SUMMARY OF PRODUCT CHARACTERISTICS
NAME OF THE MEDICINAL PRODUCT
QUALITATIVE AND QUANTITATIVE COMPOSITION
Each tablet contains 300mg of the active substance ferrous gluconate
Red, circular, biconvex sugar-coated tablets
Ferrous gluconate tablets 300mg are indicated for the prevention and treatment of iron deficiency states
Posology and method of administration
The route of administration for ferrous gluconate tablets is oral
Ferrous gluconate tablets are best taken about 1 hour before meals
Use in patients with known hypersensitivity to the active ingredient or any of the excipients.
Patients with haemochromatosis, anaemias not produced by iron deficiency unless iron deficiency is also present, iron storage or absorption diseases such as haemosiderosis or haemoglobinopathies, patients with inflammatory bowel disease, intestinal strictures and diverticulae, active peptic ulcer and patients receiving repeated blood transfusions.
Should not be administered concomitantly with parenteral iron.
Special warnings and precautions for use
The label will state: “Important warning: Contains iron. Keep out of the reach and sight of children, as overdose may be fatal.” (This will appear on the front of the pack within a rectangle in which there is no other information).
Iron preparations colour the faeces black, which may interfere with tests used for detection of occult blood in the stools. Contains sucrose. Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine.
Interaction with other medicinal products and other forms of interaction
Effect of other medicines on ferrous gluconate
Dimercaprol should not be used for the treatment of iron poisoning or in patients taking iron supplements due to the formation of toxic complexes. The absorption of iron from the gut may be reduced by concomitant administration of the following substances:
Calcium supplements or calcium containing products
Effect of ferrous gluconate on other medications
Administration of oral iron may reduce the hypotensive effect of methyldopa Absorption of the following medications are reduced in the presence of ferrous gluconate:
Pregnancy and lactation
Ferrous gluconate may be safely taken by pregnant and nursing mothers
Effects on ability to drive and use machines
Because iron salts are astringent gastrointestinal irritation may occur. Nausea, vomiting, blackening of the stools and epigastric pain may occur and are dose related but the relationship between dose and altered bowel habit, giving rise to constipation or diarrhoea is less clear.
In the first phase of acute iron overdosage, which occurs up to 6 hours after oral ingestion, gastrointestinal toxicity, notably vomiting and diarrhoea, predominates. Other effects may include cardiovascular disorders, such as hypotension and tachycardia, metabolic changes, including acidosis and hyperglycaemia, and CNS depression ranging from lethargy to coma. Patients with only mild to moderate poisoning do not generally progress past this phase. The second phase may occur at 6 to 24 hours after ingestion and is characterised by a temporary remission or clinical stabilisation. In the third phase, gastrointestinal toxicity recurs together with shock, metabolic acidosis, convulsions, coma, hepatic necrosis and jaundice, hypoglycaemia, coagulation disorders, oliguria or renal failure, and pulmonary oedema. The fourth phase may occur several weeks after ingestion and is characterised by gastrointestinal obstruction and possibly late hepatic damage.
Local guidelines should be used or the National Poisons Information Centre should be contacted about individual patient management. In less severe cases gastric lavage may be employed to remove unabsorbed iron from the stomach if the patient presents within one hour of ingestion. The serum-iron concentration should be measured as an emergency. In severe toxicity desferrioxamine should be given by continuous intravenous infusion without waiting for the results of the serum iron measurement. Desferrioxamine is a specific iron chelating agent which may be administered by intravenous injection. The dose should be adjusted according to the severity of the poisoning. Dimercaprol should not be used in the treatment of iron poisoning.
B03A A03, Iron bivalent, oral preparations
Iron is an essential constituent of the body, being necessary for haemoglobin formation and for the oxidative processes of living tissues. More than 80% of the iron present in the body is involved in the support of red blood cell production. Iron is also an essential component of myoglobin, haem enzymes such as cytochromes, catalase, peroxidase, and the metalloflavoprotein enzymes, including xanthine oxidase and the mitochondrial enzyme alpha glycerophosphate oxidase.
After acidification and partial digestion of food in the stomach, its content of iron is presented to the intestinal mucosa as either inorganic or heme iron. These fractions are taken up by the absorptive cells of the duodenum and upper small intestine and the iron is either transported directly into the plasma or is stored as mucosal ferritin. Normal absorption is about 1mg per day in the adult male and about 1.4mg per day in the adult female. Increased uptake and delivery of iron into the circulation occurs when there is iron deficiency, and when iron stores are depleted or when erythropoiesis is increased. Only 10% of total iron is lost per year from
normal men and that accounts for 1mg per day. Two thirds of this iron is excreted from the gastrointestinal tract as extravasated red cells, iron in bile and iron in exfoliated mucosal cells. The other third is accounted for in the urine. Physiological losses of iron in the male vary over a relatively narrow range decreasing to about 0.5mg in the iron deficient individual and increasing to as much as 1.5mg or possibly 2mg per day when excessive iron is consumed. Additional losses of iron occur in the female due to menstruation while this averages about 0.5mg per day, 10% of normal menstruating females loose over 2mg per day.
Preclinical safety data
No data of relevance to the prescriber, which is additional to that included in other sections of the SPC
List of excipients
Sodium starch glycollate Stearic acid Colloidal silicon dioxide Sucrose Opaseal Talc Calcium carbonate Acacia Titanium dioxide Certolake ponceau 4R Opaglos 6000P
Do not use after the ‘Use Before’ date given on the pack
Special precautions for storage
Nature and contents of container
Polypropylene tubes with low-density polyethylene caps
Pack sizes of 28, 250, 500, 1000, 5000 tablets
Special precautions for disposal
MARKETING AUTHORISATION HOLDER
Co-pharma Ltd Unit 4 Metro Centre Tolpits Lane Watford Hertfordshire WD18 9SS
MARKETING AUTHORISATION NUMBER(S)
DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
7 January 1998 / 4 April 2003
10. DATE OF REVISION OF THE TEXT
123. Age and mass of solar twins constrained by lithium abundance do Nascimento, J. D., Jr, Castro, M., Melendez, J., Bazot, M., Theado, S., Porto de Mello, G. F., de Medeiros, J. R. 2009, Astronomy & Astrophysics, 501, 687-694 124. Atmospheric effects on extensive air showers observed with the surface detector of the de Mello Neto, J. R. T., Auger, C. P. 2009, Astroparticle Physics, 32, 89
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