Ferro-Folgamma (Ferrofolgamma, Ferro Folgamma) capsules No. 50 - Instructions

Nosological classification (ICD-10)

• D50 Iron deficiency anemia
• D50.9 Iron deficiency anemia, unspecified
• D52 Folate deficiency anemia
• D61.1 Drug-induced aplastic anemia
• D63.0 Anemia due to neoplasms (C00-D48+)
• D63.8 Anemia in other chronic diseases classified elsewhere
• D64.9 Anemia, unspecified
• E53.8.0* Vitamin Bc deficiency
• E61.1 Iron deficiency
• I84.8 Hemorrhoids with other complications, unspecified
• K92.2 Gastrointestinal bleeding, unspecified
• N92.0 Heavy and frequent menstruation with a regular cycle
• N92.1 Heavy and frequent menstruation with irregular cycles
• N92.4 Excessive bleeding in the premenopausal period
• O99.0 Anemia complicating pregnancy, childbirth and the puerperium
• R58 Bleeding, not elsewhere classified

Compound

Pharmacodynamics

Ferro-Folgamma® is a complex antianemic drug containing divalent iron in the form of a simple ferrous sulfate salt, vitamins B12, folic and ascorbic acid, intended for the treatment of iron deficiency conditions. Iron is an important component of the human body. It is a constituent of hemoglobin, myoglobin and various other enzymes. Ascorbic acid improves the absorption of iron in the intestines. Vitamin B12 and folic acid are involved in the formation and maturation of red blood cells.

The active components of Ferro-Folgamma® are in a special neutral shell, which ensures their absorption, mainly in the upper part of the small intestine. The absence of local irritation on the gastric mucosa contributes to good tolerability of the drug in the gastrointestinal tract.

Ferro-Folgamma (Ferrofolgamma, Ferro Folgamma) capsules No. 50 - Instructions

Compound

The active ingredients are ferrous sulfate, folic acid and cyanocobalamin.
The composition also includes other ingredients in the form of: ascorbic acid, solid fat, refined rapeseed oil, soy lecithin, gelatin, anhydrous sorbitol solution 70%, glycerin 85%, red iron oxide (E 172), black iron oxide (E 172), ethyl vanillin.

Release form

The medicine is produced in soft gelatin capsules. Supplied in packs of 50 pieces each.

pharmachologic effect

There is a close relationship between folic acid and vitamin B12. Vitamin B12 is necessary for the normal formation of tetrahydrofolic acid from N-methyltetrahydrofolic acid. If it is deficient, red blood cell neoplasia and insufficient formation of myelin sheaths may occur. Vitamin B12 is important for the synthesis of new cells and the maturation of red blood cells.

Pharmacokinetics

Iron resorption occurs in the upper part of the small intestine, and the body controls it according to its needs. In the case of FERRO-FOLGAMMA, the active substances are enclosed in a special neutral medium, which guarantees their entry directly into the intestines. Therefore, her stomach tolerates it well.

Folic acid is absorbed quickly and almost completely (up to 15 mg) in the form of pteroylmonoglutamic acid. Simultaneous intake of folic acid increases iron resorption by two to three times.

Folic acid resorption occurs mainly in the proximal small intestine. In most foods it is in the form of polyglutamate, which is not absorbed because glutamate radicals must be broken down first. In the body, folic acid is converted into the active coenzyme tetrahydrofolic acid, which is a donor and carrier of simple carbon groups, thereby playing an important role in the synthesis of nucleic acids and the formation of new cellular structures.

Vitamin B12 is excreted in the bile and enters the enterohepatic circulation. It also crosses the placenta.

Indications for use

Combined deficiency of iron, folic acid and vitamin B12 of various etiologies.

Contraindications

Ferro-Folgamma should not be used in cases of iron accumulation (hemochromatosis, chronic hemolysis) or impaired iron utilization.

An absolute contraindication is megaloblastic anemia caused by vitamin B12 deficiency alone (eg due to intrinsic factor deficiency) or folic acid deficiency alone (requiring higher doses of these drugs).

Ferro-Folgamma should not be used by people allergic to the composition of the drug.

Side effects

The compound may cause stomach upset or constipation, sleep disturbances, irritability, or depression.

Drug interactions

Iron salts reduce the resorption of tetracyclines, penicillamine, levodopa and methyldopa.

Iron salts affect the resorption of quinolone antibiotics.

