Ferrex 150 Forte Plus Capsules
WARNING: Accidental overdose of drugs that have iron in them is a leading cause of deadly poisoning in children younger than 6 years of age. Keep away from children. If this drug is taken by accident, call a doctor or poison control center right away. @ COMMON USES: It is used to treat or prevent low iron in the body.It is used to help growth and good health.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Antianemic agent, Vitamin/Mineral supplement
Pharmacologic Class
Iron preparation, Vitamin B complex, Folic acid, Ascorbic acid
Pregnancy Category
Not applicable (Dietary Supplement), generally considered safe for deficiency with medical supervision
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
Ferrex 150 Forte Plus is a dietary supplement that provides iron, along with vitamins C, B12, folic acid, and succinic acid. It's used to treat or prevent iron deficiency anemia and other related vitamin deficiencies. Iron is essential for making red blood cells that carry oxygen, and the vitamins help your body use iron and make healthy blood cells.
How to Use This Medicine
Taking Your Medication Correctly
To get the most out of your medication, take it exactly as directed by your doctor. Carefully read all the information provided with your prescription and follow the instructions closely. For optimal effectiveness, take this medication on an empty stomach. However, if it causes stomach upset, you can take it with food. Be aware that certain foods, such as eggs, whole grain bread, cereal, dairy products, coffee, and tea, may interfere with the medication's absorption. If you experience stomach upset, consult your doctor about the best way to take this medication with food.
It's also important to note that this medication can interact with other drugs, preventing them from being absorbed properly. If you're taking other medications, consult your doctor or pharmacist to determine if you should take them at a different time than this medication.
Storing and Disposing of Your Medication
To maintain the medication's potency, store it at room temperature, protected from light, and in a dry place. Avoid storing it in a bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you're unsure about the best way to dispose of your medication, consult your pharmacist. You may also want to check if there are drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
To get the most out of your medication, take it exactly as directed by your doctor. Carefully read all the information provided with your prescription and follow the instructions closely. For optimal effectiveness, take this medication on an empty stomach. However, if it causes stomach upset, you can take it with food. Be aware that certain foods, such as eggs, whole grain bread, cereal, dairy products, coffee, and tea, may interfere with the medication's absorption. If you experience stomach upset, consult your doctor about the best way to take this medication with food.
It's also important to note that this medication can interact with other drugs, preventing them from being absorbed properly. If you're taking other medications, consult your doctor or pharmacist to determine if you should take them at a different time than this medication.
Storing and Disposing of Your Medication
To maintain the medication's potency, store it at room temperature, protected from light, and in a dry place. Avoid storing it in a bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you're unsure about the best way to dispose of your medication, consult your pharmacist. You may also want to check if there are drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Take the capsule with a full glass of water.
- For best absorption, take on an empty stomach (1 hour before or 2 hours after meals). However, if stomach upset occurs, you may take it with food.
- Avoid taking with dairy products, tea, coffee, or antacids, as these can reduce iron absorption. Separate by at least 2 hours.
- Maintain a balanced diet rich in iron (e.g., red meat, poultry, fish, beans, fortified cereals) and vitamins.
- Report any unusual side effects or symptoms to your healthcare provider.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
1 capsule daily, or as directed by a healthcare professional
Dose Range:
1 - 1 mg
Condition-Specific Dosing:
iron_deficiency_anemia:
1 capsule daily, typically for 3-6 months or until iron stores are repleted
Pediatric Dosing
Neonatal:
Not established, generally not recommended due to iron overdose risk
Infant:
Not established, generally not recommended due to iron overdose risk
Child:
Not established, generally not recommended due to iron overdose risk; specific iron supplementation for children should be under medical supervision
Adolescent:
1 capsule daily, if iron deficiency is diagnosed and under medical supervision
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment typically needed, monitor iron levels
Moderate:
No specific adjustment typically needed, monitor iron levels; caution with iron accumulation in severe cases
Severe:
Use with caution, monitor iron levels closely due to potential for iron accumulation and toxicity in chronic kidney disease. Folic acid and B12 may be beneficial.
Dialysis:
Use with caution, monitor iron levels. Iron supplementation is often required in dialysis patients, but specific formulations and doses are usually prescribed by a nephrologist.
Hepatic Impairment:
Mild:
No specific adjustment typically needed
Moderate:
No specific adjustment typically needed
Severe:
Use with caution, especially with iron, as impaired liver function can affect iron metabolism and storage. Monitor iron levels.
