Universal reference book for medicines
Name of the drug: FERRI (FERRI)

Active substance: nonappropriate

Type: Anti-anemic drug

Manufacturer: EMCURE PHARMACEUTICALS (USA)
Typical clinico-pharmacological article
This information is a reference and it is not enough that the drug has been prescribed by a doctor ..

PHARMACHOLOGIC EFFECT
The preparation of iron in the form of a polymaltose complex of hydroxide Fe3 +.
Outside, the multinucleated centers of the hydroxide of Fe3 + are surrounded by many non-covalently bound polymethyltose molecules, forming a complex with the total molecular weight of. with a mass of 50 thousand Daltons, which is so large that its diffusion through the membranes of the intestinal mucosa is approximately 40 times less than that of Fe2 + hexahydrate.

This macromolecular complex is stable, does not release iron in the form of free ions, is similar in structure to the natural combination of iron and ferritin.
Due to this similarity, the ions of fFe3 + from the intestine enter the blood only by active absorption, which explains the impossibility of overdose (and intoxication) by the drug as opposed to simple iron salts, which are absorbed through a concentration gradient.

The absorbed iron is deposited in a ferritin-related form, mainly in the liver.
Later, in the bone marrow it is included in Hb. Iron, which is part of the Fe3 + -hydroxide complex, does not have pro-oxidant properties (which are inherent in simple Fe2 + salts), which leads to a decrease in the oxidation of LDL and VLDL.

Rapidly replenishes iron deficiency in the body, stimulates erythropoiesis, restores hemoglobin.

PHARMACOKINETICS
The degree of absorption after oral administration depends on the degree of iron deficiency (the greater the deficit, the higher the absorption) and the dose of the drug (the higher the dose, the worse the absorption).
Absorbed mainly in the duodenum and small intestine. The non-sucked part is excreted with feces.

After the / m introduction enters the bloodstream through the lymphatic system.
The time to reach C max is 24 h. In the reticuloendothelial system, the complex is split into iron (III) hydroxide and polymaltose (metabolized by oxidation). In the bloodstream, iron binds to transferrin, is deposited in tissues in ferritin, in the bone marrow is included in hemoglobin and used in the process of erythropoiesis.
INDICATIONS
For oral administration:

- treatment of iron deficiency anemia of various genesis and latent iron deficiency in infants and young children;

- Increased need for iron (pregnancy, lactation period, donation, period of intensive growth, vegetarianism, elderly age).


Injection:

- Treatment of iron deficiency anemia with ineffectiveness or inability to take oral iron-containing medicines (including in patients with gastrointestinal diseases and those suffering from malabsorption syndrome).

DOSING MODE
Inside, during or immediately after a meal.
Dosage and timing of treatment depend on the degree of iron deficiency. The daily dose can be divided into several doses or taken once.

Tablets: should be chewed or swallowed whole during or after a meal.
The daily dose is acceptable for 1 time. Treatment of clinically pronounced deficiency: 1 tab. 1-3 times / day for 3-5 months before the normalization of hemoglobin. Then the reception should be continued for several more months in order to restore iron stores in the body (1 tablet per day). Pregnant: 1 tab. 2-3 times / day until the normalization of hemoglobin, followed by a dose of 1 tablet / day before delivery. For the therapy of latent iron deficiency and for the prevention of iron deficiency - 1 tab. / Day.

Drops can be mixed with fruit and vegetable juices or with artificial nutrient mixtures, without fear of a decrease in the activity of the drug.
1 ml (20 drops) contains 176.5 mg of iron (III) hydroxide of the polymaltose complex (50 mg of elemental iron), 1 drop. equal to 2.5 mg of elemental iron. Doses for the treatment of clinically pronounced iron deficiency: premature infants - 1-2 drops / kg daily for 3-5 months; children under 1 year - 10-20 drops / day; 1-12 years - 20-40 drops / day; children over 12 years and adults - 40-120 drops / day; pregnant - 80-120 drops / day. Duration of treatment - at least 2 months. In the case of clinically pronounced iron deficiency, hemoglobin normalization is achieved only after 2-3 months after the start of treatment. To restore the internal reserves of iron, taking in preventive doses should be continued for several months. Doses for the treatment of latent iron deficiency: children under 1 year - 6-10 drops / day; 1-12 years - 10-20 drops / day;children over 12 years and adults - 20-40 drops / day; pregnant women - 40 drops / day. Prevention of iron deficiency: children under 1 year - 2-4 drops / day; 1-12 years - 4-6 drops / day; children over 12 years and adults - 4-6 drops / day; pregnant women - 6 drops / day.