Iron resorption is reduced by concomitant administration of cholestyramine, antacids (calcium, magnesium, aluminum salts), as well as calcium and magnesium supplements.

Simultaneous use of Ferro-Folgamma with non-steroidal anti-inflammatory drugs can increase the irritating effect of iron on the gastrointestinal mucosa.

Iron binders such as phosphates, phytates, or oxalates, as well as milk, coffee, and tea, may inhibit iron resorption.

Susceptibility to seizures may increase during treatment with anticonvulsants.

At high doses, it cannot be excluded that the effect of folic acid and folic acid antagonists (for example, chemotherapeutic and cytostatic) will be mutually suppressed when administered together.

High doses of folic acid may cause severe diarrhea when taking fluorouracil.

Chloramphenicol may block the response to folic acid therapy and should not be used in people with severe symptoms of folic acid deficiency.

Application and dosage

Adults should take 1-2 capsules three times a day.

Children over 12 years of age and adolescents are prescribed 1 capsule 3 times per day.

Overdose

Symptoms of overdose are unlikely except in children or after excessive doses, since iron resorption is controlled by a physiological control mechanism.

special instructions

If dietary supplements or other supplements containing iron salts are used, care should be taken to avoid the risk of possible iron overdose. This medicine contains sorbitol. Patients with rare hereditary problems of fructose intolerance should not take this medicine.

Use during pregnancy and breastfeeding

Each Ferro-Folgammy capsule contains 5 mg of folic acid, so use during pregnancy is limited to one capsule per day.

Because the safety of higher doses cannot be guaranteed, folic acid doses above 5 mg per day are contraindicated during pregnancy.

The same dosage is prescribed according to indications during breastfeeding.

Impact on the ability to drive vehicles and operate machinery

No special precautions are required.

Terms of sale

As prescribed by a doctor.

Storage conditions

It is important to store the drug in its original packaging and in a dry and cool place, away from children.

Indications of the drug Ferro-Folgamma®

treatment of combined iron-folate-B12-deficiency anemia caused by chronic blood loss (bleeding from the stomach, intestines, bladder, hemorrhoids, menorrhagia, metrorrhagia), chronic alcoholism, infections, taking anticonvulsants and oral contraceptives;

anemia during pregnancy and lactation;

prevention of iron and folic acid deficiency in the II and III trimesters of pregnancy, in the postpartum period, during breastfeeding.