Pharmacology
Mechanism of Action
Ferrex 150 Forte Plus Capsules provide essential nutrients for erythropoiesis and overall metabolic function. Iron is a crucial component of hemoglobin, myoglobin, and various enzymes involved in oxygen transport and cellular respiration. Vitamin C (Ascorbic Acid) enhances the absorption of non-heme iron by reducing ferric iron (Fe3+) to ferrous iron (Fe2+), which is more soluble and readily absorbed. Folic Acid (Vitamin B9) and Vitamin B12 (Cyanocobalamin) are essential cofactors for DNA synthesis, particularly important for rapidly dividing cells like red blood cells. They are critical for the maturation of erythrocytes and prevention of megaloblastic anemia. Succinic Acid is hypothesized to enhance iron absorption or utilization, though its precise mechanism and clinical significance in this context are less established compared to Vitamin C.
Pharmacokinetics
Absorption:
Bioavailability:
Iron: Highly variable (5-35%), enhanced by Vitamin C. Folic Acid: ~85-100%. Vitamin B12: ~1-5% (dose-dependent, requires intrinsic factor for active absorption). Vitamin C: High at lower doses, decreases with increasing dose. Succinic Acid: Not well-quantified in this context.
Tmax:
Iron: 2-4 hours (for absorbed iron). Folic Acid: 1-6 hours. Vitamin B12: 8-12 hours. Vitamin C: 2-3 hours.
FoodEffect:
Iron absorption is reduced by food, especially dairy, tea, coffee, and high-fiber foods. However, taking with food can reduce gastrointestinal side effects. Vitamin C enhances iron absorption. Folic acid and B12 absorption are generally not significantly affected by food, though B12 absorption can be impaired by certain medications.
Distribution:
Vd:
Iron: Not applicable (bound to transferrin, stored as ferritin/hemosiderin). Folic Acid: ~1.7 L/kg. Vitamin B12: ~60 L. Vitamin C: ~0.2-0.3 L/kg.
ProteinBinding:
Iron: >90% (bound to transferrin). Folic Acid: ~60% (to plasma proteins). Vitamin B12: >90% (bound to transcobalamins). Vitamin C: ~25% (to plasma proteins).
CnssPenetration:
Iron: Limited. Folic Acid: Yes. Vitamin B12: Yes. Vitamin C: Yes.
Elimination:
HalfLife:
Iron: Not applicable (recycled). Folic Acid: ~15-20 minutes (unmetabolized), ~3-4 hours (total body turnover). Vitamin B12: ~6 days (plasma), body stores last for years. Vitamin C: ~2-3 hours (at physiological doses), longer at higher doses.
Clearance:
Iron: Minimal excretion, primarily through desquamation of cells. Folic Acid: Renal. Vitamin B12: Renal, enterohepatic recirculation. Vitamin C: Renal.
ExcretionRoute:
Iron: Feces (unabsorbed), minimal via urine, sweat, bile. Folic Acid: Urine. Vitamin B12: Urine, bile (enterohepatic recirculation). Vitamin C: Urine.
Unchanged:
Iron: Not applicable. Folic Acid: Small amount. Vitamin B12: Significant amount (after saturation of binding proteins). Vitamin C: Significant amount.
Pharmacodynamics
OnsetOfAction:
Gradual, clinical improvement in anemia symptoms typically seen within weeks to months.
PeakEffect:
Hemoglobin levels typically begin to rise within 2-4 weeks, reaching normal levels in 2-4 months. Repletion of iron stores (ferritin) takes longer, often 3-6 months.
DurationOfAction:
Effects persist as long as supplementation continues and underlying deficiency is addressed. Body stores of iron and B12 can last for extended periods once repleted.
Confidence:
Medium
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Black, tarry, or bloody stools
Fever
Vomiting blood or coffee ground-like material
Stomach cramps
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms that bother you or do not go away, contact your doctor:
Constipation
Diarrhea
Stomach pain
Upset stomach
Vomiting
* Change in stool color to green
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Black, tarry, or bloody stools
Fever
Vomiting blood or coffee ground-like material
Stomach cramps
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms that bother you or do not go away, contact your doctor:
Constipation
Diarrhea
Stomach pain
Upset stomach
Vomiting
* Change in stool color to green
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe stomach pain, nausea, vomiting, or diarrhea (especially if black or bloody)
- Constipation or dark, tarry stools (common, but severe changes should be reported)
- Allergic reaction (rash, itching, swelling, severe dizziness, trouble breathing)
- Signs of iron overdose (see overdose section)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
If you have an iron overload in your body.
* If you have certain types of anemia, including pernicious anemia or hemolytic anemia.
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions.