The syrup contains 10 mg of iron (III) in 1 ml.
Doses for the treatment of clinically pronounced iron deficiency: children under 1 year - 2.5-5 ml / day (25-50 mg iron);1-12 years - 5-10 ml / day; children over 12 years, adults and lactating women - 10-30 ml / day; pregnant women - 20-30 ml / day. Doses for the treatment of latent iron deficiency: children from 1 to 12 years - 2.5-5 ml / day; children over 12 years, adults and lactating women - 5-10 ml / day; pregnant women - 10 ml / day. Prevention of iron deficiency: pregnant women - 5-10 ml / day.
Solution for the / m introduction

Before the first administration of the therapeutic dose, an intramuscular test is necessary: ​​adults are injected from 0.25 to 0.5 doses of the drug (25 to 50 mg of iron), children - half the daily dose.
In the absence of adverse reactions within 15 minutes after administration, the remainder of the initial dose of the drug can be administered. Aids should be available to help with the development of anaphylactic shock.
Calculation of dose: The dose of the drug is calculated individually and adapted to the overall iron deficiency according to the following formula:

Total iron deficiency (mg) = body weight (kg) x (normal level Hb-level of Hb patient) (g / l) x 0.24 * + iron stocks (mg)

At a body weight of less than 35 kg : normal Hb = 130 g / l, which corresponds to the stock iron = 15 mg / kg body weight

With a body weight above 35 kg : a normal level of Hb = 150 g / l, which corresponds to a stock iron = 500 mg

* Factor 0.24 = 0.0034 x 0.07 x 1000 (iron content in hemoglobin - 0.34%, blood volume -7% of body weight, factor 1000 - conversion from g to mg)

If the required dose exceeds the maximum daily dose, the administration of the drug should be fractional.

Standard dosage: Adults : 1 ampoule daily (2.0 mL = 100 mg iron).
Children: dosage is determined according to body weight.
Maximum permissible daily doses: Children weighing up to 6 kg: 0.25 ampoules (0.5 ml = 25 mg of iron).
Children weighing 5 to 10 kg: 0.5 ampoules (1.0 ml = 50 mg of iron). Adults: 2 ampoules (4.0 ml = 200 mg of iron).
If the response from the hematological parameters is absent after 1-2 weeks (for example, an increase in the level of Hb by about 0.1 g / dl per day), the initial diagnosis should be reviewed.
The total dose of the drug for the course of treatment should not exceed the calculated number of ampoules.
SIDE EFFECT
Oral dosage forms : dyspepsia (sensation of overfilling and pressure in the epigastric region, nausea, constipation or diarrhea), dark stool color (due to excretion of unpaired iron and has no clinical significance).


Solution for the / m introduction : in rare cases - arthralgia, enlarged lymph nodes, fever, headache, malaise, dyspepsia (nausea, vomiting);
extremely rarely - allergic reactions. Local reactions (with the wrong technique of administration): dyeing of the skin, soreness, inflammation.
CONTRAINDICATIONS
hypersensitivity;

- excess iron in the body (hemochromatosis, hemosiderosis);

- anemia not related to iron deficiency (hemolytic anemia or megaloblastic anemia, caused by a lack of cyanocobalamin, aplastic anemia);

- a violation of the mechanisms of iron utilization (lead anemia, sideroachrestic anemia, thalassemia, late porphyria of the skin).


Only for solution for intravenous administration (optional):

Rundu-Weber-Osler disease;

- chronic polyarthritis;

- Infectious diseases of the kidneys in the acute stage;

uncontrolled hyperparathyroidism;

Decompensated cirrhosis of the liver;

- infectious hepatitis;

- early childhood (up to 4 months);

- Pregnancy (I trimester).

