ferrous fumarate: clinical use

Prescribing considerations

• Confirm iron deficiency and investigate its cause rather than treating unexplained anaemia empirically.
• Consider ongoing blood loss, malabsorption, previous gastric surgery and coexisting folate or vitamin B12 deficiency if response is inadequate.
• Oral iron darkens faeces and may interfere with occult-blood testing.
• Check the product's excipients and age restrictions.

Contraindications and cautions

• Hypersensitivity to ferrous fumarate or product excipients.
• Iron-overload states such as haemochromatosis or haemosiderosis.
• Anaemia not caused by iron deficiency, unless iron deficiency also exists.
• Active peptic ulcer, repeated transfusions and specified inflammatory or structural bowel disease are contraindications for selected products.
• Galfer products contraindicate concomitant parenteral iron or dimercaprol; the 210 mg tablet also lists paroxysmal nocturnal haemoglobinuria.

Monitoring

• Use full blood count and appropriate iron studies to establish deficiency and assess response.
• Investigate inadequate response for adherence, impaired absorption, continuing blood loss or an alternative or combined diagnosis.
• Avoid excessive or mistaken treatment because iron accumulation can occur.

Clinical pharmacology

Ferrous fumarate is a ferrous iron salt. Absorption is incomplete and occurs mainly in the duodenum and proximal jejunum. Absorbed iron binds to transport and storage proteins and is used for haemoglobin and other iron-dependent proteins.

Formulation and product differences

• Galfer Syrup can stain teeth. It contains sulfites, maltitol/sorbitol, propylene glycol, flavour ingredients including milk, and a small amount of ethanol; use within one month after opening.
• The 210 mg tablet may be swallowed, crushed or chewed.
• Galfer Capsules contain gelatin and colouring agents and are not licensed for children under 12 years.

Syrup

Route: Oral

Strengths: 140 mg/5 mL

Tablet

Route: Oral

Strengths: 210 mg, 322 mg