Ferro-Folgamma is the drug of choice for iron deficiency conditions

According to WHO, 3.6 billion people have IDA, and 1.8 billion are diagnosed with IDA. In Russia, about 480 thousand people suffer from anemia, of which 430 thousand have IDA. IDA is quite common in patients with cardiovascular diseases. For example, the prevalence of IDA was recently shown in 10% of patients with ischemic disease [7] and in 37% of patients with chronic heart failure [10]. Iron deficiency and IDA are most often observed in adolescents (especially young girls) and pregnant women, which is due to the increased need for iron in these categories of people. From 50 to 99% of pregnant women have iron deficiency, from 20 to 80% of pregnant women suffer from IDA. The entry of exogenous iron into the body is ensured by its absorption in the gastrointestinal tract (GIT). The process of microelement absorption is highly integrated and depends on a number of factors associated with both the nutritional forms of incoming iron and the individual characteristics of the body. Dietary and medicinal iron is absorbed most intensively in the duodenum (duodenum), as well as in the upper parts of the jejunum. The process of iron absorption is determined by 3 factors: – amount in food; – bioavailability; - the body's need. The stages of the iron absorption mechanism have been studied to varying degrees. It is known that under physiological conditions, the absorption of iron in the intestine consists of successive stages, such as: 1) capture of mucosal cells by the brush border; 2) membrane transport; 3) intracellular transport and formation of reserves in the cell; 4) release from the cell into the bloodstream. Oxalates and phosphates reduce its resorption, and fructose, hydrochloric, ascorbic, succinic, pyruvic acids, cysteine, sorbitol and alcohol increase it. Ferrous inorganic iron is absorbed much better than oxide iron contained in meat products. In industrialized countries, the average content of non-heme iron in food is much higher than in developing countries, amounting to 10–14 mg. However, according to a number of foreign authors, even in developed countries, women following fashionable diets experience a lack of iron in their food. Thus, normally, the homeostasis of iron metabolism in the body is maintained due to the absorption of the bioelement adequate to the loss of food [1, 3, 5]. As is known, the biological role of iron in the body is great and is determined by its participation in redox processes, tissue growth and aging, and immunity mechanisms. Hematopoiesis, the functioning of a number of enzymes, and the supply of oxygen to organs and tissues are closely related to iron metabolism [1]. Rapid growth, physical development and puberty of adolescents, pregnancy, growth and development of the fetus also determine a high need for B vitamins and especially for folic acid, which is necessary for cell proliferation [8]. VDN and IDA in adolescents and pregnant women are in most cases accompanied by folic acid deficiency and elements of folate deficiency anemia. Deficiency of iron and folic acid is equally dangerous for a pregnant woman and for the fetus and is manifested by various disorders of the course of pregnancy, pathology of labor and congenital iron deficiency anemia in a newborn (usually premature) child. With folic acid deficiency, the conversion of homocysteine ​​to methionine is impaired; the accumulation of homocysteine ​​in the blood of the fetus leads to congenital anomalies of the development of the central nervous system; hyperhomocysteinemia in adults provokes atherogenesis and progression of atherosclerosis of coronary and cerebral localization. Therefore, for the prevention and treatment of iron deficiency syndrome and iron deficiency anemia in adolescence and in pregnant women, complex preparations containing not only iron, but also folic acid and other B vitamins are recommended. In nature, iron exists in 2 chemical forms: divalent oxide and trivalent oxide. . Heme (ferrous) iron is absorbed well in the intestine, while non-heme (trivalent) iron is poorly absorbed. Meat (especially beef) and blood sausage are the richest in heme (ferrous) iron, so meat products are the main source of iron in human nutrition. There is less heme iron in poultry and fish. Liver and other by-products, liver sausage are rich in ferritin and hemosiderin, which contains non-heme ferric iron, which is poorly absorbed in the gastrointestinal tract. A lot of non-heme ferric iron is found in some brands of red wine, fruit juices, apples, pomegranates, buckwheat, dairy products, eggs, nuts, and chocolate. The bioavailability of such iron is minimal, and all these foods are not dietary sources of iron. The bioavailability of iron with a traditional mixed diet ranges from 5 to 10%, and with a vegetarian diet it is only 2–3%. That is why vegetarianism is a powerful risk factor for VDD and IDA at any age. Iron that enters the human body