Nurses Compass
Drug Guide
Ferrous Sulfate and Folic Acid
Classification
Therapeutic: Nutritional supplement, Iron deficiency anemia treatment
Pharmacological: Mineral supplement, Vitamin supplement
FDA Approved Indications
- Treatment and prevention of iron deficiency anemia
- Prenatal supplement to prevent neural tube defects
Mechanism of Action
Ferrous sulfate provides elemental iron which is incorporated into hemoglobin and myoglobin, facilitating oxygen transport. Folic acid is essential for DNA synthesis, red blood cell formation, and fetal development during pregnancy.
Dosage and Administration
Adult: Typically 325 mg ferrous sulfate (which supplies 65 mg elemental iron) once daily or divided doses; folic acid 0.4 mg daily. Dose adjustments depend on severity of deficiency.
Pediatric: Dosage varies based on age and weight; consult specific guidelines.
Geriatric: Monitor for gastrointestinal side effects; dose adjustments may be necessary.
Renal Impairment: Adjust dosage based on severity; closely monitor hematologic status.
Hepatic Impairment: Generally safe but monitor for any hepatic side effects.
Pharmacokinetics
Absorption: Absorbed primarily in the duodenum and upper jejunum.
Distribution: Iron binds to transferrin in plasma; folic acid is distributed widely in body tissues.
Metabolism: Folic acid is converted to active forms in the liver; iron is utilized in hemoglobin synthesis.
Excretion: Iron excreted mainly via the intestinal mucosa and into desquamated mucosal cells; excess iron stored in tissues. Folic acid is excreted in urine.
Half Life: Iron: approximately 6-7 hours; Folic acid: approximately 4-5 hours.
Contraindications
- Hypersensitivity to ferrous sulfate or folic acid.
- Hemochromatosis or other iron overload conditions.
Precautions
- Use with caution in patients with gastrointestinal disorders, hemolytic anemia, or hepatic impairment. Folic acid can mask vitamin B12 deficiency; monitor neurological status. Pregnancy category A.
Adverse Reactions - Common
- Gastrointestinal upset, nausea, constipation (Common)
- Dark stools (Common)
Adverse Reactions - Serious
- Iron toxicity (overdose), potentially fatal in children (Serious)
- Allergic reactions, including rash, itching, swelling (Rare)
Drug-Drug Interactions
- Antacids, tetracyclines, quinolones (may impair absorption of iron)
Drug-Food Interactions
- Calcium-rich foods may inhibit iron absorption
Drug-Herb Interactions
- Avoid high doses of certain herbal supplements that may contain iron or affect absorption.
Nursing Implications
Assessment: Monitor hemoglobin, hematocrit, serum ferritin, and folate levels.
Diagnoses:
- Risk for impaired tissue oxygenation due to iron deficiency
- Imbalanced nutrition: less than body requirements
Implementation: Administer on an empty stomach if tolerated; vitamin C enhances absorption. Educate on possible gastrointestinal side effects.
Evaluation: Improvement in hemoglobin and hematocrit levels; resolution of anemia symptoms.
Patient/Family Teaching
- Take ferrous sulfate with orange juice or vitamin C for better absorption.
- Expect dark stools; this is normal.
- Report gastrointestinal discomfort or allergic reactions.
- Continue folic acid supplementation during pregnancy as recommended.
Special Considerations
Black Box Warnings:
- Serious or fatal poisoning may occur in children who accidentally ingest iron supplements.
- Folic acid can mask vitamin B12 deficiency.
Genetic Factors: Patients with hereditary hemochromatosis should avoid excess iron supplementation.
Lab Test Interference: Folic acid supplements can affect serum folate testing results.
Overdose Management
Signs/Symptoms: Nausea, vomiting, abdominal pain, diarrhea; in severe cases, hypotension, shock, metabolic acidosis, and organ failure.
Treatment: Immediate medical attention; administration of chelating agents like deferoxamine for iron overdose, supportive care.
Storage and Handling
Storage: Store at room temperature, away from moisture, heat, and light.
Stability: Stable under recommended storage conditions.