Pharmacolo Gy of Iron: By: Salma Ahmed
Pharmacolo Gy of Iron: By: Salma Ahmed
Pharmacolo Gy of Iron: By: Salma Ahmed
GY OF
IRON
BY: SALMA AHMED
INTRODUCTION
IRON IS AN ESSENTIAL IT PLAYS A CRITICAL ROLE WITHIN A LARGE VARIETY IRON SUPPLEMENTS ARE
COMPONENT OF EVERY IN THE TRANSPORT AND OF ENZYMES IRON ALSO WIDELY ADMINISTERED TO
CELL IN THE BODY. STORAGE OF OXYGEN (IN ACTS AS A CARRIER FOR TREAT IRON DEFICIENCY
HEMOGLOBIN AND ELECTRONS, A CATALYST ANEMIA, PARTICULARLY IN
MYOGLOBIN), FOR OXYGENATION, CHRONIC DISEASES SUCH
RESPECTIVELY. HYDROXYLATION, AND IS AS KIDNEY DISEASE, HEART
NECESSARY FOR CELLULAR FAILURE OR
GROWTH AND INFLAMMATORY BOWEL
PROLIFERATION. DISEASE.
DISTRIBUTION IN BODY
Iron stores as
Parenchymal
Hemoglobin(Hb) ferritin and Myoglobin (in
iron (in enzymes,
: 62% haemosiderin : muscles) : 7%
etc.): 6%
25%
STORAGE
Hb- protoporphyrin, i.e, each molecule has 4 iron containing haem residues.
It has 0.33% iron.
Loss of 100 ml of blood (containing 15 g Hb) means loss of 50 mg elemental iron.
To raise the Hb level of blood by 1g/dl about 200 mg of elemental iron is needed.
Iron is stored only in ferric form, in combination with a large protein apoferritin.
aggregates
Apoferritin + Fe3+ Ferritin Hemosiderin (not reutilized)
Ferritin can get saturated to different extents; at full saturation it can hold 30% iron by
weight.
Most important storage sites are reticuloendothelial cells(RE).
DAILY REQUIREMENTS
Adult female
Adult male : 0.5 –
(menstruating) : Infants : 60 µg/kg
1 mg (13µg/kg)
1-2 mg (21µg/kg)
Pregnancy (last 2
Children : 25
trimesters) : 3-5
µg/kg
mg (80 µg/kg)
DIETARY SOURCES
Rich : Liver, egg yolk, oyster, Medium : Meat, chicken, fish, Poor : Milk and its products, root
dry beans, dry fruits, wheat spinach, banana, apple. vegetables
germ, yeast.
IRON ABSORPTION
Alkalis
2. Failure to absorb oral iron: malabsorption; inflammatory bowel disease. Chronic inflammation (e.g. RA)
Fe absorption, as well as rate at which iron can be utilized.
5. Along with erythropoietin in chronic kidney disease(CKD) patients: oral iron may not be absorbed at
sufficient rate to meet the demands of induced rapid erythropoiesis.
Parenteral iron therapy needs calculation of total iron requirement of patient.
A simple formula is:
Iron requirement (mg) = 4.4 × body weight(kg) × Hb deficit (g/dl)
a. Iron-dextran(i.v. , i.m.)
b. Ferrous sucrose(i.v.)
c. Ferric carboxymaltose(i.v.)
e. Iron sorbitol(i.m)
IRON-DEXTRAN
HMW colloidal solution - 50 mg elemental Fe/ml.
Route: I/M, I/V
By i/m route, it is absorbed through lymphatics, circulates without binding to transferrin and
is engulfed by RE cells where iron dissociates and is made available to erythron for haem
synthesis.
In injected muscle, 10-30% of dose remains locally bound and becomes unavailable for
utilization for several weeks. Thus, 25% extra needs to be added to calculated dose.
Iron-dextran is not excreted in urine or in bile.
Because dextran is antigenic, anaphylactic reaction are more common.
HOW TO ADMINISTER
a. INTRAMUSCULAR:
oInjection is given deeply in gluteal region using Z track technique(to avoid staining
of skin).
oIron dextran is injected 2ml daily, or on alternate days, or 5ml each side on the same
day.
b. INTRAVENOUS:
oA dose of 2ml containing 100 mg iron is injected per day taking 10 mins for
injection.
oAlt., total calculated dose is diluted in 500 mg of glucose/ saline solution and
infused i.v. over 6-8 hrs under constant observation.
ADR
LOCAL: Pain @site (i/m), skin pigmentation, sterile abscess(esp. in old, debilitated pts.)
Dose- 100mg(upto 200mg) i/v for 5 mins- once daily to once weekly
(till Total Calculated dose is administered).
M.O.A- after i/v injection, Fe rapidly taken up by RE cells, slowly released for use by erythropoietic cells; tight
binding w/n matrix-release very little labile Fe(toxicity)
Thus, admin. of single dose 1-2g i/v for 15-30 min- full Fe deficit corrected by a single short period i/v infusion
Treatment should be continued 3-6 months even after correction of cause of deficiency, to correct
anemia and replenish stores
PROPHYLAXIS: Later ½ of pregnancy, Infancy, c/c Illness, Menorrhagia, after a/c blood loss
STAGES OF IRON DEFICIENCY
2. Megaloblastic Anemia
Brisk Hematopoiesis following vit. B12/Folate therapy-can unmask Fe
deficiency.
10-20 Fe tablets or its equivalent of liquid prep(>60mg/kg Fe) can cause serious toxicity
Few cases- death occurs early(w/n 6 hrs.), but typically delayed to 12-36 hrs. w/ apparent
improvement in the intervening period