with food is absorbed in the duodenum and the proximal segment of the jejunum. Gastroferrin (a protein synthesized by the gastric mucosa) and androgens (male sex hormones) stimulate the absorption of iron in the intestine. Ascorbic acid prevents the oxidation of iron, maintains it in the ferrous divalent form and thereby promotes the absorption of iron in the intestines. The acid-forming function of the stomach and the acidity of gastric juice do not affect the absorption of iron in the gastrointestinal tract. In chronic atrophic gastritis with reduced secretory activity, the absorption of iron in the intestine is impaired due to a decrease in the production of gastroferrin, but not hydrochloric acid. It is important to note that the most pressing causes of iron deficiency in adolescence and young adulthood are not chronic recurrent blood loss, but an increased need for this microelement against the backdrop of rapid growth, physical development and puberty; dyshormonal and dysmetabolic disorders against the background of pubertal development and puberty of adolescents. Iron replacement therapy (IR) is a key component of the standard treatment for patients with IDA, especially when there are limited possibilities for radical elimination of the causes of anemia. This applies primarily to the treatment of a large population of women with menorrhagia of various origins, pregnant and lactating women, as well as some other groups of patients. Adequate therapy of the pancreas helps to normalize the level of NV in erythrocytes, which eliminates the clinical manifestations of anemic and sideropenic syndromes, restores ability to work and improves the quality of life of patients. The relevance of the problem of IDA requires optimization of pathogenetic therapy for IDA of the pancreas, studying their safety and possible negative effects on various body systems. Currently, the doctor has at his disposal a large arsenal of pancreas, characterized by different composition and properties, the amount of iron they contain, the presence of additional components that affect the pharmacokinetics of the drug, and various dosage forms. Even if it is possible to establish the origin of iron deficiency, a necessary component of treatment (in addition to influencing the factor that caused the disease) is the administration of ferrodrugs, and, if the clinical situation allows, preference is given to the oral route of administration as it is safer. Modern oral ferrous preparations are either ferrous iron salts (since ferric ions are not absorbed in the digestive tract), or compounds consisting of a ferric hydroxide-polymaltose complex (the absorption mechanism differs from ionic preparations). The main compound included in traditionally used iron salts (ionic iron salts) is ferrous sulfate. It is believed to have higher bioavailability compared to other iron salts (chloride, fumarate) and causes few side effects during therapy [6, 8, 9]. Only divalent iron is absorbed from the gastrointestinal tract in the form of ions. The most effective in increasing the bioavailability of iron are stimulators of NV synthesis and erythropoiesis - folic acid and B vitamins. Folic acid stimulates the synthesis and reduplication of nucleic acids (DNA and RNA), cell proliferation, and is therefore vital for adolescents for rapid growth and physical development and for pregnant women for normal course of pregnancy, growth and development of the fetus. Folic acid regulates myeloid hematopoiesis, stimulates proliferation and differentiation of hematopoietic cells in the bone marrow, ensures normal maturation of erythroblasts, preventing their transformation into megaloblasts. It stimulates the absorption and utilization of iron and thereby increases its bioavailability. According to modern concepts, the intake of pancreatic acid should be combined with folic acid in order to prevent its secondary deficiency against the background of successful treatment of IDA and the transformation of hypochromic microcytic anemia into hyperchromic macrocytic megaloblastic anemia [9]. Vitamin B12 is required to activate folic acid and convert it into its active metabolite, tetrahydrofolic acid. B vitamins (B1, B2, B6) and microelements (manganese, cobalt, nickel, copper, zinc) stimulate the synthesis of NV and erythropoiesis and thereby potentiate the therapeutic and preventive effect of the pancreas. Deficiency of folic acid and vitamin B12 is often observed in VHD caused by bleeding and is associated with impaired DNA synthesis in the hematopoietic organs. The inclusion of folic acid and vitamin B12 in ferrous preparations enhances the active absorption of iron in the intestines and its subsequent utilization. All of the listed components are included in the complex antianemic drug Ferro-Folgamma (Germany) [2, 9], the capsule of which contains: 112.6 mg of ferrous sulfate (corresponding to 37 mg of iron), 5 mg of folic acid, 0.010 mg of cyanocobalamin, 100 mg