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Iron counselling — GPhC CRA MCQ

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ModerateGastrointestinal TherapeuticsIron counsellingGPhC CRA

A patient who recently started ferrous sulfate reports black stools and mild constipation but no pain, dizziness, vomiting or sticky tar-like stool. Which counselling is most appropriate?

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Correct answer: C — Explain expected effects, manage constipation and safety-net possible melaena

Explain expected effects, manage constipation and safety-net possible melaena: Iron commonly darkens stool and causes gastrointestinal effects, but counselling should distinguish expected discoloration from possible melaena and include safety-netting. Stop iron and arrange routine review for possible gastrointestinal bleeding: Uniform darkening is an expected effect and does not by itself prove bleeding. Increase the iron dose and reassess stool colour after one week: Stool colour does not justify dose escalation and a higher dose may worsen constipation. Add daily loperamide and continue the prescribed iron treatment unchanged: Loperamide slows bowel transit and can worsen constipation. Treat all dark stools as expected unless haemoglobin falls significantly: Systemic symptoms or melaena-like stool require prompt clinical assessment.

Reference: BNF: ferrous sulfate: https://bnf.nice.org.uk/drugs/ferrous-sulfate/