Ferrous fumarate 210mg tablets

Iron-deficiency anemia is the most common hematologic disorder in pregnancy. Slow iron repletion, poor gastrointestinal tolerance, and late presentation during gestation often limit the effectiveness of oral ferrous salts, which remain the traditional first-line treatment. Intravenous iron offers faster iron delivery, but its role in routine antenatal care remains uncertain, particularly regarding its long-term safety and cost-effectiveness compared to traditional oral iron treatments. This qualitative systematic review included 10 randomized controlled trials published within the last decade that enrolled pregnant women with iron-deficiency anemia or persistent iron deficiency (defined, where applicable, as ferritin <30 μg/L after approximately four weeks of oral iron therapy) and compared intravenous iron with oral iron or one intravenous formulation with another. Across the included trials, intravenous iron generally produced more rapid ferritin replenishment and, in many studies, a faster rise in hemoglobin than oral therapy. Oral ferrous preparations were associated with more gastrointestinal adverse effects; for example, in one study, gastrointestinal treatment-related events were reported in more women receiving oral ferrous sulfate versus those receiving ferric carboxymaltose. In another trial, nausea/vomiting occurred in greater number of oral-iron recipients versus intravenous ones, while constipation and epigastric discomfort were reported only in the oral group. By contrast, serious intravenous treatment-related events were uncommon in the larger trials.​ ​Smaller and medium-sized trials generally favored parenteral iron for hematologic recovery, but the largest pragmatic studies from India, Malawi, and Nigeria showed that biochemical superiority did not consistently translate into lower rates of late-pregnancy anemia or improved major maternal and neonatal outcomes. One head-to-head intravenous trial also suggested practical and hematologic advantages of ferric carboxymaltose over iron sucrose. From a hematology perspective, intravenous iron appears most useful when rapid restoration of iron stores is needed, when adherence to oral therapy is doubtful, or when little time remains before delivery. Future trials should standardize ferritin-based diagnostic criteria, clearly distinguish hematologic from obstetric endpoints, and better define which patients are most likely to derive clinically meaningful benefit from parenteral iron.

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This systematic review, conducted under the COST Action CA20218 "Promoting Innovation of fermented foods" (PIMENTO), aimed to evaluate whether sourdough- and regular-bread fermentation improve iron bioavailability, absorption, and status in humans. Screening of PubMed, Scopus, and Cochrane Library (January 1970-December 2024) identified 8 human intervention studies, in healthy or iron-deficient participants, that met inclusion criteria. EFSA's scientific guidance for health claim applications, which integrates product characteristics and mechanisms of action to the human studies, was followed, and the extracted data were narratively presented. Results were inconclusive as acute postprandial studies increased non-haem iron bioavailability (especially in low-phytate breads); for example, low-phytate white bread produced a greater 2 h increase in serum iron than high-phytate wholemeal bread (59 vs. 30 μg Fe/100 mL), while exogenous phytase increased iron absorption by 50% for ferrous sulfate and 61% for iron bis-glycine chelate. However, long-term trials did not improve, and in one case even decreased, ferritin and total body iron; specifically, in the low-phytate sourdough rye bread group, ferritin declined from 32 ± 7 to 27 ± 6 μg/L and total body iron from 6.9 ± 1.4 to 5.4 ± 1.1 mg/kg over 12 weeks. On the other hand, phytate reduction combined with iron fortification showed positive effects on haemoglobin or prevented iron depletion; in anaemic children, fermented amaranth bread increased haemoglobin [adjusted β = 8.9 g/L (95% CI: 3.5-14.3)] and reduced anaemia prevalence (32% vs. 56%) compared to control bread. Despite convincing mechanistic evidence that the sourdough-fermentation process in bread fabrication improves iron bioavailability, through reduction of phytate, no human studies address this research question with the appropriate control and study quality.Systematic review registrationosf.io/gzt8m.