ascorbic acid. Ferro-Folgamma provides an average increase in NV of 2.5 g/l/day (the highest rate of NV increase among ferrous sulfate preparations). When using Ferro-Folgamma, there is a fairly rapid (within the first 10 days of use) weakening of the clinical symptoms of posthemorrhagic anemia [4]. The drug is prescribed 1 capsule 3 times a day after meals for 3-4 weeks, and for severe forms of anemia - 2 capsules 3 times a day for 16 weeks. and more [8]. After cessation of treatment with Ferro-Folgamma, the positive effect and stabilization of blood serum parameters (levels of NV, red blood cells, serum iron, total iron-binding capacity of blood serum) persist for at least 1 month. [8]. As with any long-term treatment (when oral ferrodrugs are prescribed in sufficient doses, normalization of NV levels is observed in most cases within 3–4 weeks from the start of treatment), good tolerability ensures high adherence to treatment and, thus, increases the likelihood of success of therapy. Modern oral PZ rarely cause significant side effects that require their discontinuation and switching to the parenteral route of administration. Adverse events associated with the use of oral progesterone usually occur in the gastrointestinal tract: nausea, metallic taste in the mouth, constipation (one of the possible explanations is the binding of hydrogen sulfide in the intestine, which stimulates peristalsis), less often - diarrhea, anorexia. It must be taken into account that the absorption of iron from salt preparations may be reduced under the influence of certain substances contained in food (phosphates, calcium salts, phytin, tannin), as well as with the simultaneous use of certain drugs (tetracyclines, chloramphenicol, antacids). Thus, currently, the indications for the use of the drug Ferro-Folgamma are anemia caused by deficiency of iron, folic acid and vitamin B12, occurring against the background of chronic blood loss (menorrhagia and metrorrhagia, from hemorrhoids, etc.), as well as chronic alcoholism , infectious diseases, anemia of chronic diseases, taking anticonvulsants and oral contraceptives. The drug is also suitable for the prevention and treatment of iron and folic acid deficiency in the second and third trimesters of pregnancy, the postpartum period and during lactation. Regardless of the cause of menorrhagia and the need to influence the corresponding factor, long-term therapy with ferrodrugs for oral administration is required. The dose and regimen are selected individually, taking into account the iron content in the drug, its tolerability, etc. After normalization of the level of NV, it is necessary to carry out maintenance therapy with a ferrodrug for 5–7 days after the end of menstruation. If the condition is satisfactory and the NV indicators are stable, breaks in treatment are possible, which, however, should not be long, because Women's ongoing menorrhagia quickly depletes iron stores with the risk of relapse of IDA. When treating teenage girls, after normalization of the NV level, repeated courses of treatment are possible, especially if heavy menstruation occurs or there are other blood losses (nasal, gingival). Literature 1. Goryachev V.V. Iron metabolism during pregnancy. Astrakhan, 1994. 100 p. 2. Gratsianskaya A.N. Ferro-Folgamma in the treatment and prevention of iron deficiency // Pharmateka. 2012. No. 12. P. 57. 3. Dvoretsky L.I. Treatment of iron deficiency anemia // Breast cancer. 1998. T. 6. No. 20. P. 1312–1316. 4. Kazyukova T.V., Samsygina G.A., Kalashnikova G.V. New possibilities of ferrotherapy for iron deficiency anemia // Clinical pharmacology and therapy. 2000. No. 9 (2). pp. 88–91. 5. Konovodova E.N., Burlev V.A. Comparative effectiveness of treatment of manifest iron deficiency in pregnant women with various iron preparations // RMZh. 2009. T. 17. No. 16. P. 1028–1031. 6. Ferro-Folgamma. Therapy with iron, folic acid, vitamin B12 and ascorbic acid. Scientific review. Worwag Pharma. M., 2001. 7. Boyd CM, Leff B., Wolff JL, Yu Q., Zhou J., Rand C., Weiss CO Informing clinical practice guideline development and implementation: prevalence of coexisting conditions among adults with coronary heart disease / / J Am Geriatr Soc. May 2011 Vol. 59(5). R. 797–805. 8. Ghinea MM Treatment of iron deficiencyane – mia with Ferro-Folgamma Rom // J Intern Med. 2004. Vol. 42(1). R. 225–230. 9. Isler M., Delibas N., Guclu M., Guldekn F., Sutcu R., Bahceci M., Kosar A. Superoxide dismuta-se and glutathione peroxidase in erythrocytes of patients with iron deficiency anemia: effects of different treatment modalities // Croatian medical journal. 2002. Vol. 43(1). P. 16–19. 10. Jankowska E.A., Rozentryt P., Witkowska A., Nowak J., Hartmann O., Ponikowska B., Borodulin-Nadzieja L., Banasiak W., Polonski L., Filippatos G., McMurray JJ, Anker SD, Ponikowski P. Iron deficiency: an ominous sign in patients with systolic chronic heart failure // Eur Heart J. 2010 Aug. Vol. 31 (15). R. 1872–1880.

