SAFETY PROFILES OF Fe²⁺AND Fe³⁺ORAL PREPARATIONS IN THE TREATMENT OF IRON DEFICIENCY ANEMIA IN CHILDREN

Abstract

The major purpose of this study was to compare the oxidant-related toxicities of the different oral iron preparations in children with iron deficiency anemia (IDA); the second aim was to investigate the side effects of iron preparations. Seventy-two children with IDA were randomly included in the Fe(2+) group (n = 39) or the Fe(3+) group (n = 33). Some oxidizable substrates (erythrocytes malondialdehyde (MDA), urine 8-isoprostane, and basal and Cu-stimulated-oxidized LDL and antioxidant enzyme (superoxide dismutase (SOD), catalase and glutathione peroxidase) activities were evaluated at the beginning and at the 1st, 3rd, and 6th months of therapy. Side effects due to medication were recorded. While at the end of the 1st month SOD levels were significantly increased in Fe(3+) group, at the 6th month evaluation, basal-oxidized LDL levels were significantly increased in the Fe(3+) group, as was urine 8-isoprostane in the Fe(2+) group. No other difference was found between two groups. In conclusion, there were minimal differences between children treated with ferric or ferrous iron in antioxidant system activities, the status of oxidizable substrates, and clinical toxicities.

Letter to the Editor: TREATMENT OF IRON DEFICIENCY ANEMIA

“…The article by Dr. Kavaklı and his colleagues [1] about the treatment of iron-deficiency anemia in children supports our findings that response to ferrous sulfate is much better than the response to ferripolymaltose complexes [2].…”

Tratamento da anemia ferropriva com ferro por via oral

“…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. 8,21 Além disso, o risco de toxicidade hepática é menor com a ferripolimaltose que com os sais ferrosos. 22 As principais características farmacológicas e diferenças entre sais ferrosos e a ferripolimaltose estão relacionadas no Quadro 1.…”

“…18,21,23,24 Borbolla Jr et al compararam a administração de ferripolimaltose (n=15) versus sulfato ferroso (n=15) no tratamento da anemia por deficiência de ferro em lactentes. Os autores observaram eficácia clínica e laboratorial, e incidência de EA similares entre ambos os grupos.…”

Deficiência de ferro no feto e no recém-nascido

“…42 Em termos de absorção, os sais ferrosos são melhores devido à associação da absorção ativa e a passiva, porém o mecanismo de absorção passiva acarreta a liberação de ferro livre no plasma e formação de radicais livres. 43 A fim de não aumentar a produção de radicais livres, a suplementação mais apropriada no prematuro deveria ser feita com complexo de ferro polimaltosado ou aminoquelado. O tipo de ferro mais comumente utilizado na suplementação, no Brasil, é o sulfato ferroso, medicamento disponibilizado gratuitamente à população.…”