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Iron deficiency (ID) is a common and clinically significant comorbidity in patients with heart failure (HF), contributing to reduced exercise capacity, poor quality of life, and increased hospitalization risk. Although intravenous (IV) iron therapy has demonstrated efficacy in improving functional outcomes, the comparative effectiveness of IV vs. oral (per os, or PO) iron supplementation remains uncertain. We conducted a systematic review and network meta-analysis (NMA) of 13 randomized controlled trials (RCTs) evaluating IV iron (ferric carboxymaltose, ferric derisomaltose, iron sucrose), PO iron (ferrous sulfate, ferrous fumarate, polysaccharide, sucrosomial, ferric polymaltose), and placebo in HF patients with ID, analyzed as route-specific class effects. Outcomes analyzed included six-minute walk distance (6MWD), ferritin, transferrin saturation (TSAT), HF hospitalization, all-cause mortality, and cardiovascular (CV) mortality. We used a Hartung-Knapp random-effects framework with Sidik-Jonkman variance, assessed heterogeneity and inconsistency using I2, τ2, design-by-treatment interaction, and node-splitting. Risk of bias was assessed independently by two reviewers using Risk of Bias 2 (RoB 2), and certainty of evidence for all outcomes was graded using GRADE adapted for NMA. Because most contrasts included fewer than 10 RCTs, formal tests for publication bias were not feasible, and potential small-study effects were considered qualitatively in the GRADE assessments. Trials that reported outcomes only as medians and interquartile ranges (IQRs), or baseline values without follow-up data, were excluded from quantitative pooling and described narratively. IV iron significantly improved 6MWD compared to placebo (mean difference (MD) +26.0 m; 95% confidence interval (CI): 18.1 to 33.9), increased ferritin (MD +237.2 μg/L), and reduced the risk of HF hospitalization (risk ratio (RR) 0.79; 95% CI: 0.66 to 0.93), with moderate to high certainty. PO iron showed a comparable, but not statistically significant, mean improvement in 6MWD (MD +35.1 m; 95% CI: -5.2 to +75.4), with wider CIs and inconsistent ferritin and TSAT gains. Neither IV nor PO iron was associated with a significant reduction in all-cause or CV mortality, although a trend toward benefit was observed with IV therapy. Numerical SUCRA values favored IV iron for HF hospitalization (77.9 vs. 57.6 for PO, 14.5 for placebo), ferritin (100.0 vs. 50.0 vs. 0.0), and TSAT (74.0 vs. 75.8 vs. 0.2), while PO iron ranked slightly higher for 6MWD (76.3 vs. 73.7 vs. 0.0). Included PO formulations encompassed both traditional preparations (ferrous sulfate/fumarate, polysaccharide) and newer agents such as sucrosomial iron and ferric polymaltose. Adverse events were comparable across groups: IV iron was not associated with excess mortality or serious adverse events, and PO iron was primarily limited by gastrointestinal intolerance. Sensitivity analyses restricting outcomes to trials with 3-12 months of follow-up showed consistent results, while longer studies mainly influenced event counts rather than the direction of effect. Our findings support the use of IV iron as the preferred strategy to improve symptoms and reduce hospitalizations in HF patients with ID, whereas PO iron may be considered when IV therapy is inaccessible. Further large-scale trials are needed to clarify long-term mortality impact and the role of newer PO formulations.