Interaction

Organic acids, calcium salts, phosphates, phytin, cholestyramine, as well as antacid preparations containing aluminum, magnesium, calcium, interfere with the absorption of iron due to the formation of insoluble complexes.

Preparations containing pancreatic enzymes may reduce iron absorption.

With the simultaneous use of phenobarbital, carbamazepine, valproate, sulfasalazine, hormonal contraceptives, folic acid antagonists, trimethoprim, pyrimethamine and triamterene, the absorption of folic acid is reduced.

Iron salts interfere with the absorption of tetracycline antibiotics in the gastrointestinal tract.

Solid foods, bread, raw cereals, dairy products, eggs reduce iron absorption.

When administered simultaneously with antibiotics of the tetracycline group, as well as with penicillinamine, complex compounds are formed that reduce the absorption of iron and reduce the antimicrobial activity of the antibiotics.

Iron deficiency anemia: Ferro-Folgamma

Children and adolescents during periods of intensive growth and puberty, as well as women of childbearing age, especially during pregnancy and lactation, are most susceptible to iron deficiency anemia. Against the background of iron deficiency anemia, both the course of pregnancy and childbirth and the condition of the fetus worsen significantly. Pregnant women with anemia have a significantly higher risk of spontaneous miscarriage and premature birth, chronic hypoxia and intrauterine growth retardation. Women in labor are more often susceptible to labor weakness and bleeding, while postpartum women are more susceptible to purulent-inflammatory processes and other complications of the postpartum period. Iron deficiency in women can also result from acute or chronic blood loss during heavy and prolonged menstruation, dysfunctional uterine bleeding, uterine fibroids, endometriosis, the presence of intrauterine contraceptives, and after gynecological surgery. Iron deficiency anemia is a common secondary syndrome in gastroenterological diseases due to bleeding, impaired iron absorption, dietary restrictions (therapeutic diets, religious traditions, strict vegetarianism, etc.). Basically, anemia in gastroenterological diseases occurs due to chronic blood loss and impaired absorption of hematopoietic factors [4], which most often occurs in diseases of the upper gastrointestinal tract (GIT) and colon (erosive and hemorrhagic gastritis, gastroesophageal reflux disease, peptic ulcer diseases of the stomach and duodenum (DPC), hiatal hernia, complicated varicose veins of the esophagus and stomach, cancer of the stomach and intestines, ulcerative colitis, Crohn's disease, diverticulosis and intestinal polyposis, hemorrhoids, etc.). The causes of malabsorption of hematopoietic factors can be diseases of the small intestine (celiac disease, resection of a section of the small intestine, bacterial overgrowth syndrome in the small intestine, diabetic enteropathy, amyloidosis, scleroderma, tuberculosis, small intestinal lymphoma, etc.). Chronic liver diseases accompanied by hypoproteinemia lead to a decrease in the blood level of the transport protein transferrin, which transfers iron into the hemoglobin molecule, which ultimately also leads to the development of iron deficiency anemia. Thus, the causes of the disease are usually known. However, even when the cause of anemia is established, it is not always possible to eliminate it, so the need to administer iron supplements inevitably arises. Ferric preparations are also used in the prevention of iron deficiency states during periods of increased body need for iron (Table 1). In the absence of special indications for parenteral administration, such as, for example, malabsorption, poor tolerability of oral iron preparations, the presence of social reasons (low adherence to treatment), ferrodrugs are prescribed orally, since with comparable effectiveness - with oral administration of iron, hemoglobin levels are restored usually only 2-4 days later than with parenteral administration - the safety of oral iron supplements is significantly higher. The main danger of parenteral therapy is the possibility of developing an anaphylactic reaction. In addition, unlike parenteral administration, oral intake of iron will not lead to the development of hemosiderosis if anemia is misinterpreted as iron deficiency. For example, in the case of sideroachrestic (iron-saturated) anemia, when, with a normal or even excess amount of iron in the body, for various reasons, iron is not used to build heme in the hemoglobin molecule (hypochromic red blood cells are formed). Modern oral ferrous preparations are either ferrous iron salts (since ferric ions are not absorbed in the digestive tract), or compounds consisting of a hydroxide-polymaltose complex of ferric iron (the absorption mechanism differs from that of ionic preparations). The main compound included in traditionally used iron salts (ionic iron preparations) is ferrous sulfate. Ferrous sulfate is believed to have higher bioavailability than other iron salts and is associated with few adverse events during therapy [5]. Preparations containing ferric hydroxide-polymaltose complex have bioavailability and efficacy comparable to those of ferrous sulfate, although, according to some data, they are better tolerated than ionic preparations [6, 7]. Only divalent iron is absorbed from the gastrointestinal tract in the form of an ion. The combination of iron with ascorbic acid (the desired ratio is 3:1) helps to increase the bioavailability of iron, because improves the absorption of iron ions in the intestine [8]. An important role in hematopoiesis is played by folic acid, which is involved in DNA synthesis in erythroblasts, and vitamin B12 (cyanocobalamin), the main activation factor of folic acid (promotes the conversion of folic acid into its