages of drugs. But they will be different if the drug is prescribed for latent iron deficiency or for prophylactic purposes.

Rating of popular iron-containing drugs for the treatment and prevention of anemia

Iron hydroxide polymaltosate (Ferrum Lek, Maltofer)

Rating: 4.9

Ferrum Lek is a trivalent preparation of iron, in the form of hydroxide bound to the organic residue of the polymerized sugar maltose. You can buy chewable tablets at the pharmacy for an average price of 275 rubles per pack of 30 tablets, or you can buy them in syrup form. The drug is produced by Lek from Slovenia. This medicine is only produced in Slovenia, and the registration certificate is owned by the Sandoz company from Switzerland. And this is a guarantee of quality. In addition to chewable tablets, you can also purchase 100 milliliters of syrup along with a measuring spoon, but the tablets are more convenient for adults to take.

In terms of iron, 1 tablet contains 100 mg of the drug. The resulting molecular complex of iron and maltose is very large, and its passive diffusion is quite slow, 40 times less than that of ferrous iron. Therefore, this iron is absorbed only actively in the intestines. Then in the liver it binds to ferritin, and then is transported to the red bone marrow and is included in hemoglobin. This drug is indicated in the treatment of any iron deficiency anemia, in the prevention of iron deficiency in case of pregnancy, and in the treatment of latent deficiency. Adults need to take the drug 1 tablet 3 times a day for prevention, and pregnant women 2-3 tablets daily. Children over 12 years of age can be given 1 to 3 tablets per day. In case of latent iron deficiency, you need to treat with this remedy for about 2 months.

Advantages and disadvantages

You need to remember about possible contraindications. This is high blood iron, impaired iron utilization, such as lead intoxication, or anemia of another etiology, such as hemolytic or megaloblastic. There may also be side effects, for example, a feeling of heaviness and pressure in the epigastric area, nausea and upset stool. Almost always, while taking medication, the stool turns dark in color when unabsorbed iron is excreted, but this is not scary. This drug has a convenient syrup form that can be administered to children and is inexpensive. All side effects are mild and pass quickly. Ferrum Lek has been well-tested by doctors for a long time; it is a familiar remedy with proven effectiveness.

Ferrous fumarate (Ferretab comp)

Rating: 4.8

This medicine is already ferrous fumarate, that is, a salt of organic fumaric acid. Ferretab Comp is produced by the Austrian company Lannacher. One package of 30 tablets will cost from 340 to 470 rubles. In terms of active iron, each tablet contains more than the previous drug - 163 mg. Ferretab contains ferrous iron, unlike the previous medicine. It is necessary to take it both for the treatment of anemia and for the prevention of iron deficiency.

The preventive direction is one capsule on an empty stomach with plenty of water, and if there is a deficiency of iron or folic acid, the intake can be increased from two to three capsules per day. It should be remembered that maintenance therapy should continue for at least a month after the hemoglobin level has normalized. This is necessary to increase serum ferritin, which reflects the created iron reserves in the body. Interestingly, each capsule contains three small tablets of ferrous fumarate and one tablet of folic acid, so this drug is a complex one. It is known that when combined with folic acid, iron has an improved absorption profile and digestibility in the red bone marrow. This drug can be used for any iron deficiency anemia, and for prevention.

Advantages and disadvantages

The product also has contraindications. General contraindications include excess iron in the body, including aplastic anemia, various types of hemosiderosis and hemochromatosis, anemia of other etiologies not associated with iron deficiency, but with insufficient iron absorption. The medicine is of good German quality, but before starting treatment, it is imperative to determine not only the hemoglobin concentration, but also iron and ferritin in the blood serum, and during treatment there may also be a dark coloration of the stool. You can also use the drug together with ascorbic acid to improve absorption, and if you take the medicine together with an antacid, that is, one that reduces the acidity of gastric juice and coats the mucous membrane, then its effectiveness will be lower.

Iron gluconate+manganese gluconate+copper gluconate (Totema)

Rating: 4.7

Totema is a French drug that is sold as a solution to be taken orally. One package of 20 ampoules of 10 ml each will cost you from 470 to 540 rubles. The medicine is produced in France, by the Innotek company. This is iron gluconate, manganese and copper gluconate, and it was said above that copper improves the absorption of iron, and Totema is indeed a very active remedy. One ampoule contains 50 mg of elemental iron, but this is quite enough to replenish iron deficiency and create iron reserves in the body. In turn, manganese and copper can be used by various enzyme systems and improve metabolism.

