Page 194 - pharma 1 theoretical updated MNU_Neat

Clinical pharmacy 2024/2025 Level 3 Pharm D Pharmacology 1 (PO 502)
Pharmacotherapy for Anemia

A) Non-pharmacologic Therapy

1-Transfusion of RBCs

 Restrictive transfusion trigger based on a threshold Hb level → blood transfusion is
essential only for patients with Hb concentrations in the range of 7.0-9.0 g/dl
2- Diet

 A diet that is rich in iron, folic acid, or vitamin B12 should be encouraged but is
rarely the sole approach of treatment.
B) Pharmacological Treatment

 Iron-Deficiency Anemia

1) Oral Iron Therapy

➢ Initial treatment → Oral iron therapy that provides 150-200 mg of elemental iron/day
 The preferred regimen for oral iron → 50 to 65 mg of elemental iron in 2-3 doses daily
on an empty stomach (1 h before or 2 h after a meal) for maximal absorption.

 However, if patients develop intolerable GI side effects→ they should be advised to
take it with meals
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 The Fe forms are more soluble & absorbable > the Fe form.
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 The three Fe salt preparations have similar side effects, bioavailability (10-15%
absorption rate) and effectiveness.
 Ferrous sulfate ➔ standard first-line & the most commonly prescribed preparation

due to low cost
 325 mg tablet (60 mg of elemental iron), 3 times daily → 180 mg of elemental
iron/day → assuming an absorption rate of 10 %, 500 mg of bioavailable iron /month

of therapy → should ↑ Hb level by ~ 2 g/dl

Adverse reactions of oral iron Strategies to ↓ side effects include:
Upper gastrointestinal side effects: 1. ↓ dose (e.g., single 325-mg tablet of

Nausea, heartburn, epigastric pain → Fe2+ sulfate)
more dose dependent 2. Administering iron with meals
3. Use of enteric-coated preparations

Lower gastrointestinal side effects: (Ferrograd) or a polysaccharide-iron
Constipation or diarrhea, and dark complex
stools→ less related to dosing  However, all these strategies ↓ iron
absorption

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