Are the side effects of ferrous sulfate cumulative?

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Amy
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Are the side effects of ferrous sulfate cumulative?

Postby Amy » Fri Aug 22, 2008 4:19 pm

I've been taking ferrous sulfate (iron) pills for about a month now, as my ferritin level was 10. I was suprised that it hadn't made me feel sick, but lately I've been feeling a low grade queasiness for days and I don't know if its due to the iron (which has done absolutely nothing for my rls/plmd so far). Any idea if it could be the a build-up effect of the iron or would I have felt it all along if it was the iron?

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Aiken
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Postby Aiken » Fri Aug 22, 2008 9:22 pm

Iron's hard on the GI tract. Most people take it with food to help cut that down a bit. If you're feeling more and more queasy, you might want to try a lower dose, or the same dose less often, or even a higher dose less often.

Your ferritin level was about as low as most people get around here. Apparently, you suck at absorbing iron. It's hard to say how much difference a lower dose would make. You may be bringing your iron up quite nicely, or it might be just barely moving. If the former, you could afford a lower or less frequent dose. If the latter, you probably can't afford to lower your intake, and either need to take more less often (and possibly just deal with the occasional nausea) or consider a different solution. I think there's at least one other formulation of oral iron, and then there's also IV iron infusions, which generally work quite well and last for several months.

Given that it's been a month, you might want to have your ferritin re-tested. Then you'll know how much difference your current dose actually makes and can adjust accordingly.

Me, I take 65mg of elemental iron (Feosol) about once a week. My original ferritin (years ago) was 30, and the last time I had it checked, it was 103, so for me this is a perfect maintenance dose. Once you hit 100 or so, you should also adjust your input until you're maintaining, rather than building. Too much iron is harmful to your health. It builds up in the muscles, notably the heart, and causes damage that can be life-threatening in extreme cases. Ferritin of 100 (for RLS patients), however, is supposedly fine.
Disclaimer: I often talk about what I do and what works for me, but these are specific to me and you should always consult a healthcare professional before trying these things yourself, lest you endanger your health or life.

Amy
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Postby Amy » Sat Aug 23, 2008 12:36 am

Thank you so much for your very thorough response. So it sounds like its possible that the iron could be the reason for feeling mildly queasy all the time, despite not having had that symptom earlier on.

I was told I wasn't anemic and that the ferritin range for women was 10-289, so it sounded like I was borderline low. I try to take it on an empty stomach, with a chaser of OJ and within 2-4 hours of dairy, for maximum absorption. I'm supposed to retest in 3-4 months (from start date), but that's not a bad idea to retest earlier to get some sense of where I am. Part of me hopes its increasing nicely, but part of me hopes its not---it would be too discouraging to think increasing my ferritin had no benefit with my RLS/PLMD

Thanks again!

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Postby ViewsAskew » Sat Aug 23, 2008 6:37 am

Hi Amy, the ferritin is borderline low for a "normal" person, but it's really low for one of "us." :lol: And, from my experience, getting it up to 50-100 is HARD work.

You can try other formulations and see if they help. I think, but I'm really tired right now, that Fesol is the one that is much easier to tolerate, so it might be worth a try.
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Amy
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Postby Amy » Sat Aug 23, 2008 11:41 am

Thank you, Ann.

All this information is wonderful

Amy
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Postby Amy » Sat Aug 23, 2008 3:33 pm

You know, I wasn't really aware of how much iron I was taking, but after reading that Aiken was taking 65mg of elemental iron, I was curious to see what I was taking. I take 2 (per the doctor, although he didn't specify how many mgs, he just said to start with one pill and take two after one week) 325mg pills of ferrous sulfate a day. Is that the same as elemental iron? Is a daily total of 650mg ferrous sulfate a lot/too much? It seems a far cry from 65 mg!

ed2008
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Postby ed2008 » Sat Aug 23, 2008 8:01 pm

Amy wrote:You know, I wasn't really aware of how much iron I was taking, but after reading that Aiken was taking 65mg of elemental iron, I was curious to see what I was taking. I take 2 (per the doctor, although he didn't specify how many mgs, he just said to start with one pill and take two after one week) 325mg pills of ferrous sulfate a day. Is that the same as elemental iron? Is a daily total of 650mg ferrous sulfate a lot/too much? It seems a far cry from 65 mg!


amy,

yes.. 325mg ferrous sulfate contains 65mg of elemental iron. it's kinda confusing.. table salt is sodium chloride.. part sodium, rest is chloride. same idea with ferrous sulfate part of it is iron (ferrous) and the rest is sulfate

HTH

Ed

Amy
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Postby Amy » Sat Aug 23, 2008 8:56 pm

Yes, that helps a lot. Thanks!

mackjergens
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Postby mackjergens » Sat Aug 23, 2008 9:27 pm

I have read that when taking iron pills, you should also take Vit C. at the same time, it helps the iron absorb into your system. Also there are things rich in iron such as liver and green leafy veggies that can help build you iron.

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Aiken
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Postby Aiken » Tue Aug 26, 2008 7:50 am

Amy, if I were taking as much iron as you do every day, I'd be very nauseated. I can't even take half that much every day, at least not for more than a few days in a row.

Do you take both pills at the same time? If so, that seems like it might be a good place to attack the problem. Maybe take them about eight hours apart, maybe at breakfast and at dinner. It ought to be as efficient as taking them together, maybe even moreso, hard to say.

