Preventing complications by persistence with iron replacement therapy: a comprehensive literature review

Ferrous ascorbate non-effervescent floating mini-caplets as an oral iron supplement

PURPOSE

This research aimed to develop non-effervescent floating mini-caplets of Ferrous Ascorbate (FA) using low-density polymers to overcome the problems of poor bioavailability associated with immediate-release iron products. Methods: The excipients and method (melt granulation) were selected based on pre-and post-compression parameters in trial batches. The formulation was optimized by a full factorial 32 experimental design. An optimized formulation was evaluated for drug release kinetic, accelerated stability study, and in vivo study in healthy adult New Zealand female rabbits. Results: The optimized formulation F6 mini-caplets (42.5% FA, 45% Glyceryl palmitostearate as Precirol, 10% polyvinyl pyrrolidone K-30, and 2.5% lactose) were found to have instant floating and 12 h floating duration in 0.1N Hydrochloric acid (HCl) dissolution medium. In vitro drug release (diffusion mechanism) at 1 h and 5 h was 30-35% and 65-70%, respectively. It was found stable for three months under an accelerated stability study. In vivo study showed significantly increased serum iron levels and decreased unsaturated iron binding capacity (UIBC) in the test group (optimized formulation) compared to control and standard (immediate-release iron). Conclusion: Based on the in vitro and in vivo results, we conclude that non-effervescent floating FA mini-caplets have higher bioavailability compared to immediate release FA, which may be attributed to prolonged iron release at its absorption site due to their retention in the gastric region. Hence, non-effervescent floating FA mini-caplets may act as a potential approach for iron deficiency.

Classic and emergent indicators for the assessment of human iron status

Iron deficiency is the leading cause of anemia, a significant global public health problem. Different methods exist for assessing iron nutritional status, including laboratory tests that focus on storage, transportation, and iron functional compartment parameters. Classical markers such as bone marrow, serum iron, ferritin, hemoglobin, erythrocyte parameters, transferrin, transferrin receptors, and zinc protoporphyrin are discussed in this review. Additional parameters calculated from these indicators, including transferrin saturation, ferritin index and Thomas plot, and some emergent parameters such as hepcidin, erythroferrone, and low hemoglobin density are also discussed. There is no a single indicator for assessing iron nutritional status. Therefore, the use of more than one indicator may be the best practice to obtain the correct diagnosis, also considering the influence of inflammation/infection on many of these indicators. The constant validation of the current parameters, the improvement of assessment methods, and the identification of new indicators will be the key to refine the assessment of iron nutritional status and the right choice of treatment for its improvement.

Recovery after surgery: do not forget to check iron status before

The perioperative period poses a risk for anemia due to the high prevalence of pre-existing anemia secondary to underlying pathologies in patients who are candidates for surgery, and as a result of the increased blood loss caused by surgery. Pre-operative anemia is an independent risk factor associated with higher risk of blood transfusion and negative surgery outcomes. Anemia and iron deficiency (ID), the main causes of pre-operative anemia, can be easily diagnosed with blood testing and are readily treated before elective surgery. However, pre-surgical screening and treatment of anemia and ID are frequently overlooked. These topics were presented and discussed at the symposium entitled "Recovery after Surgery: Don't Forget to Check Iron Status Before", held at the 11th Annual Meeting of the European Urogynaecological Association (EUGA) in October 2018 in Milan. The objectives of the symposium were to stress the high prevalence and the consequences of pre-operative anemia, illustrated with three clinical cases of women undergoing surgery, and to choose the best option for iron supplementation. In conclusion, it is essential to take time to diagnose and treat iron deficiency anemia (IDA) before surgery. The first-line treatment is oral iron when surgery can be delayed and when there is no intolerance to oral treatment or inefficient uptake, as in the case of iron sequestration or absorption disorders. Among iron preparations, ferrous sulfate in a polymeric complex (FSPC) was found to be one of the treatments of choice to improve hemoglobin iron stores and quality of life in IDA patients.