Remember, do not start, stop, or change the dose of any medication without first consulting your doctor. This will help ensure your safety and the effectiveness of your treatment.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
If you have an iron overload in your body.
* If you have certain types of anemia, including pernicious anemia or hemolytic anemia.
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions.
Remember, do not start, stop, or change the dose of any medication without first consulting your doctor. This will help ensure your safety and the effectiveness of your treatment.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. If you have a soy allergy, consult your doctor before taking this drug, as some formulations may contain soy.
Additionally, this medication may interfere with certain laboratory tests. Be sure to notify all your healthcare providers and laboratory personnel that you are taking this drug to ensure accurate test results.
If you are allergic to tartrazine (also known as FD&C Yellow No. 5), discuss this with your doctor, as some products may contain this ingredient.
Before taking this medication, inform your doctor if you are pregnant, planning to become pregnant, or are breastfeeding. Your doctor will help you weigh the benefits and risks of this medication to both you and your baby.
Additionally, this medication may interfere with certain laboratory tests. Be sure to notify all your healthcare providers and laboratory personnel that you are taking this drug to ensure accurate test results.
If you are allergic to tartrazine (also known as FD&C Yellow No. 5), discuss this with your doctor, as some products may contain this ingredient.
Before taking this medication, inform your doctor if you are pregnant, planning to become pregnant, or are breastfeeding. Your doctor will help you weigh the benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Initial symptoms (within 6 hours): Nausea, vomiting, diarrhea (often bloody), abdominal pain, lethargy, pallor, cyanosis.
- Latent period (6-24 hours): Apparent recovery, but toxicity is progressing.
- Later symptoms (12-48 hours): Metabolic acidosis, shock, liver damage (jaundice, elevated liver enzymes), coagulopathy, renal failure, cardiovascular collapse, coma, seizures.
What to Do:
Iron overdose is a medical emergency. Immediately call emergency services (e.g., 911 in the US) or a poison control center (1-800-222-1222 in the US). Do NOT induce vomiting. Treatment may involve gastric lavage, whole bowel irrigation, and chelation therapy (e.g., deferoxamine).
Drug Interactions
Major Interactions
- Iron with Dimercaprol (increased nephrotoxicity)
- Folic Acid with Methotrexate (folic acid can reduce methotrexate efficacy, especially in cancer treatment; not typically an issue for low-dose methotrexate for autoimmune diseases, but monitor)
Moderate Interactions
- Iron with Tetracyclines (reduced absorption of both)
- Iron with Fluoroquinolones (reduced absorption of both)
- Iron with Levothyroxine (reduced levothyroxine absorption)
- Iron with Mycophenolate Mofetil (reduced mycophenolate absorption)
- Iron with Bisphosphonates (reduced bisphosphonate absorption)
- Iron with Antacids (reduced iron absorption)
- Iron with Proton Pump Inhibitors (PPIs) / H2 Blockers (reduced iron absorption due to increased gastric pH)
- Iron with Cholestyramine (reduced iron absorption)
- Vitamin C with Aluminum-containing antacids (increased aluminum absorption)
- Folic Acid with Phenytoin, Phenobarbital, Primidone (folic acid can decrease anticonvulsant levels, potentially increasing seizure risk)
- Vitamin B12 with Metformin (can reduce B12 absorption)
- Vitamin B12 with PPIs / H2 Blockers (can reduce B12 absorption)
- Vitamin B12 with Chloramphenicol (can reduce hematologic response to B12)
Minor Interactions
- Iron with Calcium supplements (reduced iron absorption)
- Iron with Zinc supplements (reduced absorption of both if taken together)
- Iron with high-fiber foods, tea, coffee, dairy products (reduced iron absorption)
- Vitamin C with Warfarin (potential for reduced anticoagulant effect, though clinical significance is low for typical doses)
Monitoring
Baseline Monitoring
Complete Blood Count (CBC) with differential
Rationale: To assess hemoglobin, hematocrit, MCV, MCH, MCHC, and red blood cell count to confirm anemia and characterize its type (e.g., microcytic, macrocytic).
Timing: Prior to initiation of therapy
Serum Ferritin
Rationale: To assess body iron stores. Ferritin is the most sensitive indicator of iron deficiency.
Timing: Prior to initiation of therapy
Serum Iron and Total Iron Binding Capacity (TIBC)
Rationale: To evaluate circulating iron levels and iron-binding capacity, providing further insight into iron status.
Timing: Prior to initiation of therapy
Serum Folate and Vitamin B12 levels
Rationale: To rule out or confirm co-existing folate or B12 deficiencies, which can also cause anemia and affect treatment response.
