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2. Prevalence 2 Iron Deficiency : The Most Common Nutritional Deficiency Worldwide According to the WHO 30% Of the world’s population may have Iron-deficiency anemia 80% Of the world’s population is Iron deficient

3. According to NFHS 2003-06 Iron deficiency anemia is the most common type of anemia during pregnancy Iron-deficiency anemia 3 57.9% Of the pregnant women Iron-deficiency anemia 25% Direct maternal death Iron-deficiency anemia

4. Management of Iron Deficiency Anemia 4

5. Iron Supplementation 5

6. Iron Supplementation 6

7. Iron Salts 7 Supplemental iron is available in two forms: ferrous and ferric. Ferrous iron salts (ferrous fumarate , ferrous sulfate, and ferrous gluconate ) are the best absorbed forms of iron supplements.

8. Iron Salts 8 The amount of iron absorbed decreases with increasing doses. For this reason, it is recommended that most people take their prescribed daily iron supplement in two or three equally spaced doses.

9. CDC Recommendations 9

10. Elemental iron 10 Elemental iron is the amount of iron in a supplement that is available for absorption.

11. Ionic (Fe 2+ ) iron salts such as ferrous sulfate are effective in the correction of iron deficiency anemia, but their use has disadvantages, including: Risk of accidental iron poisoning in small children. Occurrence of side effects. Prolonged duration of treatment required to correct anemia and replenish iron stores. Problems of Ferrous Salts 11

12. Side effects with a standard dose of ferrous sulfate occur in 10% to I5% of patients. Restoration of hemoglobin to normal with ferrous sulfate requires 3 to 6 months of treatment. Problems of Ferrous Salts 12

13. Newer preparations are better tolerated, have less side effects with better compliance Carbonyl Iron 13 New Therapeutic Alternatives

14. Overview of Carbonyl Iron 14

15. What’s in a Name? 15 ”Carbonyl” does not refer to the composition of the iron particles but rather to the manufacturing process in which the controlled heating of vaporized iron pentacarbonyl leads to the deposition of uncharged, elemental iron as submicroscopic crystals that form microscopic spheres of less than 5 µm in diameter. The preparation is more than 98% pure. Bioavailability is about 70% of that of ferrous sulfate.

16. Highly pure iron, prepared by chemical decomposition of purified iron pentacarbonyl . Most of impurities are carbon, oxygen, and nitrogen. Carbonyl Iron 16

17. For the past century the standard therapy for iron deficiency anemia has been ferrous salts. Recently, however, it was suggested that carbonyl iron may be “an ideal therapeutic agent, effective yet lacking in toxicity .” 17

18. Carbonyl iron offers no less than 98% iron content, with high bioavailability and minimal toxicity, giving a more effective and safer choice for iron supplementation. Highly Effective for the Management of Iron Deficiency States 18

19. Very safe with no poisoning even in high doses No interaction with food stuffs The newer preparations are delicious with non-metallic taste and don’t stain the patients’ teeth Hence the compliance is very high Outstanding GI Tolerance in contrast to 20% severe side effects with conventional therapy Carbonyl iron 19

20. Resulted in less GI side effects. Prolonged absorption 20

21. What’s different about Carbonyl Iron? 21 While not previously used pharmacologically, several studies suggest that as a therapeutic agent, carbonyl iron powder may effectively correct iron deficiency anemia yet be considerably less toxic than iron salts . Human volunteers have taken oral doses of 10,000 mg of carbonyl iron (about 140 mg Fe/kg) “without deleterious effect.”

22. : The Safest Option for Management of Iron Deficiency states Carbonyl iron: The Least Toxic of All Iron Forms Carbonyl iron 22 The slow rate of solubilization of carbonyl iron by stomach acid results in a more prolonged absorption Greater reduction in its potential for toxicity Absorption of carbonyl iron is strongly down-regulated depending on dosage and whether the body already has enough stored iron

23. In the Federal Registration, dated January 15,1997, the FDA considered Carbonyl iron’s safety and gave consideration to not requiring that carbonyl iron supplement employ child-proof packaging. Carbonyl iron 23

24. Each capsule contains: elemental iron (as carbonyl iron) 36 mg zinc sulphate monohydrate 61.8 mg (equivalent to 22.5 mg elemental zinc), and folic acid 0.5 mg. Composition 24

25. For the management of iron deficiency states and when there is a need for additional zinc and folic acid. Indications & Uses 25

26. Take each capsule with a full glass of water. Take carbonyl iron on an empty stomach for best results. If stomach upset occurs, take carbonyl iron with food or following a meal. 1-2 times daily Dosage & Administration 26

27. The recommended daily allowance (RDA) for zinc during pregnancy and lactation is as follows: for women 19 years old and older, 40 mg daily. for women 14-18 years of age, 34 mg daily. Zinc with Brest feeding and Pregnancy 27

28. The folic acid content of one capsule a day is unlikely to mask pernicious anemia should this condition be present; pregnancy during pernicious anemia is very rare. Ziron ® should be used for a limited period only (preferably not longer than 6 months continuously). Warnings & Precautions 28

29. Each box of Ziron ® contains a total of 30 capsules, divided into 3 blister strips each containing 10 capsules. The pellet colors correspond to the ingredients as follows: White pellets: Zinc sulphate monohydrate. Yellow pellets: Folic acid. Black/silver pellets: Carbonyl iron. Presentation 29

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31. Thank You  31