PHARMACOLOGY I. PRIMARY PROBLEM II. THERAPEUTIC GOALS III. MANAGEMENT PHARMACOLOGIC NON PHARMACOLOGIC

PRIMARY PROBLEM Iron Deficiency Anemia In normal menstruating women, iron requirements are increased. Cause of iron deficiency anemia is probably due to heavy bleeding during menstruation The severity and cause of iron-deficiency anemia will determine the appropriate approach to treatment

THERAPEUTIC GOALS The goal of therapy in individuals with iron deficiency anemia is: To repair the anemia through Oral Iron Therapy Parenteral Iron therapy Adequate dietary intake of iron To provide iron stores To regulate bleeding due to heavy blood flow during menstruation

MANAGEMENT Pharmacologic Management of Iron Deficiency Anemia Oral Iron Therapy Ferrous sulfate, Ferrous gluconate, Ferrous fumarate Supplemental iron is needed to replenish lost iron stores Ferrous iron is most easily absorbed Treatment with oral iron should be continued for 3-6 months to correct the anemia and replenish iron stores

Commonly used Oral Iron Preparations Tablet size Elemental iron/tablet Usual Adult Dosage (tablets/day) Ferrous sulfate hydrated dessicated 325 mg 200 mg 65 mg 3-4 Ferrous gluconate 36 mg Ferrous fumarate 106 mg 2-3 Ferrous sulfate, ferrous gluconate and ferrous fumarate are all effective and inexpensive. Ferrous sulfate – most inexpensive Table 33-2 Katzung, B. Basic and Clinical Pharmacology, 9th Ed. McGraw-Hill: New York

Parenteral Iron Therapy Reserved for patients with documented iron deficiency who are unable to tolerate or absorb oral iron and patients with extensive chronic blood loss who cannot be maintained on oral iron alone. Postgastrectomy Previous small bowel resection Inflammatory bowel disease Malabsorption syndrome

Parenteral Iron Therapy Iron Dextran (IV or IM) Stable complex of ferric hydroxide and low molecular weight Dextran (50mg of elemental iron) Iron-sucrose complex and Iron Sodium gluconate complex (IV) Alternative preparations IV administration eliminates local pain and tissue staining that often occur with IM

Parenteral Iron Therapy Iron gluconate has less allergic reactions as compared to Iron dextran Iron sucrose also has less side effects, even if there is a prior history of rxn to Iron dextran Iron dextran – risk of hypersensitivity reaction Small test dose of iron dextran should always be given before full IM or IV doses are given. Faich, G. Am J Kidney Dis 1999; 33:464

MANAGEMENT Non-Pharmacologic Management of Iron Deficiency Anemia Increase intake of iron from foods such as liver, lean meats, beans, peas, tofu, dark green & leafy vegetables, and egg yolks. Stopler T (2004). Medical nutrition therapy for anemia. In LK Mahan, S Escott-Stump, eds., Krause's Food, Nutrition and Diet Therapy, 11th ed., pp. 838–859. Philadelphia: Saunders.

MANAGEMENT Pharmacologic Management of heavy bleeding during menstruation Hormonal Treatment OCP GnRH agonist Schorge J. et al(2008). Wiliams Gynecology

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