FERROUS FUMARATE
Strength200 mg
Formoral.solid
200 mg once daily (or on alternate days) ONLY if co-existing true iron deficiency confirmed (ferritin <100 mcg/L with TSAT <20%) x 2-3 months
3-6 mg/kg/day [child max 180 mg]
(3-6 mg/kg/day elemental iron in 1-2 divided doses only if co- existing iron deficiency documented. Ceiling of 180 mg is the formulary maximum for a child: 20 mL/day of the 140 mg/5 mL syrup, which is 45 mg elemental iron per 5 mL. This is deliberately above the 130 mg an adult gets here: a growing child needs more elemental iron per kilogram, and modern adult practice is lower and less frequent dosing than the formulary allows. It is not an inversion to correct.)
| 3kg | 9-18 mg/day |
|---|---|
| 4kg | 12-24 mg/day |
| 5kg | 15-30 mg/day |
| 6kg | 18-36 mg/day |
| 7kg | 21-42 mg/day |
| 8kg | 24-48 mg/day |
| 9kg | 27-54 mg/day |
| 10kg | 30-60 mg/day |
| 11kg | 33-66 mg/day |
| 12kg | 36-72 mg/day |
| 13kg | 39-78 mg/day |
| 14kg | 42-84 mg/day |
| 15kg | 45-90 mg/day |
| 16kg | 48-96 mg/day |
| 17kg | 51-102 mg/day |
| 18kg | 54-108 mg/day |
| 19kg | 57-114 mg/day |
| 20kg | 60-120 mg/day |
| 21kg | 63-126 mg/day |
| 22kg | 66-132 mg/day |
| 23kg | 69-138 mg/day |
| 24kg | 72-144 mg/day |
| 25kg | 75-150 mg/day |
| 26kg | 78-156 mg/day |
| 27kg | 81-162 mg/day |
| 28kg | 84-168 mg/day |
| 29kg | 87-174 mg/day |
| 30kg | 90-180 mg/day |
| 31kg | 93-180 mg/day (upper capped) |
| 32kg | 96-180 mg/day (upper capped) |
| 33kg | 99-180 mg/day (upper capped) |
| 34kg | 102-180 mg/day (upper capped) |
| 35kg | 105-180 mg/day (upper capped) |
| 36kg | 108-180 mg/day (upper capped) |
| 37kg | 111-180 mg/day (upper capped) |
| 38kg | 114-180 mg/day (upper capped) |
| 39kg | 117-180 mg/day (upper capped) |
| 40kg | 120-180 mg/day (upper capped) |
| 41kg | 123-180 mg/day (upper capped) |
| 42kg | 126-180 mg/day (upper capped) |
| 43kg | 129-180 mg/day (upper capped) |
| 44kg | 132-180 mg/day (upper capped) |
| 45kg | 135-180 mg/day (upper capped) |
| 46kg | 138-180 mg/day (upper capped) |
| 47kg | 141-180 mg/day (upper capped) |
| 48kg | 144-180 mg/day (upper capped) |
| 49kg | 147-180 mg/day (upper capped) |
| 50kg | 150-180 mg/day (upper capped) |
BSH Guidelines for the Management of Anemia of Chronic Disease 2017
Iron therapy is ineffective and potentially harmful in pure anaemia of chronic disease without absolute iron deficiency - the ferritin and TSAT thresholds in the dose above are the gate, not a formality. Where it is indicated, Egypt's oral iron is ferrous fumarate; 200 mg is 65.57 mg elemental.
- DO NOT ROUTINELY PRESCRIBE ORAL IRON FOR PURE ACD: High hepcidin levels block intestinal iron absorption and trap iron in macrophages.
- Definitive management is treating the underlying inflammatory, infectious, or malignant condition.
- Differentiate ACD from iron deficiency anaemia: ACD typically shows low serum iron, low TIBC, normal/high ferritin, and low transferrin saturation.
- Most iron tablets in Egypt come with folic acid in them, though not all - check the pack. Folate corrects the blood picture of B12 deficiency while the neurological damage carries on - check B12 before starting if the anaemia is macrocytic, mixed, or unexplained.
- The guideline says ferrous sulphate. The Egyptian formulary has no ferrous sulphate monograph; its oral iron is ferrous fumarate, 200 mg tablet = 65.57 mg elemental. Substitute on elemental iron, not on tablet weight.
- The pack a pharmacy hands over is a combination rather than plain iron - besides folic acid, many Egyptian iron products add vitamin C, and some add zinc or B vitamins. A combination is an acceptable way to give oral iron: the formulary's ferrous fumarate monograph lists the dosage forms as a 200 mg tablet and a 140 mg/5 mL syrup, then adds combination products to that list, and states the adult dose in elemental iron (100 to 200 mg elemental iron daily). The vitamin C is wanted rather than merely tolerated - 200 to 500 mg alongside oral iron is recommended to enhance its absorption. Dose by the elemental iron the pack states, not by tablet weight and not by the other ingredients. The Egyptian register does not record elemental iron content for most of these products, so the carton has to be read.
| Egyptian brand | Manufacturer | Indicative price |
|---|---|---|
| FERROL 10 F.C. TABLET! also contains folic acid | AMOUN | 2.00 EGP (0.20/unit) |
| FOLIFER 30 TAB.! also contains folic acid | MISR | 7.20 EGP (0.24/unit) |
| FERROZINC-C 24 CAPS.! also contains vitamin c, zinc | SAFE PHARMA > PHARCO | 7.50 EGP (0.31/unit) |
| IROFOL 30 CAPS.! also contains copper, folic acid, pyridoxine, vitamin b12, zinc | MULTICARE | 40.50 EGP (1.35/unit) |
| HAEMACTIN 30 CAPS.! also contains folic acid, vitamin b12 | DELTA GRAND PHARMA > NOBEL PHARM. INDUSTRIES | 150.00 EGP (5.00/unit) |
| TESLAGLOBIN 20 CAP! also contains b12, b6, copper, folic acid, zinc | DAWA EGYPT INTERNATIONAL > TESLA | 140.00 EGP (7.00/unit) |
| CHEMARED CAPSULE! also contains calcium, methyl cobolamine, pyridoxine | PHARMA ZAD > CHEMA HERB | 195.00 EGP |
| FERRONIL 125MG/5ML SYRUP 120 ML? strength differs? different route - not oral solid | EL NILE. | 4.00 EGP |