This medicine can be prescribed from the age of three months, and this is very convenient, since Totema is available in liquid form. In addition to iron deficiency anemia, the product can be used during pregnancy, as well as in cases of iron deficiency in the diet. The contents of the ampoule are drunk before meals, previously diluted in plain or sweet water. To treat clinically significant anemia, an adult needs, on average, 3 ampoules per day, and children over 3 months old - at a dose of 6 mg per kilogram of body weight per day, also divided into 3 doses. For pregnant women, starting from 4 months, one ampoule per day is enough for prevention. In the case of anemia treatment, its duration is individual, but not less than four to five months. The ampoule can be shaken before use.

Advantages and disadvantages

The great advantage is the complex composition, liquid dosage form, and ease of use. It is necessary to take into account standard contraindications, that is, anemia not associated with iron deficiency, excess iron in the body, peptic ulcer of the stomach and duodenum during an exacerbation, intoxication with manganese or copper, Konovalov’s disease, the child’s age is less than 3 months, as well as chronic lead intoxication . In the case of long-term use in large doses of Totem, there may be a darkening of the tooth enamel, but staining the stool black is a normal reaction. In case of treatment with Totema, you cannot additionally use other iron-containing drugs.

Iron sulfate + ascorbic acid (Sorbifer Durules, Tardiferon, Ferrogradumet)

Rating: 4.6

This is a medicinal form of inorganic iron, and most often you can purchase the drug Sorbifer Durules from the Hungarian manufacturer Egis. A standard package of 30 tablets for a month of preventive use will cost from 450 to 530 rubles. This is a preparation of ferrous iron, and one tablet, calculated per element, contains 100 mg. Also supplied together in one capsule is 60 mg of ascorbic acid, and the color of the tablet is light yellow.

The drug eliminates iron deficiency and is also used for prevention. The tablets are resistant to the action of gastric juice, but dissolve under the influence of intestinal peristalsis, and with the help of this technology (Durules) you can count on a uniform supply of medicine. If you take one tablet twice a day, the absorption of iron may be greater, just due to the active form of Durules, by 30% than other drugs. The indications for this remedy are standard: anemia, prelatent iron deficiency or prevention of deficiency. Sorbifer should be taken by swallowing the tablet whole with one glass of liquid. Adults and adolescents - one tablet twice a day; depending on the severity of anemia, the dose can be increased to 4 tablets per day. But during pregnancy and breastfeeding, one tablet per day is enough. As in other cases, after normalization of laboratory parameters, it may be necessary to continue using the medicine for 2 months.

Advantages and disadvantages

A relative disadvantage is the lack of a liquid form, which means that the medicine is not indicated for small children. It is also necessary to remember about contraindications, which include high iron levels, anemia of another cause not related to iron deficiency, children under 12 years of age. Since the tablets are quite large in size, clinically significant esophageal stenosis will be a contraindication to the use of this medication. Side effects include nausea, diarrhea, or constipation, and side effects depend on the dose. Their increase is most likely at doses up to 400 mg, and will be quite frequent. It must be remembered that use together with some antacids can reduce the absorption of iron, and it is advisable to take Sorbifer separately from medications, maintaining an interval of 3 hours.

Iron protein succinylate (Ferlatum)

Rating: 4.5

This medicine belongs to organic iron compounds, which means that Ferlatum is tolerated quite well. This is a drug in liquid form, one bottle contains 15 ml of oral solution, which corresponds to 40 mg of pure ferric iron. In this case, the patient consumes 800 mg of protein succinylate, that is, 20 times more. This drug is indicated for standard iron deficiency anemia and for prevention. It must be used before meals, for adults - one or two bottles per day in 2 divided doses, and for children in the dosage specified by the doctor, but equivalent to 4 mg per kilogram of body weight per day. This drug is produced by the Spanish company Italpharmaco, and one package of 20 such bottles will cost more than other drugs: from 800 to 1050 rubles.

