Treating Iron Deficiency

Supplements Can Ease Anemia's Pervasive Symptoms

An estimated 20% of all women, 50% of pregnant women, and 3% of men do not have a sufficient amount of iron in their bodies.¹ Causes of iron deficiency include blood loss (hemorrhagic loss and menstruation), poor diet, and/ or an inability of the body to absorb an adequate amount of iron from dietary means.^2,3

Iron deficiency anemia is considered the most prevalent form of anemia. The inability to absorb enough iron can occur in individuals who have had gastric bypass surgery or in those with Crohn’s disease or celiac disease.² The chronic use of certain pharmacologic agents such as salicylates, nonsteroidal anti-inflammatory drugs, anticoagulants, and corticosteroids may result in drug-induced blood loss due to direct irritation of the gastric mucosa or the tendency of these agents to increase bleeding.³

Symptoms of Iron Deficiency

Early symptoms of iron deficiency are often vague and may go unnoticed. As the body becomes more deficient in iron, the patient may present with symptoms such as fatigue, pale skin, weakness, dizziness, headache, dyspnea upon exertion, inflammation or soreness of the tongue, and tachycardia.^1,3,4 Some patients may have an abnormal craving to eat materials such as ice or dirt, referred to as pica.⁵

Anemia in individuals who are not pregnant, breast-feeding, menstruating, or on a meat-restricted diet may be a symptom of a more serious medical condition, and these patients should seek medical evaluation.³ Patients exhibiting signs of iron deficiency anemia should be encouraged to seek medical evaluation from their primary health care provider.

Treating Iron Deficiency

The use of iron supplements may be necessary in women with heavy or prolonged menstrual cycles or in patients who donate blood frequently. ³ Iron supplements may also be needed for individuals recovering from certain medical conditions, such as peptic ulcer disease; cancer and esophageal varices; injuries, such as automobile accidents associated with blood loss; and recent surgery.³

If iron supplements are warranted, the primary health care provider will determine what product is best for the individual (Table). Selection may be based upon how well the iron is absorbed and tolerated, dosing intervals, and the amount of elemental iron delivered per dose.³

Nonprescription iron supplements are available with 2 forms of iron: ferrous and ferric. Ferrous iron salts (ferrous fumarate, ferrous sulfate, and ferrous gluconate) are the best-absorbed forms of iron.⁶ These products are available in immediate- and controlled-release formulations, as well in enteric form to decrease gastric irritation.

Ferrous salt formulations may be administered with ascorbic acid to improve absorption, and combination products containing both iron and ascorbic acid are available. Patients may also be advised to take iron supplements with fruit juices high in ascorbic acid to improve absorption.

In 2009, Avalen Consumer introduced Bifera, which is marketed as the only nonprescription iron supplement to contain heme iron (protein-based iron) and nonheme iron (plantbased iron). It is available in pill form with minimally or virtually no gastrointestinal (GI) side effects. ⁷

Providing Guidance

During counseling, patients should be advised that the use of iron supplements may cause GI irritation, nausea, constipation, dark stools, and abdominal pain. These supplements should be taken as directed under the supervision of a primary health care provider, and patients should contact their primary health care provider if they experience any adverse effects or if symptoms worsen. Patients should also be advised to maintain routine checkups with their primary health care provider to monitor their iron levels.

Many manufacturers recommend taking iron supplements with meals to avoid stomach irritation. Patients concerned about iron deficiency should not use these products until evaluated by their primary health care provider to ensure the appropriateness of use. Patients electing to use these supplements should be reminded to not take any other multivitamin supplements containing iron while using these supplements, to prevent iron toxicity. Patients should be advised to store iron supplements in child-resistant containers out of reach of children to prevent accidental poisoning. PT

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

References

1. Iron deficiency anemia. Medline Plus Web site. www.nlm.nih.gov/medlineplus/ency/article/000584.htm. Accessed May 4, 2011

2. What causes iron deficiency anemia? United States Department of Health and Human Services National Heart Lung and Blood Institute Web site. www.nhlbi.nih.gov/health/dci/Diseases/ida/ida_causes.html . Accessed May 4, 2011.

3. Huckleberry Y, Rollins C. Essential and conditionally essential nutrients. In: Berardi R, Newton G, McDermott JH, et al, eds. Handbook of Nonprescription Drugs. 16th ed. Washington, DC: American Pharmacists Association; 2009:407-408.

4. Iron deficiency anemia. Mayo Clinic Web site. www.mayoclinic.com/health/iron-deficiency-anemia/DS00323/DSECTION=symptoms. Accessed May 5, 2011.

5. Iron deficiency anemia. Merck Manual for Healthcare Professionals Online Edition. www.merckmanuals.com/professional/sec11/ch130/ch130b.html?qt=iron deficiency anemia&alt=sh. Accessed May 4, 2011.

6. Iron Supplements Dietary Supplement Fact Sheet. National Institutes of Health Office of Dietary Supplements Web site. http://ods.od.nih.gov/factsheets/iron/. Accessed May 4, 2011.

7. Bifera Product Information. Avalen Consumer Web site. www.bifera.com/. Accessed May 4, 2011.