Personally, I never take iron on an empty stomach. My body fights back, hard. I always take it in the *middle* of a meal. I don't know if it's the recommended method, so you probably want to run it by your doctor, but it seems to work just as well and doesn't make my guts churn like there's a Kitchenaid mixer in there. I can tell by what comes out the other end that I'm not absorbing all of it, but that happened even when I took it on an empty stomach. Besides, I have to balance efficiency with comfort. Nausea's not really an improvement over RLS.
Disclaimer: I often talk about what I do and what works for me, but these are specific to me and you should always consult a healthcare professional before trying these things yourself, lest you endanger your health or life.

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Aiken
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Postby Aiken » Tue Aug 26, 2008 7:51 am

mackjergens wrote:I have read that when taking iron pills, you should also take Vit C. at the same time, it helps the iron absorb into your system.

In the same vein, don't take iron and calcium together, as that inhibits absorption.
Disclaimer: I often talk about what I do and what works for me, but these are specific to me and you should always consult a healthcare professional before trying these things yourself, lest you endanger your health or life.

Amy
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Postby Amy » Tue Aug 26, 2008 1:26 pm

Well, the other night I wasn't bothered by RLS, but I was constantly waking up from nausea, a stomach ache, and a burning, indigestion feeling in my stomach. It continued all day, peaking in waves. I decided to back off the iron yesterday (in hopes that the answer was as simple as iron pills!). It still persisted into the evening hours. After a quick search of "nausea, stomach burning", I came up with "gastritis". Then, plugging in "iron pills", I learned that there is something called "iron-pill gastritis", with my exact symptoms. So, I am going to call my doc. later and see what he has to say.
Yes, Aiken, I do take both pills at the same time. I didn't know if I was supposed to take them separately or if it mattered. By the time I drink my morning coffee, take my calcium pills 2ce/day, and eat my dairy foods, I find it hard enough to find time to take one iron pill, let alone 2 :wink: . But I do take it with a chaser of OJ for vit. C, as I understand citrus juice is more useful for absorption than vit. C pills. I have been trying to take the iron with food, while I had initially started taking them on an empty stomach--again, as I read it was best for absorption.

You're right that its a balance between RLS and nausea. Unfortunately, having such low ferritin levels (10) pretty much means I have to find a way to increase my iron stores anyway (and foods apparantly aren't sufficient enough to increase iron stores). I really would like to avoid an IV iron transfusion, which is what my doc. orginally said was next if I didn't tolerate the iron pills. I don't know, but that doesn't sound like a lot of fun!

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Aiken
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Postby Aiken » Tue Aug 26, 2008 10:04 pm

I've had an infusion, Amy. Two, in fact. It's not bad at all. Getting stuck is always kind of sucky, but then all you do is sit there for a period of time (I think mine was about 60 or 90 minutes) while the stuff drips into you. Read a book or magazine, maybe watch TV if they have it. It's a very quick way to get your stores up, since every bit of what you're given goes (directly) into your blood. Then maybe you could go on a maintenance dose of oral iron, which is must less likely to make you sick.

I wouldn't want to get iron only by infusion, but it can be a much better way of getting it up from low levels. I'd take an hour getting an infusion over an hour's nausea from too much oral iron any day.

You should do whatever you feel comfortable with, but if you're not phobic about needles, I wouldn't be too worried about the prospect of an infusion.

Regardless, you definitely want to talk to your doctor soon and ask for advice on how to adjust your dose or what else to try. If your guts are in that much discomfort from the iron, they're trying to tell you something. You should listen to them. Unless you have extremely heavy flow during your periods, your iron stores shouldn't drop if you stop the supplements until you can get further instructions. Barring blood loss, iron drops pretty slowly, only getting low when we can't replenish it at the same rate we lose it.
Disclaimer: I often talk about what I do and what works for me, but these are specific to me and you should always consult a healthcare professional before trying these things yourself, lest you endanger your health or life.

Jitterlegs
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Postby Jitterlegs » Tue Aug 26, 2008 10:35 pm

My dr. prescribed 3 vitron-c/day. I could NOT handle that. So, she suggested slo-FE and that is MUCH better. I take one vitron in the morning and midday, and then take the slo-fe at night. I just want to use up the vitron I bought, otherwise, I'd switch completely. If my iron isn't significantly better in October I will be begging for an infusion. So far, the medications for RLS aren't doing the trick (other than a tirck on my body!), I am hoping getting the ferritin up will!!

ed2008
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Re: Are the side effects of ferrous sulfate cumulative?

Postby ed2008 » Tue Aug 26, 2008 11:01 pm

Amy wrote:I've been taking ferrous sulfate (iron) pills for about a month now, as my ferritin level was 10. I was suprised that it hadn't made me feel sick, but lately I've been feeling a low grade queasiness for days and I don't know if its due to the iron (which has done absolutely nothing for my rls/plmd so far). Any idea if it could be the a build-up effect of the iron or would I have felt it all along if it was the iron?


amy,

having just read the original post, I wanted to respond. the cumulative effects of iron treatment, from a pharmaceutical standpoint, do not include the effects on the stomach. stomach effects are USUALLY seen on first dose, and continue without abatement. taking the dose with food is about all we can do, and there is no consensus that any formulation (sloFe, ferrous gluconate, etc) has any advantages over another for stomach effects.

with that in mind, the idea of taking 2 tabs at the same time versus 1 tab twice daily has no clear consensus either. the rule of thumb is anything upsettting the stomach is better taken fewer times a day, so if something bothers your stomach for 8 hours after taking,why make that 8 hours into 16 by spreading out the dosing times? But, just to contradict myself (LOL) I see dosing for pregnant women based on a blood test called hematocrit. if the hematocrit is 11, you take 1 tab of ferrous sulfate daily. hematocrit of 10 is given 1 tab twice daily, hematocrit of 9 is given 1 tab three times daily.

who says a professional can always give a clear,concise answer?? I'm guilty as charged :-)

HTH
Ed


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