carbonyl iron

Carbonyl iron is an iron supplement used as a dietary supplement and to prevent and treat iron deficiency anemia.

Iron is an important component of hemoglobin, the protein in red blood cells that delivers oxygen to all the tissues, and myoglobin, the muscle protein that stores oxygen and releases it to the muscle cells when oxygen saturation drops.

In addition to oxygen transport and storage, iron is essential for many cellular processes, synthesis of enzymes and hormones, DNA synthesis and repair, electron transport, and energy metabolism. In general, women need more iron intake because of loss of iron with menstrual bleeding, and pregnant women often need iron supplements because their requirement goes up during pregnancy and breastfeeding.

Carbonyl iron is a nonionic iron produced by vaporizing submicroscopic spheres of uncharged, highly purified metallic iron, which must be converted to ferrous iron by gastric acid before it can be absorbed. As a result, carbonyl iron is more slowly absorbed and has a higher bioavailability than ferrous sulfate, another form of iron, as well as less potential for toxicity with overdose.

Iron supplements are available over the counter (OTC) as different iron salts and are usually an ingredient of multivitamins. Dietary iron sources include lean meat, poultry, seafood, kidney beans, lentils, spinach, peas, nuts, and certain fortified foods.

• Do not use in patients with hypersensitivity to any of the components of carbonyl iron.
• Do not use supplemental iron to treat:
  • Anemias not associated with iron deficiency
  • Hemochromatosis, a hereditary disorder that causes excessive iron absorption in the body
• Do not use carbonyl iron in patients with gastrointestinal conditions including:
  • Peptic ulcer
  • Regional enteritis
  • Ulcerative colitis
• Do not take carbonyl iron within 2 hours of oral tetracycline antibiotics.
• Do not use in patients who receive frequent blood transfusions.
• Do not administer to premature infants until their deficient vitamin E stores at birth are replenished. Carbonyl iron may increase red cell destruction (hemolysis) and hemolytic anemia in infants with low serum vitamin E concentrations.
• Do not take carbonyl iron for longer than 6 months unless it is prescribed for continuous bleeding or heavy menstrual bleeding (menorrhagia).

Common side effects of carbonyl iron include:

• Nausea
• Vomiting
• Upper abdominal (epigastric) pain
• Diarrhea
• Constipation
• Dark stools
• Heartburn
• Urine discoloration
• Dental stain by some formulations
• Iron overload in organs and tissues (hemosiderosis), with prolonged use of large amounts

Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:

• Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
• Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
• Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
• Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Tablet

• 45 mg (Feosol)
• 66 mg (Ircon)

Oral Suspension

• 15 mg/1.25 mL (Icar Pediatric)

Tablet, Chewable

• 15 mg (Icar Pediatric, Wee Care)

Tablet With Vitamin C

• 100 mg iron/250 mg vitamin C (Icar C)

Adult:

Dietary Iron Supplement

Doses expressed as elemental iron unless otherwise noted

19-50 years old:

• Male: 8 mg orally every day
• Female: 18 mg orally every day
• Pregnant female: 27 mg orally every day
• Lactating female 9 mg orally every day
• Above 50 years old: 8 mg orally every day

Iron Deficiency Anemia

• 300 mg orally every 12 hours; may increase to 300 mg every 6 hours or 250 mg extended release (ER) orally every 12 hours
• Note: Dose expressed as ferrous sulfate

Prophylaxis of Iron Deficiency

• 300 mg orally every day
• Note: Dose expressed as ferrous sulfate

Geriatric:

• Lower doses of 10-50 mg elemental iron/day recommended may cause fewer gastrointestinal adverse effects

Pediatric:

Dietary Iron Supplement

• Doses expressed elemental iron unless otherwise noted
• Children 0-6 months old: 0.27 mg orally every day (adequate intake)
• Children 7-12 months old: 11 mg orally every day
• Children 1-3 years old: 7 mg orally every day
• Children 3-8 years old: 10 mg orally every day
• Children 8-12 years old: 8 mg orally every day
• Children above 12 years old: Same as adult

Severe Iron Deficiency Anemia

• 4-6 mg/kg orally divided every 8 hours

Mild to Moderate Iron Deficiency Anemia

• 3 mg/kg orally every day or divided every 12 hours

Prophylaxis

• 1-2 mg/kg oral; 15 mg oral maximum

• There have been no published reports of serious or fatal poisoning from carbonyl iron overdose. Carbonyl iron has a greater safety margin than ferrous sulfate formulations because it is more slowly absorbed and must be converted to ferrous iron by gastric acid before it can be absorbed.
• Carbonyl iron overdose may be treated with supportive and symptomatic care.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Carbonyl iron has no listed severe interactions with other drugs.
• Serious interactions of carbonyl iron include:
  • baloxavir marboxil
  • ciprofloxacin
  • demeclocycline
  • doxycycline
  • eltrombopag
  • fleroxacin
  • gemifloxacin
  • levofloxacin
  • minocycline
  • moxifloxacin
  • mycophenolate
  • ofloxacin
  • oxytetracycline
  • tetracycline
• Carbonyl iron has moderate interactions with at least 33 different drugs.
• Mild interactions of carbonyl iron include:
  • calcium acetate
  • calcium carbonate
  • calcium chloride
  • calcium citrate
  • calcium gluconate
  • gymnema
  • manganese
  • vitamin E

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or healthcare provider about all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or healthcare provider if you have any questions about the medication.

• Iron requirement increases during pregnancy, and untreated iron deficiency and iron deficiency anemia can increase the risk for low birth weight, preterm birth, or newborn mortality.
• Supplemental carbonyl iron intake during pregnancy is desirable in order to prevent iron deficiency, however, it should not exceed the daily recommended dose.
• Iron deficiency during pregnancy may be treated with carbonyl iron and iron supplementation should continue for 6 to 8 weeks after delivery to replenish the mother’s iron stores.
• Iron is present in breast milk and carbonyl iron use increases iron content in the milk; iron is a beneficial mineral nutrient for the breastfeeding baby and carbonyl iron not exceeding the recommended daily dose is compatible with breastfeeding.

• Do not take carbonyl iron in excess of the daily recommended dose.
• Do not take for longer than 6 months unless directed by your physician.
• Keep carbonyl iron out of reach of children.
• In case of accidental overdose, seek medical help or Contact Poison control.