Would you stop the iron tablets?

[IKillUnkillablePlants]

Dd (14) had some blood tests done a few weeks ago which showed she is anaemic, the GP prescribed iron which she started taking a couple of days ago, since then she's been very constipated and has now started vomiting after she eats.

I know these are common side effects but having had a google most sources seem to say to keep taking the tablets regardless until you speak to a GP about it.

The problem is obviously it's now Friday, so doctor closed until Monday, and even then it's nearly impossible to get even a telephone appointment, it took three weeks from the blood test results to get a telephone appointment to discuss how to proceed.

Dd wants to stop the tablets, and part of me feels as it took so long for the GP to prescribe them anyway it can't matter too much to wait a bit longer. Dd says she'd rather feel a bit rough and tired than be constipated and sick.

Do you think a pharmacist might be able to give advise if I took her tomorrow?

Thanks

Why are you assuming the anaemia is caused by a poor diet? 🙄

OP, does she have heavy periods?

GI effects can be common in the early stages of supplementing and should lessen over time. Has she started taking them daily? You could build up slowly eg 1-2 x a week.

Stopping for a few days until you speak to GP seems fine. Continuing them whilst she’s suffering such side effects doesn’t make sense. There are different forms of iron supplements that can be investigated.

Don't be daft, if it was that easy most women wouldn't have anaemia. There are many, many reasons why people, particularly women and girls, are anaemic despite an iron rich diet.

I've spent most of my life with anaemia despite being a big fan of spinach! According to my consultant, diet is a drop in the (iron lacking) ocean.

And to the OP, I'd stop it, and get a GP appointment for early next week. She's not going to be dramatically more anaemic for a weekend's wait on iron.If she does want to carry on, I found I felt a lot more sick if I took tablets with or after dairy products. There are other options to the tablets, or if she's been prescribed several a day, you can build up tolerance for them. They are grim though!

@TizerorFizz She has a very healthy and varied diet thank you.

Unfortunately she also has very heavy periods and also gets an upset stomach very easily, she has been tested for coeliac and bacterial infections which thankfully have come back negative so just waiting to see what happens next. The iron tablets are to help with the anaemia until we discover the cause.

Jesus Christ. Could you be more condescending?

what dose is she prescribed? One tablet a day or one every other day/ couple of times a week may work better for her if she's on 2 or 3 tablets at the mo. The side effects are mainly from unabsorbed iron that's left in the GI tract once the mechanism for absorbing it's been saturated, so if you take a bit less you may get the same amount absorbed but fewer side effects. Worth chatting to the GP about (they need to advise in the context of her actual blood results etc)... (doi: iron deficient doctor)

OP is she taking ‘gentle iron’? That’s what I take and it doesn’t affect my bowels, it’s specifically designed not to, might be worth a go.

To the more helpful posters, thank you, yes, I think we will stop them for a couple of days to allow her stomach to settle. I've only ever been anaemic when pregnant, but remember I could only tolerate the liquid iron that you mix in with orange juice. Unfortunately I think Dd has my sensitive stomach. @HopelesslySad She does love a glass of milk, so maybe I'll try and curtail that for a bit too.

She's on one 210mg ferrous fumarate tablet a day, I don't know if that's a high dose or not?

I'll ask the pharmacist about this tomorrow, thanks

I always use spa tone liquid iron. Much gentler on the stomach. I can’t take iron tablets at all, immediately get constipated.

Yes, spa tone is what I used when pregnant, I remember now, thanks for reminding me what it was called, not sure it's the same strength but I should imagine a good compromise!

Another one here recommending gentle iron. I just buy it from the pharmacy.

I also recommended taking it with a glass of orange juice as vitamin c helps absorption.

I have life long anaemia despite a good diet and no periods due to a pituitary issue. I have a whole host of autoimmune issues including lupus and it often occurs with that (although it may not be that at all) but to those saying improve her diet - 🙄🤦🏻‍♀️ you really don’t know what you’re talking about.

210mg ferrous fumerate is the daily long term dose I take. (When I was pregnant with both my dc I had to have daily iron injections, I’m severely anaemic). So it is a fairly high dose, although that dose can be tripled to 3 times a day if necessary. What I’m getting at is if she needs the 210mg per day then Spatone is minuscule in comparison so don’t switch her over to that without medical advice.

I would seek medical advice about what to do really, ring 111 if necessary. Make sure she is taking the tablet on a full stomach.

