Galfer Capsules.

Ferrous Fumarate BP 305.0mg

(equivalent to 100mg elemental iron).

Capsule.

For the treatment and prophylaxis of uncomplicated iron deficiency anaemia.

For oral administration.

Adults and children over 12 years:

Children under 12 years: Not recommended.

Elderly patients: The adult dose is appropriate.

Pregnant women during the second trimester onwards: The adult dose is appropriate.

(i) Hypersensitivity to the product or ingredients.

(ii) Haemosiderosis and haemochromatosis.

(iii) Active peptic ulcer.

(iv) Repeated blood transfusion.

(v) Inflammatory bowel disease, including regional enteritis and ulcerative colitis, intestinal strictures and diverticulae

(vi) Anaemias other than those due to iron deficiency.

(vii) Haemoglobinopathies

(viii) Concomitant use with parenteral iron

(i) Patients post-gastrectomy have poor absorption of iron.

(ii) Caution is advised when prescribing iron preparations to individuals with history of peptic ulcer.

(iii) Duration of treatment should generally not exceed 3 months after correction of anaemia.

(iv) Co-existing deficiency of vitamin B12 or folic acid should be ruled out since combined deficiencies produce microcytic blood film.

(v) Iron deficiency in a male patient warrants careful investigation to determine its cause which forms the basis of primary treatment.

(vi) Iron preparations colour the faeces black, which may interfere with tests used for detection of occult blood in the stools.

The label will state:

“Important warning: Contains iron. Keep out of reach and sight of children, as overdose may be fatal”.

This will appear on the front of the pack within a rectangle in which there is no other information.

(i) Iron and tetracyclines interfere with the absorption of each other.

(ii) Absorption of iron is impaired by penicillamine, antacids, neomycin, cholestyramine, tea, eggs and milk.

(iii) Chloramphenicol delays plasma clearance of iron and incorporation of iron into red blood cells by interfering with erythropoiesis.

(iv) Reduced iron absorption with calcium supplements, zinc and trientine.

(v) Reduced hypotensive effect of methyldopa

(vi) Reduced absorption of fluoroquinolones, levodopa, carbidopa, entacapone, bisphosphonates, and zinc with iron.

Pregnant women also need to take folic acid.

Administration of drugs during the first trimester of pregnancy requires careful assessment of the potential risks versus the benefits to be gained and should not be administered unless clearly indicated. For the remainder of the pregnancy, iron therapy may be indicated but only on the advice of a physician.

Not applicable.

Anorexia, nausea, vomiting, gastro-intestinal discomfort, constipation, diarrhoea, dark stools and allergic reactions. These side-effects may be minimised by taking the capsules after food.

Iron overdosage is an acute emergency requiring urgent medical attention. An acute intake of 75mg/kg of elemental iron is considered extremely dangerous in young children.

Symptom:

Initial symptoms of iron overdosage include nausea, vomiting, diarrhoea, abdominal pain, haematemesis, rectal bleeding, lethargy and circulatory collapse. Hyperglycemia and metabolic acidosis may occur. However, if overdosage is suspected, treatment should be implemented immediately. In severe cases, after a latent phase, relapse may occur after 24-48 hours manifested by hypotension, coma, hypothermia, hepatocellular necrosis, renal failure, pulmonary oedema, diffuse vascular congestion, coagulopathy and/or convulsions. In many cases, full recovery may be complicated by long-term effects such as hepatic necrosis, toxic encephalitis, CNS damage and pyloric stenosis.

Treatment:

The following steps are recommended to minimise or prevent further absorption of the medication.

Children:

1. Administer an emetic such as syrup of ipecac.

2. Emesis should be followed by gastric lavage with desferrioxamine solution (2g/1). This should then be followed by the installation of desferrioxamine 5g in 50-100ml water, to be retained in the stomach. Inducing diarrhoea in children may be dangerous and should not be undertaken in young children. Keep the patient under constant surveillance to detect possible aspiration of vomitus - maintain suction apparatus and standby emergency oxygen in case of need.

3. Severe poisoning:

In the presence of shock and/or coma with high serum iron levels (serum iron > 90umol/1) immediate supportive measure plus IV infusion of desferrioxamine should be instituted. Desferrioxamine 1 5mg/kg body weight should be administered every hour by slow IV infusion to a maximum 80mg/kg/24 hours.

Warning:

Hypotension may occur if the infusion rate is too rapid.

4. Less severe poisoning: i/m desferrioxamine 1g 4-6-hourly is recommended.

5. Serum iron levels should be monitored throughout.

Adults:

1. Administer an emetic.

2. Gastric lavage may be necessary to remove drug already released into the stomach. This should be undertaken using a desferrioxamine solution (2g/1).

Desferrioxamine 5g in 50-100ml water should be introduced into the stomach following gastric emptying. Keep the patients under constant surveillance to detect possible aspiration of vomitus; maintain suction apparatus and standby emergency oxygen in case of need.

3. A drink of mannitol or sorbitol should be given to induce small bowel emptying.

4. Severe poisoning.

In the presence of shock and/or coma with high serum iron levels (>142umol/1) immediate supportive measures plus IV infusion of desferrioxamine should be instituted. The recommended dose of desferrioxamine is 5mg/kg/h by a slow IV infusion up to a maximum of 80mg/kg/24 hours.

Warning:

Hypotension may occur if the infusion rate is too rapid.

5. Less severe poisoning:

i.m. deferrioxamine 50mg/kg up to a maximum dose of 4g should be given.

6. Serum iron levels should be monitored throughout.

Iron is a haematinic essential for satisfactory erythropoiesis during haemoglobin synthesis.

Absorption of iron is a complicated process. Iron is absorbed throughout the GI tract but it is greatest in the duodenum and proximal jejunum.

Approximately 5-10% of dietary iron is absorbed during prophylaxis and 10-30% in iron deficient subjects. Ferrous ion is easily absorbed compared to ferric ion. Transfer of iron across the placenta is an active process. Excess iron ingested is stored as ferritin and haemosiderin.

Not applicable.

Microcrystalline Cellulose

Capsule shell ingredients:

Quinoline Yellow (E104)

Indigotine (E132) Pharm Fr

Titanium Dioxide (E171) Pharm Fr

Erythrosine (E127) Pharm Fr

Gelatin Ph Eur

None stated.

Store in a cool place.

Keep container tightly closed.

Keep out of reach of children.

Cylindrical polypropylene containers with polyethylene snap-close caps.

Pack sizes: 100 and 250 capsules.

Child resistant vial complying with British standard (BSI 5321).

Pack size: 30 capsules.

PVdC – Aluminium foil blisters.

Pack size: 28 capsules.

None stated.

Thornton & Ross Limited.

Linthwaite

Huddersfield

West Yorkshire

HD7 5QH

United Kingdom

PL 00240/0104

31 May 2003

10^th January 2007

Not Applicable

Not Applicable