Skip to 0 minutes and 14 secondsSo it is still very important to check Iron status even though most of CR patients actually their anemia is front EPO deficiency. So if the patient don't have enough iron level, they probably even though we as supply for EPO they still cannot correct the anemia. So checking a patient's TSAT or TIBC level of serum ferritin level is very important at the beginning of therapy And the goal of iron anemia therapy includes TSAT, above 20%, serum ferritin, above 100 ng/mL, for CKD stages two patients. And even higher for CKD stage 5. And iron therapy for renal anemia, you can actually select several different kind of products including ferrous sulfate or gluconate, fumarate, polysaccharide.

Skip to 1 minute and 29 secondsAnd we as a pharmacist always need to remember how much elemental iron included in different formula, formulations and the dose for iron therapy is actually depends on elemental iron. So we need to do the calculation correctly. And for oral iron therapy, there are a couple adverse effects. Tthe major issue is about the GI stomach pain or some patients they may have constipation, diarrhea, nausea, vomiting and we have to encourage your patient and start slow and go slow and the patient may actually divided the dose of iron into different doses in a day.

Skip to 2 minutes and 24 secondsSo, they can actually slowly increase the dose at the beginning and even food may decrease the absorption but some of the patient they really couldn't take it on empty stomach. So we can at least starting to give them a little bit food but later on when the patient can actually tolerate to those oral Iron we can actually give more and basically if the patient could stand on empty stomach, that will be better. However we don't encourage patient take with antacid or another other tetracycline because there is a serious drug interaction. Vitamin C concomitantly with oral iron is not needed.

Iron status & Oral Iron therapy

In this step, Prof. Chen clarifies how to check the iron status of patients and how to execute good oral iron therapy.

To begin with, if the patient don’t have enough iron level, their anemia can’t be corrected even with suitable supplement of EPO.

Therefore, checking a patient’s TSAT or TIBC level of serum ferritin is important at the beginning of therapy.

Given the table on the third slide, as a pharmacist, we need to remember how much elemental iron included in different formula. Formulations and the dose for iron therapy depend on elemental iron, so we must do the calculation correctly.

For oral iron therapy, if patients start to experience some adverse drug effects, we have to encourage them to divide the dose of iron into different doses in a day.

Finally, remember to tell the patients not to take the iron with antacid or tetracycline.

Have you ever monitored the Iron status in clinical practice? Please share your experience below. If possible, you can share which country you’re in as well.

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This video is from the free online course:

Pharmacokinetics: Drug Dosing in Renal Disease

Taipei Medical University