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BackgroundInnovative fortification solutions are needed to address micronutrient deficiencies, which remain highly prevalent among adult females in India.ObjectivesThe objective of this trial was to evaluate the effects of quintuply-fortified salt (QFS) compared with iodized salt on the micronutrient status of nonpregnant females of reproductive age (NPFRA) in Punjab, India.MethodsWe conducted a double-blind, randomized, controlled, community-based trial. A total of 998 NPFRA were randomly assigned to receive: 1) QFS with iron as encapsulated ferrous fumarate, zinc, vitamin B12, folic acid, and iodine (eFF-QFS); 2) QFS with the same micronutrients, but iron as encapsulated ferric pyrophosphate plus ethylenediaminetetraacetic acid (eFePP-QFS); or 3) iodized salt. Biomarkers of micronutrient status were assessed at enrollment, 6 mo and 12 mo.ResultsAt enrollment, the prevalence of anemia, iron deficiency, hypozincemia, vitamin B12 insufficiency, and folate insufficiency among trial participants was 47.9%, 59.7%, 35.5%, 61.5%, and 69.7%, respectively. Mean household salt disappearance, measured at monthly home visits, was 6.0 g/adult female equivalent/day [95% confidence interval (CI): 5.9, 6.1] and did not vary across groups or time. At 6 mo, the odds of vitamin B12 insufficiency, folate insufficiency, and hypozincemia were, respectively, 80% [odds ratio (OR): 0.20; 95% CI: 0.13, 0.31], 86% (OR: 0.14; 95% CI: 0.09, 0.21), and 38% (OR: 0.62; 95% CI: 0.41, 0.93) lower in the eFF-QFS compared with the iodized salt group. Effects on vitamin B12 and folate status were sustained at 12 mo, and were comparable in the eFePP-QFS compared with the iodized salt group. There was a small, marginally significant, reduction in iron deficiency in the eFF-QFS compared with the iodized salt group at 6 (OR: 0.64; 95% CI: 0.42, 0.98; P = 0.08) and 12 mo (OR: 0.58; 95% CI: 0.35, 0.95; P = 0.06), but not in the eFePP-QFS compared with the iodized salt group. There were no groupwise differences in anemia at either time point.ConclusionsMultiple micronutrient salt fortification may be an effective strategy to improve micronutrient status, especially vitamin B12 and folate, among NPFRA at high risk of deficiency.Trial registration numberThis study was registered at clinicaltrials.gov, with NCT05166980 and at Clinical Trials Registry-India with CTRI/2022/02/040333.

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Introduction The biotransformation of minerals through glycosylation by microorganisms, such as yeast or probiotics, can produce nutrients bound to a food matrix, potentially enhancing their bioavailability. This study aimed to compare the absorption kinetics of iron bound to a glycoprotein matrix (GPM) with those of ferrous bisglycinate chelate (FBC) and ferrous fumarate (FF). Methods In a double-blind, crossover design, 17 participants ingested 11 mg of iron in one of three forms: GPM (Pharmachem Innovation, Kearny, NJ, USA), FBC (Ferrochel®, Balchem Corp., Montvale, NJ, USA), or FF (FerroPharma Chemicals Ltd, Hungary). Blood samples were collected at baseline and 30-, 60-, 90-, 120-, 180-, 240-, 300-, 360-, 420-, and 480-minutes post-ingestion. Water intake was standardized throughout the protocol, and an iron-free snack was provided at four hours post-ingestion. Pharmacokinetic analysis was performed, with key outcome variables including the incremental area under the concentration vs. time curve (iAUC), maximum concentration (Cmax), and time to maximum concentration (Tmax). The a priori significance level was set at p < 0.05. Results Linear mixed-effects models indicated statistically significant effects of the GPM condition for both raw iron concentrations and changes from baseline (p = 0.03). On average, participants had iron concentrations that were 27.1 mcg/dL (95% CI: 2.8 to 51.4) higher after consuming GPM iron compared to the FF reference condition. Changes in iron concentrations from the baseline were 16.6 mcg/dL (95% CI: 1.5 to 31.7) higher after GPM consumption compared to FF. In contrast, iron concentrations and changes in iron levels after FBC consumption did not significantly differ from those observed with FF. Significant effects of time were also observed in both linear mixed-effects models. When expressed as percentage changes from baseline, iron concentrations in the GPM condition were 9.4% to 35.0% higher than FF and 5.9% to 32.6% higher than FBC. Pharmacokinetic analysis revealed a significant effect of condition on the iAUC (p = 0.047), but no significant effects for Cmax (p = 0.15) or Tmax (p = 0.81). Post hoc tests for the iAUC indicated a trend (p = 0.07) for a difference between the GPM and FBC conditions, but no significant differences between GPM and FF (p = 0.17) or FBC and FF (p = 0.75). Conclusion These findings suggest that iron bound to a glycoprotein matrix can improve absorption kinetics without any associated side effects. This data could have important implications for addressing iron deficiency or absorption disorders in a variety of populations.

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