T fe 500 mg
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Based on my research from the textbooks, here is a comprehensive overview of Tablet Ferrous Sulfate (FeSO₄) 500 mg:
T. Ferrous Sulfate 500 mg
Drug Class
Oral iron supplement — used to correct iron deficiency anemia.
Elemental Iron Content
Ferrous sulfate 500 mg contains approximately ~100 mg of elemental iron (elemental iron is ~20% of ferrous sulfate by weight).
Note: Ferrous sulfate 325 mg is the most commonly referenced dose in textbooks, containing ~65 mg elemental iron. A 500 mg tablet provides proportionally more.
Indications
- Iron deficiency anemia (most common nutritional deficiency)
- Prophylaxis during pregnancy (increased iron demands)
- Replenishment after blood loss (menstruation, GI bleeding, surgery)
Mechanism of Action
Provides elemental iron to correct the underlying iron deficit. Iron is absorbed primarily in the duodenum in its ferrous (Fe²⁺) form, then transported via transferrin to the bone marrow for hemoglobin synthesis, and stored as ferritin in the liver, spleen, and bone marrow.
Pharmacokinetics
- Absorption: Oral; enhanced by acidic gastric conditions (Fe²⁺ is more soluble than Fe³⁺)
- Absorption site: Duodenum
- Enhancer: Vitamin C (ascorbic acid ≥200 mg) increases absorption by ≥30%
- Inhibitors: Food, antacids (calcium carbonate, aluminum hydroxide), proton pump inhibitors, tetracyclines, fluoroquinolones — all reduce absorption
- As body iron stores rise, fractional absorption decreases (regulated by hepcidin)
Dosing
| Indication | Dose |
|---|---|
| Iron deficiency anemia (adult) | 150–200 mg elemental iron/day in divided doses |
| Equivalent ferrous sulfate | 325 mg 2–3× daily (traditional regimen) |
| Alternative (newer evidence) | Once daily or every-other-day dosing — comparable efficacy, fewer side effects |
| Pregnancy prophylaxis | 30–60 mg elemental iron/day |
Emerging evidence shows that once-daily or every-other-day dosing may be as effective as three-times-daily dosing, and produces fewer GI side effects — likely because frequent high doses raise hepcidin, which paradoxically reduces iron absorption.
Adverse Effects
- GI (most common): Nausea, heartburn, epigastric discomfort, constipation, diarrhea
- Dark/black stools (harmless but important to warn patients)
- Iron overload is a risk only in patients with underlying conditions augmenting absorption (e.g., hemochromatosis)
Tip: Start at a low dose and titrate up to minimize GI side effects and improve adherence.
Drug Interactions
- Levothyroxine: Ferrous sulfate reduces thyroxine absorption — separate by ≥4 hours
- Fluoroquinolones, tetracyclines: Chelation reduces antibiotic absorption — separate by 2–4 hours
- Antacids (Ca²⁺, Al³⁺, Mg²⁺): Reduce iron absorption
- Proton pump inhibitors / H₂ blockers: Raise gastric pH → reduce Fe²⁺ solubility → less absorption
Counseling Points
- Take on an empty stomach if tolerated (increases absorption); with food if GI side effects occur
- Take with orange juice/vitamin C to boost absorption
- Stools will turn dark/black — this is normal
- Avoid taking with milk, antacids, or other medications simultaneously
- Complete the full course — hemoglobin typically corrects in 4–8 weeks, but iron stores take 3–6 months to replenish
Monitoring
- Hemoglobin/hematocrit: Expect rise of ~1–2 g/dL per week once adequate dosing is achieved
- Reticulocyte count peaks at 7–10 days after starting therapy
- Serum ferritin to confirm iron store repletion
— Lippincott Illustrated Reviews: Pharmacology; Goodman & Gilman's The Pharmacological Basis of Therapeutics
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