active form - tetrahydrofolic acid) [9]. Deficiency of folic acid and vitamin B12 is often observed in iron deficiency conditions caused by bleeding and is associated with impaired DNA synthesis in the hematopoietic organs. The inclusion of folic acid and vitamin B12 in ferrous preparations enhances the active absorption of iron in the intestines and its subsequent utilization. The above-mentioned components that increase the bioavailability of iron are part of the complex antianemic drug Ferro-Folgamma (Verwag Pharma, Germany) [10], which was developed and produced in accordance with WHO recommendations (WHO, 1998). Ferro-Folgamma capsule contains: • 112.6 mg of ferrous sulfate (corresponding to 37 mg of iron); • 5 mg folic acid; • 10 mcg cyanocobalamin; • 100 mg ascorbic acid. Ferro-Folgamma provides an average increase in hemoglobin of 2.5 g/l/day (the highest rate of increase in hemoglobin among ferrous sulfate preparations). When using Ferro-Folgamma, a weakening of the clinical symptoms of posthemorrhagic anemia is observed during the first 10 days of use [11]. Ferro-Folgamma is prescribed 1 capsule 3 times a day after meals for 3-4 weeks, and for severe forms of anemia - 2 capsules 3 times a day for 16 weeks. and more. After cessation of treatment with Ferro-Folgamma, the positive effect and stabilization of blood serum parameters (level of hemoglobin, red blood cells, serum iron, total iron-binding capacity of blood serum) persist for at least 1 month. [12]. Treatment of iron deficiency anemia is always long-term, and the effectiveness directly depends on the patient’s tolerability of the drug: good tolerability ensures high adherence to treatment and, thus, increases the likelihood of therapy success. Modern oral iron preparations rarely cause significant side effects that require their discontinuation and switching to the parenteral route of administration. Adverse events associated with the use of oral iron supplements usually occur in the gastrointestinal tract: nausea, metallic taste in the mouth, constipation (which may be due to the binding of hydrogen sulfide in the intestine, which stimulates peristalsis), less commonly - diarrhea, anorexia [9]. As an alternative to daily dosing, in order to improve tolerability and adherence to therapy, an intermittent regimen (1–3 times/week) of oral iron supplementation has been proposed for women receiving it to prevent anemia. A Cochrane review of 21 studies (n=10,258) found that intermittent iron was inferior to daily iron supplementation. Nevertheless, this regimen reduces the risk of anemia, increases the concentration of hemoglobin and ferritin (compared to no treatment and placebo), and is therefore quite acceptable in cases where daily dosing is for some reason unacceptable [13]. It must be taken into account that the absorption of iron from salt preparations may be reduced under the influence of certain substances contained in food (phosphates, calcium salts, phytin, tannin), as well as with the simultaneous use of certain medications (tetracyclines, chloramphenicol, antacids). Some foods, on the contrary, improve the absorption of iron from the intestines (Table 2). The active components of Ferro-Folgamma are located in a special neutral shell, which ensures their absorption mainly in the upper part of the small intestine. The drug also contains rapeseed oil, which improves the absorption of iron and at the same time reduces the irritating effect of iron on the gastric mucosa, which contributes to good tolerability of the drug in the digestive tract [14, 15]. Due to the absence of an aggressive effect on the gastrointestinal mucosa, Ferro-Folgamma can be successfully used to correct anemic syndrome, characteristic of hidden prolonged bleeding, as well as in cases of vitamin B12 and folic acid deficiency due to impaired absorption in the gastrointestinal tract (atrophy of the gastric and duodenal mucosa). The effectiveness of Ferro-Folgamma for the treatment and prevention of iron deficiency anemia with good tolerability and favorable pharmacoeconomic characteristics (price/iron dose/efficacy) was also shown in several Russian studies that included a wide range of patients, incl. pregnant women, women with gynecological diseases, patients with chronic heart failure [16–20]. Thus, at present, the indications for prescribing the drug Ferro-Folgamma are anemia caused by a combined deficiency of iron, folic acid and vitamin B12, occurring against the background of chronic blood loss (menorrhagia and metrorrhagia, from hemorrhoids, etc.), as well as with chronic alcoholism, infectious diseases, taking anticonvulsants and oral contraceptives. The drug is also suitable for the prevention and treatment of iron and folic acid deficiency in the second and third trimesters of pregnancy, in the postpartum period and during lactation. References 1. International Nutritional Anemia Consultative Group, World Health Organization and UNICEF. Guidelines for the use of iron supplements to prevent and treat iron deficiency anemia. Washington, DC, International Life Sciences Institute, 1998. https://www.who.int. 2. Kozlovskaya L.V. Hypochromic anemia: differential diagnosis and treatment // New medical journal. 1996. No. 56.S. 8–12. 3. Dolgov V.V., Lugovskaya S.A., Morozova V.T., Pochtar M.E. Laboratory diagnosis of anemia. M., 2001. P. 84. 4. Kozlovskaya L.V., Rameev V.V., Sarkisova I.A. Pathogenesis and clinical significance of anemia of chronic diseases // Anemia. 2005. No. 4. P. 4–10. 5. Kazyukova T.V., Samsygina G.A., Kalashnikova G.V. et al. New possibilities of ferrotherapy for iron deficiency anemia // Clinical pharmacology and therapy. No. 2000. No. 9 (2). pp. 88–91. 6. Jacobs P. Equivalent bioavailability of iron from ferrous salts and a ferric polymaltose complex. 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