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Iron-Deficiency Anemia and Its Oral Treatment with Iron Protein Succinylate (Ferretts IPS) Lester Partlow, Ph.D. Pharmics, Inc., Salt Lake City, Utah In iron-deficiency anemia (IDA), the concentration of erythrocytes and/or hemoglobin in the blood is below normal. This can result from (a) inadequate iron in the diet, (b) poor absorption of ingested iron, (c) blood loss, or (d) an increased need for iron due to, for example, pregnancy. An estimated 3 to 12 million people suffer from IDA in the United States1.

Since two thirds of all iron in the body is contained in hemoglobin, iron deficiency is often simply thought of as a disorder that reduces oxygen delivery. However, iron is also required for normal activity by many other important enzymes (myoglobin, cytochromes, catalase, peroxidase, tryptophan pyrrolase, xanthine oxidase, alpha-glycerophosphate oxidase, and aconitase) that are unrelated to oxygen transport.

The symptoms of iron deficiency can include any or all of the following: anemia, fatigue, shortness of breath during exercise, muscle abnormalities, tachycardia (rapid heat rate), pallor, headache, glossitis (inflammation of the tongue), koilonychias (spoon nails), pica, decreased work performance, impaired cognitive development and/or functioning, premature labor, and increased perinatal maternal mortality2.

Ferrous sulfate, the traditional treatment for IDA, was first approved in 1938. The most prominent side effects of iron salts (ferrous sulfate) include heartburn, nausea and vomiting, upper gastric discomfort, diarrhea, and constipation. Reported gastrointestinal symptoms due to treatment with iron salts range in frequency from 15% to 40% depending on dose and other factors1,2. In many patients, these effects lead to noncompliance, which prevents the effective treatment of IDA2.

The annoying GI effects of iron salts (ferrous sulfate) can be largely overcome by use of an Iron Protein Succinylate solution (Ferretts IPS), a preparation in which ferric iron is encapsulated in milk protein (casein); this form of iron is similar to that found in natural foodstuffs3. Because IPS is present as an insoluble precipitate at stomach pH, very little iron is released until IPS reaches a more alkaline environment in the intestine. Thus, there is very little gastric irritation4. In a clinical study of 3,500 patients, 93.7% reported satisfactory gastric tolerability4.

Another advantage of Ferretts IPS is that, unlike iron salts, antacids, H2-receptor antagonists, or food intake3 does not reduce its absorption. Yet another advantage is that, since Ferretts IPS is in solution, it cannot become lodged or retained like dry tablets or capsules of iron salts in the upper parts of the GI tract and cause serious irritation or ulceration in the oral cavity, larynx, or esophagus.

1. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 11th edition, 2006

2. Harrison's Principles of Internal Medicine, 16th edition, Volume 1, 2005

3. US Pharm. 2005;12:60-70

4. ChemiNutra, 2004