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IRON SUPPLEMENTS (Systemic)
Some commonly used brand names are:
In the U.S.—
Iron is a mineral that the body needs to produce red blood cells. When the body does not get enough iron, it cannot produce the number of normal red blood cells needed to keep you in good health. This condition is called iron deficiency (iron shortage) or iron deficiency anemia.
Although many people in the U.S. get enough iron from their diet, some must take additional amounts to meet their needs. For example, iron is sometimes lost with slow or small amounts of bleeding in the body that you would not be aware of and which can only be detected by your doctor. Your doctor can determine if you have an iron deficiency, what is causing the deficiency, and if an iron supplement is necessary.
Lack of iron may lead to unusual tiredness, shortness of breath, a decrease in physical performance, and learning problems in children and adults, and may increase your chance of getting an infection.
Some conditions may increase your need for iron. These include:
In addition, infants, especially those receiving breast milk or low-iron formulas, may need additional iron.
Increased need for iron supplements should be determined by your health care professional.
Injectable iron is administered only by or under the supervision of your health care professional. Other forms of iron are available without a prescription; however, your health care professional may have special instructions on the proper use and dose for your condition.
Iron supplements are available in the following dosage forms:
Importance of DietFor good health, it is important that you eat a balanced and varied diet. Follow carefully any diet program your health care professional may recommend. For your specific dietary vitamin and/or mineral needs, ask your health care professional for a list of appropriate foods. If you think that you are not getting enough vitamins and/or minerals in your diet, you may choose to take a dietary supplement.
Iron is found in the diet in two forms—heme iron, which is well absorbed, and nonheme iron, which is poorly absorbed. The best dietary source of absorbable (heme) iron is lean red meat. Chicken, turkey, and fish are also sources of iron, but they contain less than red meat. Cereals, beans, and some vegetables contain poorly absorbed (nonheme) iron. Foods rich in vitamin C (e.g., citrus fruits and fresh vegetables), eaten with small amounts of heme iron-containing foods, such as meat, may increase the amount of nonheme iron absorbed from cereals, beans, and other vegetables. Some foods (e.g., milk, eggs, spinach, fiber-containing, coffee, tea) may decrease the amount of nonheme iron absorbed from foods. Additional iron may be added to food from cooking in iron pots.
The daily amount of iron needed is defined in several different ways.
Normal daily recommended intakes in milligrams (mg) for iron are generally defined as follows (Note that the RDA and RNI are expressed as an actual amount of iron, which is referred to as “elemental”" iron. The product form [e.g., ferrous fumarate, ferrous gluconate, ferrous sulfate] has a different strength):
Before Using This Dietary Supplement
If you are taking this dietary supplement without a prescription, carefully read and follow any precautions on the label. For iron supplements, the following should be considered:
Allergies—Tell your health care professional if you have ever had any unusual or allergic reaction to iron medicine. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.
Pregnancy—It is especially important that you are receiving enough vitamins and minerals when you become pregnant and that you continue to receive the right amount of vitamins and minerals throughout your pregnancy. Healthy fetal growth and development depend on a steady supply of nutrients from mother to fetus. During the first 3 months of pregnancy, a proper diet usually provides enough iron. However, during the last 6 months, in order to meet the increased needs of the developing baby, an iron supplement may be recommended by your health care professional.
However, taking large amounts of a dietary supplement in pregnancy may be harmful to the mother and/or fetus and should be avoided.
Breast-feeding—It is especially important that you receive the right amounts of vitamins and minerals so that your baby will also get the vitamins and minerals needed to grow properly. Iron normally is present in breast milk in small amounts. When prescribed by a health care professional, iron preparations are not known to cause problems during breast-feeding. However, nursing mothers are advised to check with their health care professional before taking iron supplements or any other medication. Taking large amounts of a dietary supplement while breast-feeding may be harmful to the mother and/or infant and should be avoided.
Children—Problems in children have not been reported with intake of normal daily recommended amounts. Iron supplements, when prescribed by your health care professional, are not expected to cause different side effects in children than they do in adults. However, it is important to follow the directions carefully, since iron overdose in children is especially dangerous.
Studies on sodium ferric gluconate have shown that this supplement is safe to use in children ages 6 to 15 years. The safety of sodium ferric gluconate has not been determined in patients who are younger than 6 years of age.