I have very heavy periods and have bouts of anaemia I take Holland and Barratt high dose gentle iron take it on an empty stomach with a small amount of orange juice.
The ones from the doctor were awful.

I just checked, spatone only contains 5mg of ferrous iron, so you are right in saying probably not enough!

Spa tone is a much lower dose than the ferrous sulphate or fumarate tablets - it would take your daughter much longer to feel better on that dose (or any gentle iron) than with the prescription iron. It's annoying, I also get side effects.

However! There are lots of things your daughter can do to reduce her symptoms with the tablets she's been given. And little harm to taking the weekend off to reset her digestion.

Taking tablets once every other day gives as much benefit as one or two tablets per day. There have been some good recent clinical trials on this.

Take the tablet with a small glass of orange juice - increases the uptake of the iron.

Take the tablet right before bed (but not after a glass of milk). Iron tablets give me very bad stomach ache, and taking them at bed time avoids that.

Prunes...

If she can find a tolerable way to take the high dose iron tablets, she will start to feel the benefit within three weeks (time taken for new red blood cells to come in to circulation). I felt like a new woman and that made it easier to put up with the side effects. So much more energy.

Yes. I really wish posters wouldn’t come along on threads about anaemia and suggest it when someone has anaemia severely enough to have been prescribed iron tablets. Anaemia can be really serious if left untreated, I’ve had severe chest pain which needed cardiology investigations and all sorts. I’m not saying that to scare you, obviously your dd is getting treated and that’s great but when people say just take Spatone or whatever I sit there like 😳 because it’s actually quite a dangerous thing to suggest.

the over the counter 'gentle' stuff doesn't cause side effects because it has barely any iron in it.

That dose of Fe fumarate is a pretty standard starting point, but some people still struggle with it. The next best thing for her depends on how bad the bloods are etc which is why the doctor probably needs to advise, but until then taking it a bit less frequently may be a compromise.

Yeah I had lots of recommendations for Spatone when I was pregnant and was so disappointed when I looked up how little iron it contains :(

Try floradix, it’s an iron supplement with herbs and vitamin C in a liquid, much gentler on the tummy than iron tablets and contains a decent dose of iron unlike spatone. Make sure she takes it away from cups of tea (if she drinks that). When feeding iron rich foods make sure there is vitamin c foods with it (fruit juice/ veg) as this helps iron absorption. Hope she is on the mend soon.

What is her ferritin and Hb? 1x 210mg ferrous fumarate a day isn't the highest dose for anaemia correction- I was on 3x a day at 1 time. I'm not saying she isn't anaemic BTW and a GP wouldn't recommend such meds unless she was!

To those saying take 'gentle iron' or 'spatone' 'floradix' are great, do you have any idea what the iron content (or lack their of) are in these??? Its 'gentle' because it contains barely any iron and is the same of filling a swimming a pool with a teaspoon!
For context:
Spatone 5mg (36% of daily intake- for someone that ISN'T anaemic)
Over the counter multi vit with iron 14mg of iron
210mg ferrous fumarate is 69mg of iron

Spatone and over the counter meds are for maintenance, NOT to correct a deficiency. Taking meds with Vit C rich foods such as citrus juice, meals with peppers and kiwi fruit helps absorption of iron. Tannin rich foods such as grapes, tea/coffee decrease the absorption or iron and should be restricted.

Her periods must be extremely heavy to become anaemic if eating a health diet. Has her GP recommended anything to help with the heavy periods? The pill?

In addition to her meds and ensuring she eats a diet rich in red meat, a spirulina supplement can also help. Its a blue green algae in a tablet or powder form. This is not a replacement for prescribed meds, but can be used in conjunction.

For the constipation/vomiting, she could take the tablet before bed, and take every 2nd day for a week or 2 then up to daily. A squatty potty or anything to lift her feet whilst on the loo- bricks, steps etc will help with the constipation. Along with increasing water. Constipation and feeling sick will pass with time after regular use. For context though, red blood cells take 3mths to replicate, so only taking iron meds for a days of pills won't help at all! This is a long term dietary and management/med plan she needs to continue.

@JDM625her ferritin is 10, to be honest I don’t know if that is particularly low or not? Thank you for all the advice.

Yes that is low but not surprising if she is anaemic. Low ferritin = low iron stores.

Taking iron tablets made me very sick so I do sympathise. I ended up taking a much lower dose - about 30 mg was the least I could take without being ill. It did build my iron up again but very slowly. Definitely talk through other options with the gp.