citric-acid--iron--sorbitol-drug-combination and Anemia--Iron-Deficiency

Absolute and functional iron deficiency is the most common cause of epoetin (recombinant human erythropoietin) hyporesponsiveness in renal failure patients. Diagnostic procedures for determining iron deficiency include measurement of serum iron levels, serum ferritin levels, saturation of transferrin and percentage of hypochromic red blood cells. Patients with iron deficiency should receive supplemental iron, either orally or intravenously. Adequate intravenous iron supplementation allows reduction of epoetin dosage by approximately 40%. Intravenous iron supplementation is recommended for all patients undergoing haemodialysis and for pre-dialysis and peritoneal dialysis patients with severe iron deficiency. During the maintenance phase (period of epoetin therapy after correction of iron deficiency), the use of low-dose intravenous iron supplementation (10 to 20 mg per haemodialysis treatment or 100 mg every second week) avoids iron overtreatment and minimises potential adverse effects. Depending on the degree of pre-existing iron deficiency, markedly higher iron doses are necessary during the correction phase (period of epoetin therapy after correction of iron deficiency) [e.g. intravenous iron 40 to 100 mg per haemodialysis session up to a total dose of 1000 mg]. The iron status should be monitored monthly during the correction phase and every 3 months during the maintenance phase to avoid overtreatment with intravenous iron.

Topics: Anemia, Iron-Deficiency; Citric Acid; Drug Combinations; Drug Monitoring; Erythropoietin; Ferric Compounds; Ferric Oxide, Saccharated; Ferrous Compounds; Glucaric Acid; Humans; Infusions, Intravenous; Injections, Intravenous; Iron Compounds; Iron Overload; Iron-Dextran Complex; Kidney Failure, Chronic; Sorbitol

To compare the efficacy, tolerability and compliance of oral iron preparations (iron edetate and iron polymaltose complex) with each other and with intramuscular iron sorbitol in iron deficiency anaemia in children.. A Randomized Controlled Trial (RCT) was carried out at the Paediatric Department of Combined Military Hospital (CMH) from January 2006 to December 2007. In total 146 children, up to 12 years age having haemoglobin (Hb%) less than 8 gm% were included. They were randomly distributed into three groups. Group A (64 cases) received oral sodium iron edetate (SIE), Group B (40 cases) received oral iron polymaltose complex (IPC) and group C (42cases) received intramuscular iron sorbitol (IS) in recommended dosages. Rise in Hb% > 10gm% was kept as desired target. Maximum duration of treatment planned was 2 weeks for parenteral iron (group C) and 12 weeks for oral iron (groups A and B). Haematological parameters- Hb%, mean corpuscular volum (MCV), mean corpuscuar haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) were measured at induction followed at 2 weeks, 4 weeks, 8 weeks and 12 weeks after start of treatment. Compliance and drop out rates were determined on each visit. Data was analyzed using SPSS version10.ANOVA was used to analyze difference in rise in Hb% at various intervals.. Statistically significant increase in mean Hb%, MCV, MCHC after 02 weeks was observed in group C (IS). Rise in these parametes became significant in group A (SIE) and B (IPC) after 04 weeks. Peristent rise was observed in oral groups at 08 and 12 weeks. Rise in Hb% was much faster in group C (IS). It took 2 weeks to achieve mean Hb% > 10gm% and compliance rate was 40.5%, while to achieve same target, duration required was 8 weeks in group A (SIE) and 12 weeks in group B (IPC) and compliance rate was 39% and 30% respectively. Adverse effects were much more common with group A (SIE) as compared to other two groups.. Intramuscular iron sorbitol is a reliable and faster alternative modality for treatment of iron deficiency anaemia in children. Short duration of treatment, sure rise in Hb% and minimal adverse effects improve compliance as compared to oral preparations. Among oral preparations, rise in Hb% is more rapid with iron edetae. While IPC gives relatively slower rise in Hb% but side effects are much less as compared to SIE.

Topics: Administration, Oral; Analysis of Variance; Anemia, Iron-Deficiency; Child; Child, Preschool; Citric Acid; Drug Combinations; Edetic Acid; Female; Ferric Compounds; Humans; Injections; Iron Chelating Agents; Male; Sorbitol; Treatment Outcome

One hundred and twenty-eight patients with iron deficiency anemia were treated with a new intramuscular iron preparation, iron-sorbitol-citric acid. One group of 10 patients received a total of 1000 mg. each of elemental iron intramuscularly. All obtained a rise in hemoglobin of over 2.1 g. %, an elevation of serum iron, and a reticulocyte response over 6%. A second larger group of subjects consisted of 113 prenatal and five gynecologic patients; these received an average total dose of 1050 mg. and 1020 mg., respectively, and the average increase in hemoglobin ranged from 1.6 g. % to 2.5 g. %.None of the patients developed significant side effects after injection or permanent staining at the site of injection. Three patients experienced a transient ache at the injection site, and three developed local urticaria-like reactions lasting 24 hours.This new preparation appears to be a safe and clinically effective therapeutic agent in situations in which parenteral iron is indicated.

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Citrates; Citric Acid; Drug Combinations; Drug Therapy; Ferric Compounds; Hemoglobins; Humans; Injections, Intramuscular; Iron; Sorbitol; Toxicology

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Citric Acid; Drug Combinations; Drug Therapy; Ferric Compounds; Humans; Iron; Sorbitol

Topics: Anemia, Hypochromic; Anemia, Iron-Deficiency; Citrates; Citric Acid; Drug Combinations; Ferric Compounds; Humans; Iron Isotopes; Iron-Dextran Complex; Sorbitol