Comparison between oral ferrous ascorbate and colloidal iron in the treatment of iron deficiency anemia

Background: Anemia is a global health issue. There is association of impaired cognition and iron deficiency anemia. Ferrous and ferric forms of oral iron preparations are available for the treatment of iron deficiency anemia. This study was conducted with an aim to compare the efficacy and safety of oral ferrous ascorbate and colloidal iron in the treatment of iron deficiency anemia.Methods: It was a prospective interventional study with 12 weeks of treatment protocols alternatively assigned to children diagnosed with iron deficiency anemia. Patients received either of two iron preparation used in study and they were assessed at week 0, 4, 8 and 12.Results: Hemoglobin (gm%) significantly increased from 7.40 to 12.87 in ferrous ascorbate group and from 7.24 to 11.32 in colloidal iron group at the end of 12 weeks of treatment (p<0.05). There was significant increase in corrected reticulocyte count (%) from 0.52 to 1.39 in ferrous ascorbate group and from 0.42 to 1.27 in colloidal iron group (p<0.05). Serum ferritin (mcg/liter) was also significantly increased from 11.54 to 21.53 in ferrous ascorbate group and from 10.57 to 20.52 in colloidal iron group at the end of 12 weeks (p<0.05).Conclusions: The present study concluded that the ferrous ascorbate is an efficient oral iron supplement in the treatment of iron deficiency anemia in the pediatric age group compared to colloidal iron.

Assessment of the Inherent in-vitro Antioxidant Potential of Commelina benghalensis Leaf Extract

Commelina benghalensis is a troublesome but exotic weed native to the African and Asian subregions used traditionally for the treatment and management of various disorders. The aim of this study was to investigate the potential antioxidant activity of the methanolic leaf extract of Commelina benghalensis using various in vitro models. This was done by investigating the ability of the extract to scavenge hydrogen peroxide and hydroxyl radical. Other activities assessed were the reducing ability, ability to inhibit erythrocyte damage and reduce ferrous-ascorbate induced lipid peroxidation on bovine liver and egg yolk homogenates. The results revealed that the plant extract possessed significant hydrogen peroxide and hydroxyl radical scavenging abilities. The extract also possessed significant ability to reduce ferric ions and molybdate VI. The methanolic extract also significantly inhibited hydrogen peroxide-induced erythrocyte hemolysis and lipid peroxidation. Lipid peroxidation in bovine liver and egg yolk homogenates induced by the ferrous-ascorbate system was also reduced by the extract. In many instances, the effect of the extract was concentration-dependent. (p < 0.05). This antioxidant activity of the extract is ascribed to the phytochemicals which probably acted in synergy thus the Commelina benghalensis leaves could be exploited both nutraceutically and pharmacologically.

Comparative evaluation of efficacy of ferrous ascorbate and ferrous calcium citrate prepared in multidrug delivery system on haemoglobin status in anaemic pregnant women

Iron deficiency anaemia (IDA), the most prevalent nutritional deficiency leading to mortality globally. Oral ferrous salts are effectively used to treat iron deficiency in pregnancy. For the present study, no direct comparison demonstrating the efficacy of ferrous ascorbate and ferrous calcium citrate was considered. An open-label, observational study was designed and conducted for two months. Subjects were randomly allocated to two groups (Group A and Group B). The medication followed in Group A was, ferrous calcium citrate with elemental iron 50 mg; In Group B ferrous ascorbate containing elemental iron 100 mg orally for two months at bedtime. Haemoglobin levels, other hematological parameters, weight changes, side effects, conjunctival colour and general wellbeing were assessed in every visit (i.e. 0, 30th and 60th day) for clinical efficacy assessment. There was an increase in the mean serum haemoglobin and ferritin levels (p<0.05). In Group A and Group B, the mean values of all the assessment parameters increased significantly (p<0.05) in follow-up visits (i.e. 1st month and 2nd month) when compared to baseline values. Out of 69 adverse drug events, 29 (42%) were reported from Group A and 40 (58%) from Group B. Ferrous calcium citrate showed considerable efficacy and safety profiles. Keywords: Iron deficiency; anaemia; haemoglobin; ferrous calcium citrate; ferrous ascorbate

A study on the aspects of pharmacoepidemiology and pharmacohaemovigilance of ferrous ascorbate, ferrous fumarate, ferrous sulphate and ferric ammonium citrate, among the rural anaemic women, in the Indian spectrum