Advantages and disadvantages

The advantage would be the organic form and liquid that can be safely given to children. Its contraindications are standard; the manufacturers, in addition to anemia of other etiologies, added chronic pancreatitis and cirrhosis of the liver, since the organic component is, after all, a complex protein. Usually the drug is well tolerated, and the symptoms of overdose are mild, and even then at the very beginning of treatment, on the first day. A relative disadvantage is the rather high price, and it is not often available in pharmacies, especially in the regions.

Iron sulfate + ascorbic acid + multivitamins (Fenuls)

Rating: 4.4

Finally, in conclusion of this short review, let’s look at the popular Indian drug Fenyuls, which is produced by Sun or Ranbaxy. This is an example of a complex preparation of ferrous sulfate, in terms of pure divalent sulfate - 45 mg in one capsule, with the addition of various vitamins: vitamin C, riboflavin, a group of neurotropic vitamins B1, B6, as well as pantothenic acid.

This complex preparation does not contain much iron, in terms of elemental composition, and is best used to prevent deficiency in adolescents, pregnant and lactating women, as well as in cases of delicate iron deficiency due to heavy and prolonged periods. In case of hidden deficiency, one capsule once a day for one to two months is sufficient. To prevent hidden deficiency, with polymenorrhea, that is, when there is still a supply of iron in the body, before menstruation you need to take 1 capsule 2 days before the start, during menstruation and within 2 days after it ends. The cost of this drug is from 230 to 270 rubles per pack of 30 pieces, this is a very affordable price on the iron supplement market.

Advantages and disadvantages

The contraindications and disadvantages of this remedy are standard, the same as for other iron preparations, maybe Fenyuls, as an inorganic, may feel somewhat rough, and unpleasant sensations in the epigastrium are possible at the beginning of the prescription, but they also soon pass. A big plus is the presence of the required amount of the required vitamins, and this may be the drug of choice for the patient who is looking for both vitamins and an oral iron supplement. Choosing Fenyuls allows you to save money; the drug itself is inexpensive. The only relative disadvantage is the coloring of urine yellow due to the presence of riboflavin, and stool dark color due to the presence of unabsorbed iron, but these are rather “non-critical” disadvantages. And it cannot be prescribed to children, since the drug is only available in capsules.

How do iron supplements affect teeth?

Iron supplements can cause darkening of tooth enamel. This applies mainly to liquid forms (drops, syrup, oral solution) and chewable tablets.

Even if the instructions say that this drug does not stain tooth enamel, judging by the reviews of those who have taken iron supplements, sometimes it does.

Apparently, this is due to some characteristics of the microflora of the oral cavity or tooth enamel, because this does not happen to everyone.

Is it possible to avoid darkening of teeth while taking iron supplements?

Can. To do this, you need to follow several rules:

1. Do not bite, dissolve, coated tablets, or keep them in your mouth.
2. If a person has difficulty swallowing tablets or capsules and purchases chewable tablets, they should thoroughly rinse their mouth and brush their teeth after each dose.
3. It is better to take drops, syrup, or oral solution through a straw and rinse your mouth after taking it.
4. It is impossible to accomplish the previous point in small children, therefore you need to let the child drink the drug, preferably with a large amount of water, and then wrap a bandage around his finger, moisten it with clean boiled water and wipe his teeth.

Some of you asked:

“How do you solve the problem of teeth staining in chewable tablets?”

Please note that only complex iron preparations have the form of chewable tablets, because They are less likely than ordinary iron salts to cause staining of tooth enamel. Most likely, it is due to the different structure of the active substance, when iron is surrounded by either polysaccharides or protein.

Reviews for all iron preparations that we are talking about today, and almost all liquid forms or chewable tablets, in some cases cause staining of tooth enamel, with the exception of Ferlatum. If you heard that it also caused darkening of teeth in some of your customers, write about it in the comments.

You may also be asked:

“Do iron supplements destroy teeth?”

Judging by the reviews, children’s teeth sometimes get damaged from them, but I haven’t found any scientific evidence for this.

Perhaps it's all about the sweeteners that are included in the liquid forms, and not about the iron itself.

