Ferrous sulfate

Generic name: Ferrous sulfate anhydrous

Commonly known or available as Ferrous sulfate
Chemical formula: FeO4S
Indications: Ferrous sulfate is used for the prevention
and treatment of iron deficiency anemia in adults and
children.
Mechanism of action: Iron is required to maintain optimal
health, particularly for helping to form red blood cells (RBC)
that carry oxygen around the body. A deficiency in iron
indicates that the body cannot produce enough normal red
blood cells.9,22 Iron deficiency anemia occurs when body stores
of iron decrease to very low levels, and the stored iron is
insufficient to support normal red blood cell (RBC) production.
Insufficient dietary iron, impaired iron absorption, bleeding,
pregnancy, or loss of iron through the urine can lead to iron
deficiency.9,24 Symptoms of iron deficiency anemia include
fatigue, breathlessness, palpitations, dizziness, and headache.
PHARMACOKINETICS
Absorption: Approximately 5 – 10% of dietary iron is
absorbed, and this absorption rate increases to up to 30%
in iron deficiency states. Oral iron supplements are
absorbed up to 60% via active and passive transport
processes.17 Gastrointestinal absorption of iron occurs via
strict regulation by the enterocyte and duodenal
cytochrome and ferric reductase enzymes. The hormone
hepcidin heavily regulates iron absorption and distribution
throughout the body
. Volume of distribution: About 60% of iron is
22

distributed the erythrocytes.6 The remainder of the iron is

found in muscle tissues (as a part of myoglobin), and in a
variety of different enzymes, as well as in storage form.
Most stored iron is in the form of ferritin, which can be
found in the liver, bone marrow, spleen and, and muscle.
Iron crosses the placenta and is also found in breast milk.
Metabolism: The metabolism of iron is complex.
Normally, iron exists in the ferrous (Fe2+) or ferric (Fe3+)
state, but since Fe2+ is oxidized to Fe3+, which
hydrolyzes to insoluble iron(III)hydroxides in neutral
aqueous solutions, iron binds to plasma proteins and is
either transported or stored throughout the body.
Half-life: The half-life of orally administered iron is not
readily available in the literature, with total effects lasting
2-4 months (congruent with the red blood cell life
span)11 with an onset of action of 4 days and peak activity
at 7-10 days.
PHARMACODYNAMICS Ferrous sulfate replenishes
iron, an essential component in hemoglobin, myoglobin,
and various enzymes. It replaces the iron that is usually
found in hemoglobin and myoglobin. Iron participates in
oxygen transport and storage, electron transport and
energy metabolism, antioxidant and beneficial pro-oxidant
functions, oxygen sensing, tissue proliferation and growth,
as well as DNA replication and repair.6,9

INTERACTION Ferrous sulfate anhydrous can cause a

decrease in the absorption of Alendronic acid resulting in a
reduced serum concentration and potentially a decrease in
efficacy
Toxicity: The toxicity of ferrous sulfate in humans
depends on the amount of iron ingested. Up to 20 mg/kg
of elemental iron is not toxic, 20-60 mg/kg has mild
toxicity, and more than 60 mg/kg can lead to severe
symptoms and morbidity.
Dosage: Oral ferrous iron salts are the most economical
and effective medication for the treatment of iron
deficiency anaemia. Of the various iron salts available,
ferrous sulfate is the one most commonly used.
Although the traditional dosage of ferrous sulfate is 325
mg (65 mg of elemental iron) orally three times a day,
lower doses (eg, 15-20 mg of elemental iron daily) may be
as effective and cause fewer side effects. To promote
absorption, patients should avoid tea and coffee and may
take vitamin C (500 units) with the iron pill once daily.