PREGNANCY AND LACTATION
Solution for the / m administration is contraindicated for use in the first trimester of pregnancy.

Solution for injection: experimental study of reproduction, as well as controlled studies in pregnant women were not performed.
In small quantities, unaltered iron from the polymaltose complex can penetrate into breast milk, but it is unlikely that unwanted effects will occur in the infants fed.

There are no negative effects on the fetus when prescribing oral forms during pregnancy (including in the first trimester).

APPLICATION FOR FUNCTIONS OF THE LIVER
Contraindicated in infectious diseases of the kidneys in the acute stage.

Caution should be exercised with the / m introduction of the drug to patients with renal insufficiency.

APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS
Contraindicated in decompensated liver cirrhosis, infectious hepatitis.

Care should be taken with the introduction of the drug in patients with hepatic insufficiency.

APPLICATION FOR CHILDREN
The introduction of a solution for IM administration to children up to 4 months of age is not recommended.
In children, parenteral iron preparations can adversely affect the course of the infectious process.
SPECIAL INSTRUCTIONS
When prescribing the drug for patients with diabetes, it should be noted that 1 ml of syrup contains 0.04 XE, and 1 ml of drops - 0.01 XE.


Reception of iron preparations should be continued and after the normalization of hemoglobin.


Does not cause dyeing of tooth enamel.

Parenteral iron preparations can cause allergic and anaphylactic reactions.
In the case of moderate allergic reactions, antihistamines should be prescribed; with the development of severe anaphylactic reaction, immediate adrenaline administration is necessary. The means of cardiopulmonary resuscitation should be available. Care should be taken when administering the drug to patients with allergies, as well as hepatic and renal insufficiency. Side effects that occur in patients with cardiovascular diseases can aggravate the course of the underlying disease. Patients with bronchial asthma or having a low iron-binding capacity of serum and / or deficiency of folic acid belong to a group at high risk of developing allergic or anaphylactic reactions. Introduction to children under 4 months of age is not recommended due to lack of experience. In children, parenteral iron preparations can adversely affect the course of the infectious process.
Solution for injection is intended only for the / m introduction .
The technique of injection is important. As a result of improper administration of the drug, soreness and staining of the skin at the injection site may occur. The method of ventro-gluteal injection is recommended instead of the standard - in the upper outer quadrant of the gluteus maximus.

1) The length of the needle should be at least 5-6 cm. The needle clearance should not be too wide.
For children, as well as for adults with a small body weight, needles should be shorter and thinner.

2) According to the recommendations of Hochstetter, the injection site is determined as follows: the vertebral column at the level corresponding to the lumbosacral articulation is fixed at point A. If the patient lies on the right side, the middle finger of the left arm at point A is placed. The index finger from the middle so that it is under the iliac crest line at point B. The triangle, located between the proximal phalanges, the middle and index fingers, is the injection site.


3) Tools are disinfected by the usual method.


4) Before inserting the needle, shift the skin about 2 cm to close the puncture hole well after removing the needle.
This prevents the penetration of the injected solution into the subcutaneous tissues and the dyeing of the skin.

5) Position the needle vertically with respect to the skin surface, at a large angle to the point of the iliac joint, than to the point of the femoral joint.


6) After the injection, slowly remove the needle and press the finger of the skin area adjacent to the injection site, for about 5 minutes.


7) After the injection, the patient needs to move.


Only intact ampoules can be used.
When a precipitate forms, the solution is not suitable for use. After opening the ampoule, the solution should be administered immediately.
OVERDOSE
With the introduction of a solution for intravenous administration at too high doses, the complex can not be excreted from the body by hemodialysis because of its high molecular weight.
Periodic monitoring of serum ferritin can help in the timely recognition of progressive accumulation of iron.
Overdose can cause acute overload with iron, which manifests itself as symptoms of hemosiderosis.
In case of overdose, it is recommended to use symptomatic agents and, if necessary, iron-binding substances (chelates), for example deferoxamine IV.
DRUG INTERACTION
Oral forms : no interactions with other drugs.


Solution for Injection: ACE inhibitors increase systemic effects.
Do not use simultaneously with oral iron-containing medications (iron absorption from the digestive tract decreases).
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