Ferrex Tablets 28s

• Iron: Hemochromatosis, hemosiderosis, hemolytic anemia (unless iron deficiency coexists), porphyria cutanea tarda.

• Iron + Tetracyclines/Doxycycline: Iron can chelate tetracyclines, significantly reducing their absorption. Separate administration by at least 2-4 hours.
• Iron + Fluoroquinolones (e.g., Ciprofloxacin, Levofloxacin): Iron can chelate fluoroquinolones, significantly reducing their absorption. Separate administration by at least 2-6 hours.
• Iron + Levothyroxine: Iron can impair levothyroxine absorption. Separate administration by at least 4 hours.
• Folic Acid + Methotrexate: Folic acid can reduce the efficacy of methotrexate (a folate antagonist). Careful monitoring and specific dosing regimens are required.
• Vitamin B12 + Chloramphenicol: May antagonize the hematopoietic response to Vitamin B12 in patients with megaloblastic anemia.

• Iron + Antacids/PPIs/H2 Blockers: May reduce iron absorption by increasing gastric pH. Separate administration by several hours.
• Iron + Bisphosphonates (e.g., Alendronate): Iron can interfere with bisphosphonate absorption. Separate administration by at least 30 minutes to 2 hours.
• Iron + Mycophenolate Mofetil: Iron may decrease mycophenolate absorption. Separate administration.
• Iron + Zinc/Copper: High doses of iron can interfere with zinc and copper absorption. Administer at different times.
• Folic Acid + Anticonvulsants (e.g., Phenytoin, Phenobarbital, Primidone): Folic acid may decrease serum levels of these drugs, potentially increasing seizure frequency. Anticonvulsants can also lower folate levels.
• Vitamin B12 + Metformin: Metformin can reduce Vitamin B12 absorption.
• Vitamin B12 + Colchicine: May reduce Vitamin B12 absorption.
• Vitamin B12 + Nitrous Oxide: Can inactivate Vitamin B12, leading to functional deficiency.

• Vitamin C + Warfarin: High doses of Vitamin C may theoretically decrease warfarin effect, though clinical significance is generally low.
• Iron + Dairy products/Calcium supplements: Calcium can inhibit iron absorption. Separate administration by at least 2 hours.
• Iron + Tea/Coffee: Tannins can inhibit iron absorption. Avoid taking with meals.

• Fatigue
• Pallor (pale skin)
• Shortness of breath
• Dizziness
• Pica (craving for non-food items like ice, dirt)
• Restless legs syndrome
• Glossitis (sore tongue)
• Cheilosis (cracks at corners of mouth)
• Neurological symptoms (numbness, tingling, gait instability - for B12 deficiency)

Iron, folic acid, and vitamin B12 are essential nutrients during pregnancy and are often recommended to prevent and treat anemia. Vitamin C is also safe and beneficial. Ferrex, providing these components, is generally considered safe and often prescribed during pregnancy for iron deficiency anemia. Close monitoring of iron levels is recommended.

Components of Ferrex (iron, vitamin C, folic acid, vitamin B12) are essential nutrients and are excreted in breast milk in small, physiologically normal amounts. They are generally considered safe for use during lactation and are often recommended to support maternal health and prevent postpartum anemia.

Use with extreme caution. Accidental iron overdose is a leading cause of fatal poisoning in children under 6 years of age. Ferrex is not typically formulated for pediatric use; specific pediatric iron supplements with appropriate dosing should be used under medical supervision. Keep out of reach of children.

Generally safe for use in geriatric patients. However, older adults may have underlying conditions affecting iron absorption (e.g., atrophic gastritis, use of acid-reducing medications) or may be at higher risk for B12 deficiency. Monitoring for iron overload is important if there are pre-existing conditions like hemochromatosis. Dosage adjustments are typically not required based on age alone, but individual patient factors should be considered.

• Advise patients to take iron supplements with a source of Vitamin C (like orange juice) to enhance absorption, but avoid taking with milk, tea, or coffee.
• Warn patients about potential GI side effects (constipation, nausea, dark stools) and strategies to manage them.
• Emphasize the critical importance of keeping iron supplements out of reach of children due to severe overdose risk.
• Educate patients that correction of anemia takes time; hemoglobin levels typically rise by 1-2 g/dL every 3-4 weeks, and iron stores may take 3-6 months to replete after hemoglobin normalizes.
• Always investigate the underlying cause of iron deficiency anemia, as supplementation alone may mask a more serious condition (e.g., GI bleeding).
• For patients with difficulty swallowing tablets, some iron formulations are available in liquid or chewable forms, though Ferrex is typically a tablet.

• Oral Iron Supplements (e.g., Ferrous Sulfate, Ferrous Gluconate, Ferrous Fumarate)
• Intravenous Iron (e.g., Iron Dextran, Iron Sucrose, Ferric Carboxymaltose) for severe deficiency or intolerance to oral iron
• Folic Acid supplements (e.g., Folic Acid tablets)
• Vitamin B12 supplements (e.g., Cyanocobalamin tablets, injections)
• Dietary modifications to increase iron, folate, and B12 intake.