Makindo Medical Notes

💊 Modern practice: Once daily or alternate-day ferrous sulphate (FeSO₄) is sufficient. ⚠️ Please stop prescribing TDS oral iron — this only increases side effects without added benefit. ❗ Iron overdose is potentially fatal in children → always keep tablets out of reach.

📖 About

• Iron deficiency anaemia may be the first sign of GI malignancy → always investigate underlying cause in adults.
• Iron is essential for haemoglobin, myoglobin, and many enzymes (cytochromes, peroxidases, ribonucleotide reductases, catalase).
• Most body iron is recycled from old red blood cells; dietary absorption (1–2 mg/day) just replaces normal losses (bleeding, skin, GI epithelium).

🧪 Physiology

• Adults need ~25 mg iron daily for RBC production, but only 1–2 mg is absorbed through the intestine.
• Absorption requires ferric (Fe³⁺) iron to be reduced to ferrous (Fe²⁺) form in the stomach.
• Low gastric pH, ascorbic acid (vitamin C) and sulphydryl groups help this conversion.

🎯 Indications

• Iron deficiency anaemia (treat the cause + replace stores).
• Increased requirements (e.g. pregnancy — folate often co-prescribed).
• Prevention in high-risk groups with poor diet or chronic blood loss.

💊 Dose

• Ferrous sulphate: 200 mg once daily (65 mg elemental iron) or on alternate days (better tolerated & improves absorption).
• Continue for 3 months after Hb normalises to replenish iron stores.
• IV iron may be used if oral not tolerated, absorption is poor, or rapid correction is needed (e.g. in CKD, IBD, pre-op) — but can cause allergy, hypotension, metallic taste, bradycardia, abdominal pain.

⛔ Contraindications & Cautions

• Active or severe inflammatory bowel disease (may worsen symptoms).
• Oesophageal/gut strictures (risk of mucosal damage with tablets).
• Use with care in older patients (constipation) and those at risk of non-compliance.

💢 Side Effects

• GI upset — nausea, constipation, diarrhoea, epigastric pain.
• Dark stools (benign but alarming to patients).
• Poor adherence due to side effects is common.

🔄 Interactions

• ⬇️ Reduced absorption with tetracyclines, quinolones, penicillamine, levodopa, bisphosphonates.
• ⬇️ Magnesium/aluminium antacids reduce absorption.
• ⬆️ Vitamin C (ascorbic acid) enhances absorption.

📚 References