Timing: Prior to initiation of therapy
Routine Monitoring
Complete Blood Count (CBC)
Frequency: Every 2-4 weeks initially, then every 1-3 months once stable
Target: Hemoglobin: Age and sex-specific normal ranges (e.g., Adult male: 13.5-17.5 g/dL, Adult female: 12.0-15.5 g/dL). MCV: 80-100 fL.
Action Threshold: Lack of hemoglobin increase (e.g., <1 g/dL increase in 4 weeks) or persistent microcytosis may indicate non-compliance, malabsorption, ongoing blood loss, or alternative diagnosis.
Reticulocyte Count
Frequency: 1-2 weeks after initiation (optional)
Target: Increase in reticulocyte count (reticulocytosis) is an early sign of bone marrow response.
Action Threshold: No reticulocyte response may indicate inadequate dose, non-compliance, or other underlying issues.
Serum Ferritin
Frequency: Every 3-6 months, or after hemoglobin normalizes
Target: Typically >30-50 ng/mL for repletion of iron stores.
Action Threshold: Ferritin levels not increasing or remaining low despite adequate hemoglobin response indicates continued need for supplementation to replete stores.
Symptom Monitoring
- Fatigue
- Pallor (pale skin)
- Shortness of breath
- Dizziness
- Pica (craving for non-food items like ice or dirt)
- Restless legs syndrome
- Glossitis (sore tongue)
- Cheilosis (cracks at corners of mouth)
- Neurological symptoms (e.g., numbness, tingling, gait disturbance) if B12 deficiency is severe
Special Patient Groups
Pregnancy
Iron, folic acid, and B12 are often recommended during pregnancy to prevent and treat anemia, which is common due to increased blood volume and fetal demands. Vitamin C also supports iron absorption. Use under medical supervision to ensure appropriate dosing and monitoring.
Trimester-Specific Risks:
First Trimester:
Generally safe and often recommended for prevention of neural tube defects (folic acid) and iron deficiency.
Second Trimester:
Generally safe and often recommended as iron deficiency anemia risk increases.
Third Trimester:
Generally safe and often recommended as iron deficiency anemia risk is highest.
Lactation
Components are generally considered safe and compatible with breastfeeding. Iron, folic acid, and B12 are transferred into breast milk in small amounts and are essential for infant development. Supplementation may be necessary for the mother to replete her own stores.
Infant Risk:
Low risk to infant at recommended maternal doses. Monitor infant for any unusual symptoms.
Pediatric Use
Not generally recommended for routine use in children without specific medical advice due to the high risk of accidental iron overdose, which can be fatal. Iron supplementation in children should be carefully dosed based on weight and deficiency severity, and only under the guidance of a healthcare professional.
Geriatric Use
Older adults may have an increased risk of iron, B12, and folate deficiencies due to decreased absorption (e.g., atrophic gastritis, use of acid-reducing medications) or poor dietary intake. Supplementation can be beneficial, but underlying causes of deficiency should be investigated. Monitor for potential drug interactions and gastrointestinal side effects.
Clinical Information
Clinical Pearls
- Advise patients that iron supplements can cause dark or black stools, which is a normal and harmless side effect.
- Constipation is a common side effect of iron; recommend increasing fluid and fiber intake, or using a stool softener if necessary.
- To maximize iron absorption, advise patients to take the supplement with a source of Vitamin C (e.g., orange juice) and avoid taking it with calcium-rich foods, dairy, tea, or coffee.
- Emphasize the importance of consistent daily dosing for effective treatment of iron deficiency anemia.
- Educate patients on the signs of iron overdose and the critical need for immediate medical attention if suspected, especially in households with young children.
- Remind patients that while symptoms may improve quickly, full repletion of iron stores takes several months, and they should continue therapy as prescribed even after feeling better.
Alternative Therapies
- Dietary modifications to increase iron, folate, and B12 intake.
- Intravenous iron infusions (for severe deficiency, malabsorption, or intolerance to oral iron).
- Blood transfusion (for severe, symptomatic anemia requiring rapid correction).
- Specific single-ingredient supplements (e.g., ferrous sulfate, folic acid, cyanocobalamin injections/oral).
Cost & Coverage
Average Cost:
Varies widely, typically $15-$50 per 30 capsules
Generic Available:
Yes
Insurance Coverage:
Often considered an over-the-counter (OTC) supplement; may not be covered by prescription drug plans. Some plans may cover with a prescription and diagnosis of deficiency.
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication, including the amount taken and the time it happened, to ensure you receive the best possible care.