Background: Anaemia is a global health concern, associated with increased maternal and perinatal mortality, preterm delivery, low birth weight, extreme fatigue and impaired immune system; and controlled by oral haematinics; with a rise in haemoglobin concentration. The objective was to examine the various aspects of pharmacoepidemiology and pharmacohaemovigilance of oral haematinics, among the anaemic women population, in rural India.Methods: This was a multi-centre, retrospective, observational and analytical study of the hospital medical records of 250 anaemic patients, who were allocated into group A of 125 patients within 15-21 years and group B of 125 patients within 22-35 years. The patients were prescribed oral haematinics, containing 60 mg of elemental iron, thrice daily, with meals. The various aspects of pharmacoepidemiology and pharmacohaemovigilance of ferrous ascorbate, ferrous sulphate, ferrous fumarate and ferric ammonium citrate, including patients’ demographic characteristics, anaemic symptoms assessment, prescription patterns, and safety assessment, on 1st, 2nd, 3rd months and follow-up visits, were recorded and thoroughly analysed..Results: In groups A and B, the demographic characteristics of the patients were comparable; ferrous ascorbate was the most commonly prescribed oral haematinic, followed by ferrous sulphate, ferrous fumarate and ferric ammonium citrate, which controlled mild to moderate iron deficiency anaemia, with a gradual significant rise in haemoglobin concentration, in the successive 3 months; and adverse effects were observed to be statistically non-significant in either group.Conclusions: The different aspects of pharmacoepidemiology and pharmacohaemovigilance in the study established that the oral haematinics were reasonably beneficial and safe among the anaemic women population, in rural India.

Formulation and Evaluation of Ferrous Ascorbate Floating Tablets for the Treatment of Anaemia

Background and Objective: Ferrous ascorbate (FA) is preferentially absorbed from the upper gastrointestinal (GI) track, and has low bioavailability due to less residence time of FA in upper GI track. In addition, FA has low solubility and stability at higher pH. The aim of this study was to prepare gastro-retentive tablets of FA in order to increase its gastric residence time and hence, bioavailability. Methods: Floating tablets of FA were prepared by wet granulation method using different retarding polymers, Povidone K30 as binder and sodium bicarbonate as effervescent agent. The prepared floating tablets were compared with immediate release (IR) tablets and characterized in detail for in vitro and in vivo studies. Results: In-vitro drug release study of the optimized batch showed 96% drug release in 12 h in 0.1 N HCl. The mechanism of drug release from the floating tablets was non-fickian and release kinetics was best fit in peppas model. The gastric retention time of optimized was found to be significantly increased (6 h) in comparison with IR tablet (<1h). Further, bioavailability was also found significantly increased (>70%) in comparison with IR tablet (15-30%). X-ray studies carried on healthy rabbits suggested that the optimized batch remained buoyant in gastric contents up to 6 h and pharmacokinetic study showed sustained released behaviour of optimized batch in comparison to conventional IR tablet. Conclusion: Floating tablet of FA improved the bioavailability of iron by increasing its gastric residence time, hence it could be a better approach for treating iron deficiency and help in improving the patient compliance than IR tablets.

Compare the safety and efficacy of intravenous iron supplementation with iron sucrose to the oral supplementation with ferrous ascorbate in subjects with post-partum anemia

Background: The post-partum period is challenging enough for most new mothers. Recovering from birth, learning to parent, and taking care of her child requires lot of energy. Having anemia in postpartum period can make this process much more difficult. According to WHO, in India incidence of anemia in postnatal mother is around 58% and according to ICMR prevalence of anemia in Tamil Nadu population 76% during pregnancy. The objective of this study was to compare the efficacy of intravenous iron supplementation with Iron sucrose to the oral supplementation with ferrous ascorbate in management of patient with post-partum anemia. To study the safety and side effects of these two preparations.Methods: This was a prospective study conducted on 100 post-partum anemic women in KG Hospital in Coimbatore, October 2012 to November 2013 with hemoglobin less than 10g/dl but more than 6g/dl within 24-48 hours of delivery ,after satisfying inclusion and exclusion criteria were included in the study.Results: Mean hemoglobin of oral group was 8.49±0.75 and mean hemoglobin of IV group was 8.43±0.76; 24 hours after delivery. After treatment, that is after 4 weeks mean hemoglobin of oral group was 10.38±0.79 and mean hemoglobin of IV group was 11.20±0.71.on comparing both groups, the increase in hemoglobin in the IV groups was significant. Reticulocyte count and other parameters increased significantly after four wks of starting therapy in IV group compare to the oral group. No major side effects or anaphylactic reactions were noted during study period.Conclusions: Intravenous iron sucrose complex is safe, convenient and effective in postpartum anemic women as compared with the oral ferrous ascorbate. Intravenous iron sucrose have shorter treatment periods, increased likelihood of compliance, a lack of gastrointestinal side effects, and rapid replenishment of iron stores, making them superior to oral ferrous ascorbate.