Medications for Anemia

Hemoglobin

Normal Lab Levels

• For AMAB 13.5 to 17.5 grams/dL

• For AFAB, 12.0 to 15.5 grams/dL

Blood Components

• Plasma

• Formed Elements of the Blood

Leukocytes (WBCs)

Erythrocytes (RBCs)

• Hematinic drugs provide essential building blocks for RBC production

Factors Essential to Producing Healthy RBCs

• Adequate amounts of iron

• Minute amounts of Vitamin B12 and folic acid

• Essential amino acids and carbohydrates

Erythropoietin

Stimulate the bone marrow to make more RBC’s

• Prototype: Epoetin Alfa (Epogen)

Actions

• Acts like the natural glycoprotein erythropoietin

Indications

• Treats anemia associated with chronic renal failure

Pharmacokinetics

• Metabolized through the normal kinetic process

Erythropoietin Contraindications

• Uncontrolled hypertension

• Allergy to mammalian cell-derived

• Allergy to human albumin

• Lactation

Erythropoietin Adverse Effects

• CNS – Headache, fatigue, asthenia, dizziness, and seizure

• GI -Nausea, vomiting, and diarrhea

• CV – Hypertension, edema, possible chest pain

Oral Iron Preparations

• Ferrous Fumarate (Feostat)

• Ferrous Gluconate (Fergon)

• Prototype: Ferrous Sulfate (Feosol)

• Ferrous Sulfate Exsiccated (Feratab, Slow FE)

• Actions- Elevate the serum iron concentration

Indications-

• Treatment of iron deficiency anemias and may also be used as adjunctive therapy in patients receiving Epoetin Alfa

Pharmacokinetics

• Absorbed in the small intestines

• Transported in the blood bound to transferrin

• Small amounts are lost daily in the sweat, urine, sloughing of skin and mucosal cell, and sloughing of intestinal cells

Oral Iron Preparations Contraindications

• Allergy

• Hemochromatosis

• Hemolytic anemia

• Normal iron balance

• Peptic ulcer, colitis, or regional enteritis

Iron Preparations Adverse Effects

• Oral - GI irritation and CNS toxicity

• Oral: constipation – may need a stool softener

Iron Preparations Drug-to-Drug Interactions

• GI meds: Antacids, cimetidine, cholestyramine,

• Antibiotics: (fluoroquinolones) ciprofloxacin, norfloxacin, or ofloxacin

• Antibiotics: chloramphenicol, tetracycline

Iron Preparations Teaching points

• Take with Vitamin C supplement or food with vitamin C

• NO milk or Tea; On empty stomach if tolerated

Parenteral Iron Therapy

Iron dextran

• IM injection or

• slow continuous IV infusion.

Iron sucrose

• indicated for use in the hemodialysis patient

• administered by IV infusion.

Ferric Gluconate

Folic Acid

Prototype: Folic acid (generic)

Folate derivatives:

• Leucovorin (generic)

• Levoleucovorin (Fusilev)

Indications:

• Folate Deficiencies

• Prevention of neural tube defects in pregnancy

Serum folic acid levels less than 5 mg indicate folic acid deficiency

Folic Acid containing foods

• Cauliflower

• Asparagus

• Broccoli

• Leafy greens

• Avocado

• Beetroot

• Papaya

• Oranges

• Seeds, nuts, lentils, pear

Folic Acid and Folate Derivatives

Pharmacokinetics: absorbed rapidly in the first third of the small intestine and distributed into all body tissues. Synthetic folic acid is readily absorbed even in patients with malabsorption syndromes.

• Indications

Replacement therapy for dietary deficiencies, pregnancy

Folic acid is used as a rescue drug for cells exposed to some toxic chemotherapeutic agent

• Pharmacokinetics

Well absorbed after injection, metabolized in the liver, and excreted in the urine

Folic Acid and Folate Derivatives Adverse Effects

• Pain and discomfort at the injection site

• Nasal irritation with intranasal spray

Folic Acid and Folate Derivatives Drug-to-drug interactions

• decreased by methotrexate and sulfonamides

• Decrease phenytoin levels

Vitamin B12 Deficiency

• dizziness

• High temperature

• Mood changes

• Pale/jaundiced skin

• Disturbed vision

• Fatigues

• Sensations of pins and needles

• Glossitis/mouth ulcers

Vitamin B12

Prototype: hydroxocobalamin –naturally occurring

Cyanocobalamin is synthetic

Indications: Vitamin B12 deficiency/malabsorption

Pharmacokinetics

• available in parenteral, oral, and intranasal forms.

• Either form -liver slowly releases vitamin B12 as needed. Replaces what would be absorbed from food

Vitamin B12 Adverse Effects

• pain and discomfort at the injection site

• Hypokalemia

• Nasal irritation with intranasal spray

General Adverse Effects with meds for Anemia

• headache, fatigue, dizziness

• Staining of the tissue, itching, rash

• DVTs, MI, stroke, hypertension, edema

• Constipation, nausea, vomiting, diarrhea, anorexia

Key teaching points about hematinic drugs

• The best source of minerals and electrolytes is a well-balanced diet that includes a variety of foods.

• Don’t take over-the-counter preparations, other drugs, or herbal remedies without first talking to the prescriber. Herbal preparations may inhibit iron absorption.

• Keep follow-up appointments for periodic blood tests and procedures to make sure treatment is appropriate.

• Take the drug as prescribed. Take with or after meals with 8 oz of fluid. Oral iron with vitamin C

• Don’t crush or chew slow-release tablets or capsules. Liquid preparations can be diluted with water and sipped through a straw.

• Rinse the mouth after taking liquid preparations to prevent staining of the teeth.

• Iron preparations may cause dark green or black stools.

• Get plenty of rest and rise slowly to avoid dizziness. Take rest periods during the day to conserve energy.

Supplements that may put you at higher risk of bleeding

• Angelica

• Aniseed

• Black cohosh

• Bromelain

• Butcher’s broom root

• Cat’s claw

• Chamomile*

• Curcuma/turmeric

• Fenugreek

• Feverfew

• Fish oil

• Ganoderma

• Garlic*

• Ginger*

• Horse chestnut

• Licorice*

• Omega 3*

• Pau D'Arco

• Red clover

• St. John’s Wort

• Vitamin E

• Willow

• Wintergreen

• Zinc