Health Help, Calling all Pharmacists!!

[JD_USD]

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Ok, I need help!

My fiance who is a mother-to-be went to the doctor's for a check up on how the pregnancy is going (she's 32 wks=8 months). She last went a month ago and hadn't seen anyone since. She took a glucose test and the doctor said that looked fine but that she tested for being slightly anemic. And he recommended Ferrous Sulfate which we bout over the counter at Wal-mart pharmacy at the given dose and taken as directed.

Today (day 2 of taking the pills), she broke out w/ about 4 bumps on each arm and "her legs and chest are itching" too. It's been pretty hot out her in San Diego, CA so we don't know if it's an allergic rxn to the Ferrous Sulfate or just "prickley heat" (may also be bug bites?).

Should she stop taking the pills until she talks w/ a doctor? Or should she continue taking them incase it's not an allergic rxn so she continues to get the iron she may be lacking.....I say may because we both don't think she might be "slightly anemic" because she never took a test for anemia, just a glucose one. Does the glucose test also test for anemia??? But "slightly anemic" might explain the swellilng she usually gets of her ankle/feet (which we try and keep elevated whenever she's off her feet).

We're very grateful for any and all suggestions.

 

[vafcarrot]

(note: I'm not a pharmacist, not even in pharmacy school, aren't a doctor and haven't ever been pregnant. So, if anyone actually knows what they're talking about, please few free to tell me to shutup🙂)

For an anemia test, they put a drop of blood in some solution and see if it floats or not, or they can put it in a special machine and measure it that way. (long time attempter of blood donating, long time vegetarian... hence long time low blood iron and rejectee of blood donating). Anyways, they could have tested for it without you knowing.

I would call the doc asap and ask. If you can't get ahold of him and are really worried, I would stop the pills until you can talk to them and stuff her full of spinach and liver and other foods that are high in iron. (don't really stuff her... you know what I mean). When I was told I was on the "verge" of being anemic, my doctor told me to take daily vitamins and to focus on eating more green leafy stuff. He told that it wasn't necessary to take an actual iron pill. I don't know how far apart on the "verge" and "slightly" are, so call her doctor as soon as possible! Is your finacee taking special pregnancy vitamins?

Also, the fact that she has swollen feet may have nothing to do with the fact that she's "slightly anemic". I bet it's because she's "slightly pregnant" and is carrying a ton of extra water weight because of the baby.

Everyone out there, correct me if I'm wrong, but anytime you suspect you're having an adverse reaction to a drug, you should discontinue use until you get ahold of your doctor.

Hope this helps and good luck with the pregnancy and tell the baby to stop being such an iron piglet!

 

[dgroulx]

Is she taking immediate release iron tablets or the extended release? We learned last semester that the ER iron can cause flushing of the skin. Whether this is the flushing or an allergic reaction, I couldn't tell you. I would have her stop taking the iron ASAP and check with her physician.

 

[bananaface]

Flushing is a reddening of the skin. When you are embarassed your cheeks flush and become warm. It sounds like she has itching but no reddening of the skin.

The swelling in the feet is just part of being pregnant. I recommend that you stick her on the couch with her feet up and make her dinner! 🙂

In this case it is okay to stop taking the iron tablets and take extra iron in the diet until she can talk to the doctor. If she takes prenatal vitamins, you might compare the active and inactive ingredients to those in the iron tablets. If all of the ingredients in the iron tablets are in the prenatals, there may be other causes for her distress. Have you changed laundry soap, bar soap or anything like that lately?

As a side note- Not all medications should be discontinued when you have an allergic reaction, because some prescription medications can have adverse effects when stopped immediately. Some medications need to be discontinued by tapering (gradually lowering) the dose. Paxil (paroxetine) is an example of a medication where suddenly discontinuing can cause a person to feel severely anxious and sometimes panicky. If someone was taking tablets without dye and switched to ones with dye then had a minor allergic reaction such as a rash, it would probably be to the patient's benefit to put up with the rash until they can be switched back to the original tablets. In case of a serious reaction, a pharmacist will have to use their drug knowledge and medical background to decide what to advise the patient. Options may include (not limited to) discontinuing the medication, changing to tablets from a different manufacturer, referring the patient to their physician, or referring the patient to the emergency room.

 

[jdpharmd?]

If you can't get ahold of him and are really worried, I would stop the pills until you can talk to them and stuff her full of spinach and liver and other foods that are high in iron. (don't really stuff her... you know what I mean). When I was told I was on the "verge" of being anemic, my doctor told me to take daily vitamins and to focus on eating more green leafy stuff.

Green leafy stuff? Gross. A steak has about 10-20x more iron than spinach... and it doesn't taste like it grew in the dirt. 🙂

 

[jdpharmd?]

Facts and Comparisons Monograph on Iron products:

Tartrazine sensitivity:
Some of these products contain tartrazine, which may cause allergic-type reactions (including bronchial asthma) in susceptible individuals. Although the incidence of tartrazine sensitivity in the general population is low, it is frequently seen in patients who also have aspirin hypersensitivity. Specific products containing tartrazine are identified in the product listings.


Sulfite sensitivity:
Some of the products contain sulfites, which may cause allergic-type reactions (eg, hives, itching, wheezing, anaphylaxis) in certain susceptible persons. Although the overall prevalence of sulfite sensitivity in the general population is probably low, it is seen more frequently in asthmatics or in atopic nonasthmatic persons. Specific products containing sulfites are identified in the product listings.

 

[jdpharmd?]

Is she taking immediate release iron tablets or the extended release? We learned last semester that the ER iron can cause flushing of the skin.

I've never heard that. Are you thinking of immediate release Niacin vs Extended release Niacin?

