Iron

What is it?
Iron is an essential mineral used to treat iron deficiency, certain types of anemia (due to low iron), breath holding in kids, and to increase mental function.

Other names for iron include: Ferrous Fumarate, Ferrous Gluconate, and Ferrous Sulfate.

Ask your doctor, nurse, or pharmacist if you need more information about this medicine or if any information in this leaflet concerns you.

Before Using:
Tell your doctor if you

• are taking medicine or are allergic to any medicine (prescription or over-the-counter (OTC) or dietary supplement)
• are pregnant or plan to become pregnant while using this medicine
• are breastfeeding
• have hemochromatosis (not normal redness of the blood) or hemosiderosis (a disease that destroys red blood cells) (2)
• have any other health problems, such as high blood pressure or heart or blood vessel disease

Dosage:
Talk with your caregiver about how much iron you should take. The amount depends on the strength of the medicine and the reason you are taking iron. If you are using this medicine without instructions from your caregiver, follow the directions on the medicine bottle. Do not take more medicine or take it more often than the directions tell you to.

To store this medicine:
Keep all medicine locked up and away from children. Store medicine away from heat and direct light. Do not store your medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down and not work the way it should work. Throw away medicine that is out of date or that you do not need. Never share your medicine with others.

Drug and Food Interactions:
Do not take iron without talking to your doctor first if you are taking:

• Cholestyramine (Questran(R))
• Antacids or ulcer medicine (examples: aluminum hydroxide (Maalox(R)), calcium carbonate (Tums(R), Rolaids(R)), lansoprazole (Prevacid(R)), omeprazole (Prilosec(R)), pantoprazole (Protonix(R)), rabeprazole (Aciphex(R)). Separate use of these medications by an hour or two from time of iron use.
• Etidronate (Didronel(R))
• Gossypol
• Levodopa (Sinemet (R))
• Levothyroxine (Eltroxin(R), Levothroid(R), Synthroid(R))
• Methyldopa (Aldomet(R), Aldoril(R))
• Mycophenolate mofetil
• Penicillamine
• Medicines used to treat infection (examples: cefdinir (Omnicef(R)), ciprofloxacin (Cipro(R)), levofloxacin (Levaquin(R)), doxycycline (Vibramycin(R)), minocycline (Minocin(R)), tetracycline (Sumycin(R)). Separate use of these medications by an hour or two from time of iron use.
• Trientine (Syprine(R))
• Dairy products, eggs
• Gossypol
• Soy
• Zinc, Vanadium

Warnings:

• Before taking iron, tell your doctor if you are pregnant or breastfeeding
• If you have a normal iron level, you should not take iron supplements
• Do not use if you have hemochromatosis (not normal redness of the blood) or hemosiderosis (a disease that destroys red blood cells)
• Do not take iron if you have an infection or illness of any type (4)
• Do not crush or chew any sustained-release products
• It is a good idea to take other medications about 2 hours before or after iron is taken

Side Effects:
Stop taking your medicine right away and talk to your doctor if you have any of the following side effects. Your medicine may be causing these symptoms which may mean you are allergic to it.

• Breathing problems or tightness in your throat or chest
• Chest pain
• Skin hives, rash, or itchy or swollen skin

Other Side Effects:
You may have the following side effects, but this medicine may also cause other side effects. Tell your doctor if you have side effects that you think are caused by this medicine.

• Taking too much iron (poisoning) can cause you to feel very tired, vomit (throw up) and have stomach pain, with a weak, fast heart beat, and dehydration (loss of water) (2)
• You may experience an upset stomach and throwing up, loss of appetite (feeling hungry), constipation, diarrhea (loose stools), and stools may be dark in color (2)

