Iron prescription drugs
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Iron Prescription Drugs: A Comprehensive Overview
Overprescription of Iron Tablets in Elderly Populations
Iron Prescription in Elderly Patients
Iron tablets are frequently overprescribed to elderly individuals, particularly in Sweden. A study revealed that over 10% of women aged over 65 were prescribed iron tablets, with the highest prescription rates observed in the oldest age groups. However, a significant portion of these prescriptions lacked a justified medical basis. Only 27% of patients over 75 years and 38% of those aged 45-75 had probable or possible iron-deficiency anemia. This suggests a need for more stringent diagnostic criteria before prescribing iron, especially considering the potential underlying causes such as gastrointestinal tumors.
Pediatric Iron Prescription Practices
Knowledge and Practices in Pediatric Wards
In the pediatric ward of the Gabriel Touré University Hospital in Bamako, Mali, a study assessed the knowledge and practices regarding iron prescription. Despite more than half of the prescribers being aware of the need for iron in children, there were significant gaps in practice. For instance, the length of treatment was not indicated in 92% of the cases, highlighting a discrepancy between theoretical knowledge and practical application. This underscores the necessity for improved training and adherence to guidelines in pediatric iron prescription.
Intravenous vs. Oral Iron Supplementation
Shift to Intravenous Iron in Inflammatory Bowel Disease (IBD)
A significant shift from oral to intravenous (IV) iron supplementation has been observed in patients with inflammatory bowel disease (IBD) in Switzerland. This change aligns with international guidelines recommending IV iron due to its superior effectiveness and tolerance. Between 2006 and 2009, the frequency of IV iron prescriptions increased significantly, while oral iron prescriptions remained unchanged. This trend reflects the growing preference for IV iron in managing iron deficiency in IBD patients.
Comparative Efficacy in IBD Patients
A randomized study comparing IV iron sucrose and oral iron sulfate in IBD patients found that both methods were equally effective in increasing hemoglobin levels. However, IV iron sucrose was better tolerated, with fewer gastrointestinal side effects leading to discontinuation. This suggests that while both forms of iron supplementation are effective, IV iron may offer a better quality of life for patients due to its lower side effect profile.
Iron Supplementation in Infants
Ferrous Sulfate Prescription Patterns
A study evaluating the prescription patterns of ferrous sulfate for preventing iron deficiency anemia in infants found that compliance with recommended guidelines was suboptimal. Only 18.1% of prescriptions met all five criteria for proper iron supplementation. This indicates a need for interventions to improve adherence to guidelines and ensure effective prevention of iron deficiency anemia in infants.
Safety and Efficacy of Intravenous Iron
High Doses and Mortality in Hemodialysis Patients
Data from the Dialysis Outcomes and Practice Patterns Study indicated an association between high doses of IV iron and increased mortality in hemodialysis patients. Patients receiving more than 300 mg/month had a higher risk of mortality and hospitalization compared to those receiving 100-199 mg/month. This finding highlights the importance of cautious dosing and monitoring in patients requiring IV iron therapy.
FDA Approval of Ferumoxytol
The FDA approved ferumoxytol for IV iron therapy in adult patients with chronic kidney disease (CKD) based on its efficacy in increasing hemoglobin levels and improving iron stores. However, safety concerns such as hypersensitivity reactions and hypotension were noted, necessitating careful patient monitoring.
Conclusion
Iron prescription practices vary widely across different patient populations and conditions. While oral iron remains a common treatment, the shift towards intravenous iron, particularly in conditions like IBD and CKD, reflects its superior efficacy and tolerance. However, the overprescription of iron, especially in the elderly, and the need for better adherence to guidelines in pediatric and infant populations, highlight areas for improvement. Ensuring appropriate dosing and monitoring is crucial to maximize the benefits of iron therapy while minimizing risks.
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