Older adults—Problems in older adults have not been reported with intake of normal daily recommended amounts. Elderly people sometimes do not absorb iron as easily as younger adults and may need a larger dose. If you think you need to take an iron supplement, check with your health care professional first. Only your health care professional can decide if you need an iron supplement and how much you should take.
Medicines or other dietary supplements—Although certain medicines or dietary supplements should not be used together at all, in other cases they may be used together even if an interaction might occur. In these cases, your health care professional may want to change the dose, or other precautions may be necessary. When you are taking iron supplements, it is especially important that your health care professional know if you are taking any of the following:
Other medical problems—The presence of other medical problems may affect the use of iron supplements. Make sure you tell your health care professional if you have any other medical problems, especially:
Proper Use of This Dietary Supplement
Dosing—The amount of iron needed to meet normal daily recommended intakes will be different for different individuals. The following information includes only the average amounts of iron.
After you start using this dietary supplement, continue to return to your health care professional to see if you are benefiting from the iron. Some blood tests may be necessary for this.
Iron is best absorbed when taken on an empty stomach, with water or fruit juice (adults: full glass or 8 ounces; children: 1/2 glass or 4 ounces), about 1 hour before or 2 hours after meals. However, to lessen the possibility of stomach upset, iron may be taken with food or immediately after meals.
For safe and effective use of iron supplements:
Liquid forms of iron supplement tend to stain the teeth. To prevent, reduce, or remove these stains:
Missed dose—If you miss a dose of this dietary supplement, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage—To store this dietary supplement:
Precautions While Using This Dietary Supplement
When iron is combined with certain foods it may lose much of its value. If you are taking iron, the following foods should be avoided, or only taken in very small amounts, for at least 1 hour before or 2 hours after you take iron:
Do not take iron supplements and antacids or calcium supplements at the same time. It is best to space doses of these 2 products 1 to 2 hours apart, to get the full benefit from each medicine or dietary supplement.
If you are taking iron supplements without a prescription :
If you have been taking a long-acting or coated iron tablet and your stools have not become black, check with your health care professional. The tablets may not be breaking down properly in your stomach, and you may not be receiving enough iron.
It is important to keep iron preparations out of the reach of children. Keep a 1-ounce bottle of syrup of ipecac available at home to be taken in case of an iron overdose emergency when a doctor, poison control center, or emergency room orders its use.
If you think you or anyone else has taken an overdose of iron medicine :
Early signs of iron overdose may not appear for up to 60 minutes or more. Do not delay going to the emergency room while waiting for signs to appear.
Side Effects of This Dietary Supplement
Along with its needed effects, a dietary supplement may cause some unwanted effects. Although not all of these effects may occur, if they do occur they may need medical attention.
Check with your health care professional if any of the following side effects occur:
More common—with injection only
Backache , groin, side, or muscle pain; chest pain; chills; dizziness; fainting; fast heartbeat; fever with increased sweating; flushing; headache; metallic taste; nausea or vomiting; numbness, pain, or tingling of hands or feet; pain or redness at injection site; redness of skin; skin rash or hives; swelling of mouth or throat; troubled breathing
More common—when taken by mouth only
Abdominal or stomach pain; cramping (continuing) or soreness
Less common or rare—with injection only
Double vision; general unwell feeling; weakness without feeling dizzy or faint
Less common or rare—when taken by mouth only
Chest or throat pain, especially when swallowing; stools with signs of blood (red or black color)
Early symptoms of iron overdose
Diarrhea (may contain blood); fever; nausea; stomach pain or cramping (sharp); vomiting, severe (may contain blood)
Late symptoms of iron overdose
Bluish-colored lips, fingernails, and palms of hands; convulsions (seizures); drowsiness; pale, clammy skin; shallow and rapid breathing; unusual tiredness or weakness; weak and fast heartbeat
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the dietary supplement. However, check with your health care professional if any of the following side effects continue or are bothersome:
Constipation; diarrhea; leg cramps; nausea; vomiting
Darkened urine; heartburn; stained teeth
Stools commonly become dark green or black when iron preparations are taken by mouth. This is caused by unabsorbed iron and is harmless. However, in rare cases, black stools of a sticky consistency may occur along with other side effects such as red streaks in the stool, cramping, soreness, or sharp pains in the stomach or abdominal area. Check with your health care professional immediately if these side effects appear.
If you have been receiving injections of iron, you may notice a brown discoloration of your skin. This color usually fades within several weeks or months.
Other side effects not listed above may also occur in some individuals. If you notice any other effects, check with your health care professional.
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