The best iron supplements for children

When choosing a medication for a child, parents take into account which iron supplements are better absorbed for anemia. This characteristic affects the duration and comfort of treatment. Most children do not like to take medicine, so a quick effect often becomes the main selection criterion. Medicines for children under 3 years of age are produced in the form of drops, since they can choke on the tablet. The presence of Fe2+ worsens the taste and irritates the gastrointestinal tract. Children often vomit and refuse treatment. For this reason, the category presents nominees with good absorption parameters, which contain Fe3+.

Maltofer drops

20 drops of a brown solution contain 50 mg of the trace element. Sucrose and cream flavoring give the medicine a pleasant smell and taste. Studies have confirmed the high effectiveness of the drug in increasing iron levels in the blood. The active substance synthesizes hemoglobin in the bone marrow, unabsorbed residues are excreted in the feces. For ease of administration, Maltofer is mixed with fruit juices, baby porridge, and infant formula.

Advantages

• Convenient dosage;
• It is possible to treat iron deficiency without anemia;
• Average price;
• Allowed during pregnancy, children from infancy;
• High degree of security;
• Low probability of intoxication in case of overdose.

Flaws

• Not found.

The drug contains sugar, but its concentration does not affect the daily need for insulin in diabetics. The popularity of use is due to the comfort of use and the minimum treatment period, which is 1-5 months.

The best vitamins for the heart and blood vessels

Ferrum Lek

The medication is available in the form of syrup or chewable tablets. In the first case, the concentration of the active substance in 1 measuring spoon corresponds to 200 mg of Fe3+, in the second - 100 mg. Cream and chocolate flavors provide a pleasant taste of the drug. The amount of sugar in the composition is higher than that of the previous nominee, so treatment for diabetics is carried out with the permission of an endocrinologist.

Advantages

• Choosing a convenient form of administration, taking into account the age of the child;
• Does not stain tooth enamel;
• Rare side effects from the gastrointestinal tract;
• Does not distort the results of fecal occult blood tests;
• Does not affect concentration;
• Cases of intoxication due to overdose have not been recorded.

Flaws

• High concentration of sugar in the composition.

The inexpensive iron supplement is valued for its quick effect and pleasant taste. 82% of respondents recommend taking medication if you have low hemoglobin. The main side effect is constipation in children.

What questions should a buyer ask when selling iron supplements?

-Do you have any stomach or intestinal diseases? (and specify: gastritis, colitis, peptic ulcer?)

If there is, but the doctor still prescribed the drug, recommend taking it during or after meals, and if abdominal pain occurs, advise initially reducing the dosage and increasing it gradually. If the pain persists, let him see a doctor.

-What other medications are you taking?

We talked about drug interactions above, but it’s difficult to remember all this, so use the cheat sheets, which I hope you will download (download link at the end of the article).

These two questions are especially important to ask if the customer is prescribed ferrous iron.

I remind you once again that the iron supplement is taken until hemoglobin normalizes, plus another 1-3 months. The course of treatment for iron deficiency anemia is usually 3-6 months. The duration of the course depends on the severity of anemia, compliance with dosage recommendations, the presence or absence of diseases of the digestive tract, which may reduce the absorption of iron, and if we are talking about a ferrous iron preparation, on how the drug is taken: on an empty stomach or with food. Taking the drug during or after meals slows down the absorption of iron.

How to increase the effectiveness of treatment

To reduce the likelihood of side effects, iron salts are taken before meals.

The absorption of iron is higher when taken simultaneously with ascorbic and succinic acids, fructose, and cysteine. This property is used in some combination drugs.

Iron absorption is reduced by certain substances from food or medications. Thus, it is reduced by tannin (strongly brewed tea), calcium salts (in milk or medications), magnesium and manganese (in mineral complexes or antacid preparations, such as phosphalugel), tetracycline antibiotics, phosphoric and phytic acids (cereal seeds, legumes). This effect is smoothed out when using preparations based on ferric iron.

Iron absorption is increased in severe iron deficiency. Therefore, you should be more careful about the prescribed dosage. Doctors often rely on a therapeutic dose of 200 mg of iron ion/day. If you understand that an iron supplement is not suitable for you due to the development of adverse reactions, difficulties in taking it, or lack of improvement in your well-being, tell your doctor about this. Under no circumstances should you change the dosage of the drug yourself. Exceeding the dose can lead to overdose and poisoning, reducing the dose can lead to useless use and lack of effect.