Ferrous fumarate + Folic acid + Docusate sodium
Indications
Ferrous fumarate + Folic acid + Docusate sodium is used for:
Prophylaxis and treatment of iron deficiency anaemia.
Adult Dose
Oral
Prophylaxis of iron deficiency
Adult: 1-2 caps daily.
Child Dose
Renal Dose
Administration
Contra Indications
Anaemia other than those due to Fe deficiency (e.g. megaloblastic anaemia due to vit B12 deficiency), paroxysmal nocturnal haemoglobinuria, haemosiderosis, haemochromatosis and haemoglobinopathies, active peptic ulcer, inflammatory bowel disease, including regional enteritis and ulcerative colitis, intestinal strictures and diverticulae. Patients requiring repeated blood transfusion.
Precautions
Patient w/ folate dependent tumours, erythropoietic protoporphyria, history of peptic ulcer. Pregnancy and lactation. Patient Counselling This drug may colour the stool black.
Pregnancy-Lactation
Interactions
Ferrous fumarate: Fe chelates w/ tetracyclines, absorption of both agents may be impaired; it also chelates w/ acetohydroxamic acid, reducing the absorption of both. Reduced absorption w/ antacids and PPIs, neomycin, cholestyramine, Ca, oral Mg salts and other mineral supplements, Zn and trientine. May form insoluble complexes w/ bicarbonates, carbonates, oxalates, or phosphates, thus absorption is reduced. Increased absorption w/ ascorbic or citric acid. Chloramphenicol delays plasma clearance and incorporation of Fe into red blood cells by interfering w/ erythropoiesis. Reduces the hypotensive effect of methyldopa.
May form toxic complexes w/ dimercaprol. Reduces the absorption of fluoroquinolones, levodopa, carbidopa, entacapone, bisphosphonates, penicillamine, thyroid hormones, mycophenolate, cefdinir and Zn. May reduce the absorption of eltrombopag (give at least 4 hr apart). Folic acid: May reduce serum levels of anticonvulsants (e.g. phenobarbital, phenytoin, primidone). Reduced absorption w/ sulfasalazine. May interfere w/ the action of raltitrexed.
Adverse Effects
Side effects of Ferrous fumarate + Folic acid + Docusate sodium :
GI: Nausea, anorexia, vomiting, constipation or diarrhoea, abdominal cramps, heartburn, black stool. Dermatologic: Allergic reactions.
Mechanism of Action
Ferrous fumarate is an Fe compound that is used in the prevention and treatment of iron deficiency anaemia. It provides a high level of elemental Fe w/ low incidence of gastric distress.
Folic acid is a precursor of a large family of compounds which serve as coenzymes in carbon transfer reactions. These reactions are required for the synthesis of purine and pyrimidine bases, inter-conversion of glycine and serine, biosynthesis of methionine methyl groups and degradation of histidine. It also increases jejunal glycolytic enzymes and is involved in the desaturation and hydroxylation of long-chain fatty acids in the brain.
Docusate sodium is an anionic surfactant which is considered to act primarily by increasing the penetration of fluid into the faeces. It may also have other effects on intestinal fluid secretion, and may act both as stimulant and as faecal softening agent.