Comparative bioavailability of ferric polymaltose and ferrous sulphate in iron‐deficient blood donors

Abstract

Absolute iron deficiency is treated by correcting the causative lesion and then, traditionally, administering sufficient amounts of ferrous salt to return the haemoglobin level to normal and replenish body stores. The bioavailability of ferric compounds has been questioned and accordingly their therapeutic role remains controversial. A special problem is posed by regular blood donation, where the frequency of phlebotomy is limited by the haemoglobin level, which, in turn, requires maintenance of an adequate supply of iron from dietary sources. Since this latter situation may not always occur, it would be of practical benefit to have a form of supplementation that is effective and can be taken without side effects. These issues were prospectively examined in a consecutive series of otherwise healthy blood donors who developed absolute iron deficiency anaemia and were then randomly allocated to receive 60 mg of this metal as ferrous sulphate twice a day (Group 1: n = 51), 100 mg as chewable ferric polymaltose daily (Group 2: n = 53), or the latter product twice a day (Group 3: n = 55). Serial studies showed that 80% of patients in Groups 1 and 3 had reached normal haemoglobin levels by 12 weeks, but this figure was only 50% in Group 2. Similarly, the proportion of patients improving their percentage saturation of transferrin to within the normal range was significantly better in Groups 1 and 3 than in Group 2 (P < .01). However, body iron stores, reflected in serum ferritin level, was significantly better in Group 1 (P < .01); there was no difference in this respect between Groups 2 and 3.(ABSTRACT TRUNCATED AT 250 WORDS)

Efficacy, Tolerability, and Acceptability of Iron Hydroxide Polymaltose Complex versus Ferrous Sulfate: A Randomized Trial in Pediatric Patients with Iron Deficiency Anemia

“…Randomized studies in adults have confirmed a lower rate of gastrointestinal symptoms with IPC versus ferrous sulfate [8, 20, 27, 28]. In children, comparative data are more sparse, but there are reports of fewer gastrointestinal adverse events [12] and less frequent tooth staining [11] in IPC-treated children compared to those given ferrous sulfate.…”

“…Polynuclear preparations based on the ferric form of iron, such as iron hydroxide polymaltose complex (IPC), have been developed to improve tolerability. IPC provides similar iron bioavailability to ferrous sulfate [8] but has a stable structure that confers more controlled absorption of iron [9]. A recent meta-analysis [10] has confirmed that IPC and ferrous sulfate provide similar improvements in hemoglobin (Hb) levels in adult patients with iron deficiency anemia, but with superior tolerability.…”

Evaluation of Ferric and Ferrous Iron Therapies in Women with Iron Deficiency Anaemia

“…Less improvement was seen in anaemia in the group receiving the 100 mg (daily) Fe +3 polymaltose complex when compared to the other groups [17]. In 1994, Nielsen et al compared Fe +2 sulphate and the ferric-polymaltose complex and found that there was no significant change in the mean haemoglobin value in the group receiving the ferric-polymaltose.…”

Tratamento da anemia ferropriva com ferro por via oral

“…[9][10][11]18 As propriedades mencionadas anteriormente conferem à ferripolimaltose menor incidência de EA, proporcionando maior adesão ao tratamento e melhores resultados. [17][18][19] Estudos em animais têm demonstrado que o processo de oxidação necessário para a absorção dos sais ferrosos provoca geração de radicais livres e lesão celular, o que pode justificar o maior incremento dos níveis da ferritina nos pacientes tratados com sulfato ferroso. Entretanto, quando se analisa o incremento de ferritina tecidual, que é o que realmente interessa, esse aumento é maior para aqueles que recebem a ferripolimaltose que para os que recebem o sulfato ferroso.…”

“…O estudo prospectivo controlado e randomizado mais importante é o de Jacobs et al, 19 que compararam a biodisponibilidade e bioequivalência da ferripolimaltose e do sulfato ferroso em candidatos à doação de sangue e recusados para tal procedimento devido ao diagnóstico de anemia ferropriva. Os autores utilizaram 120 mg de sulfato ferroso (60 mg 2x/dia, em jejum; n=51) versus 100 mg de ferripolimaltose no café da manhã (n=55) versus 200 mg de ferripolimaltose (100 mg no café e no jantar; n=53).…”