Drugs List

Therapeutic Indications

Uses

Dietary supplement

Contraindications

Children under 18 years
Acute renal failure
First trimester of pregnancy
Haemoglobinopathies
Haemolytic anaemia
Haemosiderosis
Hereditary fructose intolerance

Precautions and Warnings

Glucose-galactose malabsorption syndrome
Second trimester of pregnancy
Third trimester of pregnancy

Not suitable for treatment of deficiency states
Exclude any serious underlying cause of anaemia before starting treatment
Oral liquid contains propylene glycol
Preparation contains sucrose
Oral iron may mask signs of occult blood loss

Iron salts may exacerbate diarrhoea in patients with inflammatory bowel disease.

Care is needed in patients with intestinal strictures and diverticular disease.

Pregnancy and Lactation

Pregnancy

Use ferric ammonium citrate with glycerophosphates and B vitamins with caution during pregnancy.

Safe after the first trimester only when taken in recommended doses and if no other iron or calcium supplements are taken concurrently.

During pregnancy, the maternal need for iron increases to fulfil the requirements of the foetus and placenta. Although the volume of maternal plasma increases, the number of erthyrocytes does not, thus leading to a decrease in haemoglobin value. Consequently, a pregnant woman needs about 5 mg of iron per day, which cannot be adequately covered by diet alone. Iron supplements are recommended if haemoglobin levels fall below 100 g/litre (Schaefer, 2015).

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Safe for use during lactation when used in the recommended doses.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Allergic reaction
Constipation
Diarrhoea
Discolouration of stools
Epigastric pain
Gastric irritation
Nausea

Presentation

Oral syrup containing:
Ferric ammonium citrate
Thiamine hydrochloride (Vitamin B1)
Riboflavine (Vitamin B2)
Nicotinamide (Vitamin B3)
Calcium pantothenate (Vitamin B5)
Pyridoxine hydrochloride (Vitamin B6)
Calcium glycerophosphate
Sodium glycerophosphate
Potassium glycerophosphate
Manganese glycerophosphate

Drugs List

Therapeutic Indications

Uses

Dietary supplement

Dosage

Adults

Contraindications

Children under 18 years
Acute renal failure
First trimester of pregnancy
Haemoglobinopathies
Haemolytic anaemia
Haemosiderosis
Hereditary fructose intolerance

Precautions and Warnings

Glucose-galactose malabsorption syndrome
Second trimester of pregnancy
Third trimester of pregnancy

Not suitable for treatment of deficiency states
Exclude any serious underlying cause of anaemia before starting treatment
Oral liquid contains propylene glycol
Preparation contains sucrose
Oral iron may mask signs of occult blood loss

Iron salts may exacerbate diarrhoea in patients with inflammatory bowel disease.

Care is needed in patients with intestinal strictures and diverticular disease.

Pregnancy and Lactation

Pregnancy

Use ferric ammonium citrate with glycerophosphates and B vitamins with caution during pregnancy.

Safe after the first trimester only when taken in recommended doses and if no other iron or calcium supplements are taken concurrently.

During pregnancy, the maternal need for iron increases to fulfil the requirements of the foetus and placenta. Although the volume of maternal plasma increases, the number of erthyrocytes does not, thus leading to a decrease in haemoglobin value. Consequently, a pregnant woman needs about 5 mg of iron per day, which cannot be adequately covered by diet alone. Iron supplements are recommended if haemoglobin levels fall below 100 g/litre (Schaefer, 2015).

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Safe for use during lactation when used in the recommended doses.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Counselling

Advise patients that iron is best absorbed when taken on an empty stomach but may be taken after food to reduce gastrointestinal symptoms.

Inform patients that iron treatment might cause darkening of the stool.

Side Effects

Allergic reaction
Constipation
Diarrhoea
Discolouration of stools
Epigastric pain
Gastric irritation
Nausea

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: May 2017

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Joint Formulary Committee. British National Formulary. 73rd ed. London: BMJ Group and Pharmaceutical Press; 2017.

Summary of Product Characteristics: Ironorm Syrup. Wallace Manufacturing Chemists Ltd. Revised April 2009.