References:
1. National Research Council: Iron. Recommended Dietary Allowances, 10th ed. National Academy Press, Washington, DC; 1998.
2. Campbell NRC, Campbell RRA & Hasinoff BB: Ferrous sulfate reduces methyldopa absorption: methyldopa: iron complex formation as a likely mechanism. Clin Invest Med 1990; 13:329-332.
3. Cook JD, Dassenko SA & Whittaker P: Calcium supplementation: effect on iron absorption. Am J Clin Nutr 1991; 53(1): 106-111.
4. Scott JL, Finegold SM, Belkin GA et al: A controlled, double-blind study of the hematologic toxicity of chloramphenicol. N Engl J Med 1965; 272(22): 1137-1142.
5. Daoud AS, Batieha A, Al-Sheyyab M et al:Effectiveness of iron therapy on breath-holding spells. J Pediatr 1997; 130:547-550.
6. Bruner AB, Joffe A & Duffan AK: Randomized study of cognitive effects of iron supplementation in non-anemic iron-deficient adolescent girls. Lancet 1996; 348:992-996.
7. Couper RTL & Simmer KN: Iron deficiency in children: food for thought. Med J Australia 2001; 174(4):162-163.
8. Johnson KB: The Harriet Lane Handbook, 13th ed. Mosby-Year Book, Inc, St Louis, MO, USA; 1993: 194-195.
9. Baker WF: Iron deficiency in pregnancy, obstretics, and gynecology. Hematol Oncol Clin North Am 2000; 14(5): 1061-1077.
10. Camitta BM & Nathan DG: Anemia in adolescence: I. Disturbances of iron balance. Postgrad Med 1975; 57(2):143-146.
11. Product Information: Slow FE(R), iron. CIBA Consumer, Summit, NJ, USA; 1996.
12. Beard J, Borel M & Peterson FJ: Changes in iron status during weight loss with very-low-energy diets. Am J Clin Nutr 1997; 66:104-110.
13. Hoffman RM & Jaffe PE: Plummer-Vinson syndrome: a case report and literature review. Arch Intern Med 1995; 155(18):2008-2011.
14. Milman N, Bergholt T, Byg KE et al: Iron status and iron balance during pregnancy. A critical reappraisal of iron supplementation. Acta Obstet Gynecol Scand 1999; 78(9):749-757.
15. Groner JA, Holtzman NA, Charney E et al: A randomized trial of oral iron on tests of short-term memory and attention span in young pregnant women. J Adolesc Health Care 1986; 7(1):44-48.
16. Hansten PD: Drug Interactions, 5th ed. Lea & Febiger, Philadelphia, PA, USA, 1985.
17. Das KM & Eastwood MA: Effect of iron and calcium on salicylazosulphapyridine metabolism. Scand Med J 1973; 18:45-50.
18. Product Information: Prilosec(R), omeprazole. Astra Merck Inc., Wayne, PA, 1995.
19. Venho VM, Salonen RO & Mattila MJ: Modification of the pharmacokinetics of doxycycline in man by ferrous sulfate or charcoal. Eur J Clin Pharmacol 1978; 14:277-280.
20. Leonard JP, Desager JP, Beckers C et al: In vitro binding of various biological substances by two hypocholesterolaemic resins, cholestyramine and colestipol. Arzneimittelforschung 1979; 29:979-981.
21. Cook JD, Reddy MB & Hurrell RF: The effect of red and white wines on nonheme-iron absorption in humans. Am J Clin Nutr 1995; 61:800-804.
22. Schaefer JP, Tam Y, Hasinoff BB et al: Ferrous sulphate interacts with captopril. Br J Clin Pharmacol 1998; 46:377-381.
23. Campbell NR, Hasinoff BB, Stalts H et al: Ferrous sulfate reduces thyroxine efficacy in patients with hypthyroidism. Ann Intern Med 1992; 117:1010-1013.
24. Pizarro F, Olivares M, Hertrampf E, Walter T (1994). Factors which modify the nutritional state of iron: tannin content of herbal teas. Arch Latinoam Nutr 44:277-80.
25. Product Information: Syprine(R), trientine hydrochloride. Merck & Co., Inc., West Point, PA, 1997.
26. Morii M, Ueno K, Ogawa A et al: Impairment of mycophenolate mofetil absorption by iron ion. Clin Pharmacol Ther 2000; 68:613-616.
27. Herman DL & Smith FH: Effect of bound gossypol on the absorption of iron by rats. J Nutr 1973; 103(6):882-889.
28. Product Information: Didronel(R), etidronate disodium. Procter & Gamble Pharmaceuticals, Inc., Cincinnati, OH, 1998.
29. Muijsers AO, vand de Stadt RJ, Henrichs AM et al: D-penicillamine in patients with rheumatoid arthritis: serum levels, pharmacokinetics aspects, and correlation with clinical course and side effects.Arthritis Rheum 1984; 27(12):1362-1369.
30. Gabrielli GB & De Sandre G: Excessive tea consumption can inhibit the efficacy of oral iron treatment in iron-deficiency anemia. Haematologica 1995; 80(6):518-520.
31. Hallberg L & Rossander L: Effect of different drinks on the absorption of non-heme iron from composite meals. Hum Nutr Appl Nutr 1982; 36(2):116-123.
32. Product Information: Prevacid(R), lansoprazole. TAP Pharmaceuticals, Lake Forest, IL (PI revised 8/2002) reviewed 10/2002.
33. Product Information: Aciphex(R), rabeprazole sodium. Eisai Co., Ltd., Tokyo, Japan, 2002.