ferrous fumarate + folic acid: clinical use

Prescribing considerations

• Confirm the preventive pregnancy indication and investigate anaemia developing despite supplementation.
• Exclude vitamin B12 deficiency and consider combined deficiencies when microcytosis does not respond as expected.
• Review gastrointestinal disease, previous gastric surgery, transfusion history, iron overload and folate-dependent tumours.
• Reconcile interacting medicines and supplements.

Contraindications and cautions

• Hypersensitivity to an active substance or excipient
• Vitamin B12 deficiency
• Haemochromatosis, haemosiderosis or paroxysmal nocturnal haemoglobinuria
• Active peptic ulcer, regional enteritis or ulcerative colitis
• Repeated blood transfusions
• Anaemia not caused by iron deficiency

Monitoring

• Assess full blood count and iron status according to clinical context.
• Investigate inadequate haematological response or anaemia arising despite prophylaxis.
• Check vitamin B12 and folate status where deficiency is suspected.
• Monitor seizure control and phenytoin concentrations when relevant.

Clinical pharmacology

Iron is absorbed chiefly in the duodenum and jejunum, with absorption favoured in the ferrous state. Folic acid is absorbed mainly from the proximal small intestine and converted to active folates.

Formulation and product differences

• The selected preparation is a film-coated combination tablet rather than separate products.
• It contains ferrous fumarate equivalent to elemental iron together with folic acid and is supplied in calendar blister packs.
• Its pregnancy-specific licence, contraindications and excipients may differ from single-ingredient preparations.

Tablet

Route: Oral

Strengths: 322 mg + 0.35 mg