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Therapeutic Use

Iron mineral repletion

Examples: pregnant or menstruating women, malnourished patients

Treatment of iron-deficiency associated anemia

Off-Label Use

Restless leg syndrome

LM/PO

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Iron is an essential component of hemoglobin, which allows red blood cells to carry oxygen.

PO

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Absorption: Occurs in the upper half of the small intestine (duodenum and part of the jejunum). 10% yield in patients with adequate iron levels, and up to 30% yield during iron insufficiency. Taking with food decreases absorption.

Excretion: Occurs via the renal and integumentary systems (urine and sweat), as well as during menses.

Onset: 3-10 days.

Peak: Hemoglobin increases over 2 to 4 weeks.

PO

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Routes

Tablets/capsules

Swallow whole; do not crush

Liquid (drops)

Shake well before use

Liquid (elixir)

Mix liquid with water/juice and drink from a straw for less stains in teeth

Doses

Dose is expressed in terms of elemental iron; ferrous sulfate contains ~20% elemental iron per mg of mineral salt

Each 325 mg tablet contains 65 mg elemental iron

Fun fact:
Daily dosing is not recommended. It has been showed to decrease absorption over time. Anemic patients are therefore recommended to take a 65 mg elemental iron once every other day.

LM

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Stains that occur from iron supplements. Typically seen if a patient does not use a straw or fails to rinse mouth after administration.

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Well tolerated; usually no side effects
Common Adverse Effects

GI upset

Constipation, diarrhea, nausea/vomiting, anorexia

Green stool

Liquid: staining of mouth/teeth

Severe Adverse Effects

Fever

Black, tarry, blood stool

Bloody/coffee-ground emesis

LM

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Be prepared to manage adverse effects:

Encourage oral hygiene to prevent tooth staining

Non-pharmacological management:

Elevate HOB/side lying position

Encourage fluid and fiber intake

Pharmacological management: encourage fluid and fiber intake

Antiemetics

Laxatives

Analgesics

Review labs:

Hemoglobin and Hematocrit

Serum Iron

Male: 75-175mcg/dL

Female: 65-165mcg/dL

PO

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Burcham, J., Rosenthal, L. (2019). Lehne’s Pharmacology for Nursing Care (10th edition). St. Louis, MO: Elsevier

Lexicomp. (2022). Ferrous Sulfate. Lexicomp (wrlc.org)

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A nurse is providing education to his/her patient who has been diagnosed with anemia last year. Which statement made by the patient about ferrous sulfate (Feosol), suggests a need to provide further education? Select all that apply.

A) "Sometimes I have greenish stool, but I know that can happen with this supplement, so I am not concerned."
B) "Since I am anemic, I make sure I take this supplement daily to ensure I have sufficient iron levels."
C) "I don't like swallowing pills, so I crush the pill and put it in my apple sauce."
D) "I need to notify my provider immediately if I see blood in my vomit."
E) "I use a straw if I am using a liquid form, that way I am not staining my teeth."
LM