 

[vafcarrot]

Green leafy stuff? Gross. A steak has about 10-20x more iron than spinach... and it doesn't taste like it grew in the dirt. 🙂

don't bash the vegetarian. It's rude. 😛

 

[futoi]

Ok, I need help!

My fiance who is a mother-to-be went to the doctor's for a check up on how the pregnancy is going (she's 32 wks=8 months). She last went a month ago and hadn't seen anyone since. She took a glucose test and the doctor said that looked fine but that she tested for being slightly anemic. And he recommended Ferrous Sulfate which we bout over the counter at Wal-mart pharmacy at the given dose and taken as directed.

Today (day 2 of taking the pills), she broke out w/ about 4 bumps on each arm and "her legs and chest are itching" too. It's been pretty hot out her in San Diego, CA so we don't know if it's an allergic rxn to the Ferrous Sulfate or just "prickley heat" (may also be bug bites?).

Should she stop taking the pills until she talks w/ a doctor? Or should she continue taking them incase it's not an allergic rxn so she continues to get the iron she may be lacking.....I say may because we both don't think she might be "slightly anemic" because she never took a test for anemia, just a glucose one. Does the glucose test also test for anemia??? But "slightly anemic" might explain the swellilng she usually gets of her ankle/feet (which we try and keep elevated whenever she's off her feet).

We're very grateful for any and all suggestions.

I've never heard of a glucose test that also checked for anemia. low blood levels of ferritin are the hallmark indicator of iron deficiency anemia, and I've yet to sell a glucose monitor that tested for this as well.

I've also never heard of anyone being allergic to iron. most adverse reactions from iron involve the GI: N/V, constipation.....but, there could be some inactive ingredient in the tablet that could be causing the reaction. however, I'd be looking for something else to be responsible for this.

I'd talk to the doc, and see how he came to this diagnosis of anemia. stop the iron for 1 day and see if the bumps and the itching goes away. if it does, maybe, rechallenge with another iron tablet and see if it comes back.

 

[GravyRPH]

I've also never heard of anyone being allergic to iron.

I think there's probably a reason for that. I don't think life would be compatible or at least very comfortable with an iron allergy.

 

[bananaface]

Extended release niacin helps prevent flushing. Immeriate release niacin causes flushing in 50% of those using it. Flushing is not listed as an adverse reacton to iron in my references.

Feel free to ask the doctor how they diagnosed the anemia. There are some outward symptoms she may have described to him during the exam. She as the patient should feel free to ask her doctor about any of her concerns.

JD get in the kitchen and make your lady a steak dinner!

 

[JD_USD]

Thank you everybody so much!

She let up on the iron pill for the day (they're once a day Ferrous Sulfate pills) and the hives/rash went away. We're going to challenge it again tomorrow... I suspect it may be a reaction to the sulfate.

I was overwhelmed w/ all the help and support, it's like one big SDN family!! Thanks Pharms!!! 👍

 

[dgroulx]

I've never heard that. Are you thinking of immediate release Niacin vs Extended release Niacin?

Maybe. I'd have to drag out my notes from last semester. They're still in a big pile. I've been meaning to sort them out before school starts again, but I haven't wanted to look at them.

 

[bananaface]

There are other forms of iron available over the counter. Maybe you could have her try ferrous gluconate instead. There is no need for her to be any more uncomfortable than she already is by being 8 months pregnant. Taking one ferrous gluconate 324mg tablet and one ferrous gluconate 240mg tablet would give a total of 63mg of elemental iron per dose, which is pretty close to the 65 mg of elemental iron in one 325mg ferrous sulfate tablet. Fergon is one brand with 240mg of ferrous gluconate per tablet. 324mg ferrous gluconate tablets are pretty common and are available under many different brand names. Ferrous gluconate is also a bit easier on the stomach than ferrous sulfate. You should be able to find these on the shelf at Wal-Mart right where you found the ferrous sulfate tablets.

Is she at the point where she is living off of antacids? They will decrease iron absorbtion quite a bit. I would recommend that if she is taking antacids she take the iron doses at a different time of day than her antacids, if possible. The ideal time would be at least 2 hours before or 4 hours after a dose of antacids. If she is in the Pepto Bismol stage already, you may not be able to work around the antacids. Just do your best.

 

[JD_USD]

There are other forms of iron available over the counter. Maybe you could have her try ferrous gluconate instead. There is no need for her to be any more uncomfortable than she already is by being 8 months pregnant. Taking one ferrous gluconate 324mg tablet and one ferrous gluconate 240mg tablet would give a total of 63mg of elemental iron per dose, which is pretty close to the 65 mg of elemental iron in one 325mg ferrous sulfate tablet. Fergon is one brand with 240mg of ferrous gluconate per tablet. 324mg ferrous gluconate tablets are pretty common and are available under many different brand names. Ferrous gluconate is also a bit easier on the stomach than ferrous sulfate. You should be able to find these on the shelf at Wal-Mart right where you found the ferrous sulfate tablets.

Is she at the point where she is living off of antacids? They will decrease iron absorbtion quite a bit. I would recommend that if she is taking antacids she take the iron doses at a different time of day than her antacids, if possible. The ideal time would be at least 2 hours before or 4 hours after a dose of antacids. If she is in the Pepto Bismol stage already, you may not be able to work around the antacids. Just do your best.

She hasn't yet had heart burn, etc. so she doesn't use antacids. But I will look into ferrous gluconate pills as an alternative. Thanks for the suggestion 🙂

 

[futoi]

She hasn't yet had heart burn, etc. so she doesn't use antacids. But I will look into ferrous gluconate pills as an alternative. Thanks for the suggestion 🙂

taking iron w/vitamin c (>200mg) at the same time increases the absorption of iron, too.