用藥安全 Drug Safety 1 表一導致缺鐵性貧血的胃腸道疾病 ( ) 參缺鐵性貧血的治療 ( ) () ( ) ( vascular lesions) ( v a s c u l a r lesions ) C ( ) 1 一口服鐵劑

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1 Drug Safety 用藥安全胃腸道疾病患者治療缺鐵性貧血的考量台南市立醫院藥劑科藥師羅惠珍摘要 ( ferric carboxymaltose) iron deficiency anemia infinflammatory bowel disease eradication therapy of Helicobacter pylori 壹前言 65 貳缺鐵性貧血的症狀和病因 ( ) ( ) ( ) ( ) ( ) 藥學雜誌第 111 冊 111

2 用藥安全 Drug Safety 1 表一導致缺鐵性貧血的胃腸道疾病 ( ) 參缺鐵性貧血的治療 ( ) () ( ) ( vascular lesions) ( v a s c u l a r lesions ) C ( ) 1 一口服鐵劑 ( ) (randomized, double blind study) ferrous sulfate ferrous gluconate ferrous fumarate Rimon et al 15 mg 1 ( ) 2 表二口服鐵劑吸收率的差異 Carbonyl iron 100.0% Polysaccharide iron complex 100.0% Ferrous fumarate 33.0% Ferrous gluconate 12.0% Ferrous sulfate 20.0% 二注射劑型鐵劑 (hemoglobin) (ferritin) LMWID (low molecular weight iron dextran) iron dextran 25 mg (total dose infusion) Ganzoni's formula: [2.4 body weight (kg)] [target Hb (g/dl) observed Hb (g/dl)]+500 mg ( ) mg FeCarb (ferric carboxymaltose) 15 mg/kg ( 66 kg ) mg THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.2

3 () 14 3,4 1 表三靜脈注射鐵劑的選擇 FDA LMWID Iron gluconate Iron sucrose FeCarb IV injection dose 100 mg over 2-5 min 125 mg over 10 min 100 mg over 5 min 100 mg over 2 min Test dose required Yes,25 mg slow IV push No No No Maximal single dose for IV infusion Not limited Total dose infusion Yes, in NS over 1-6 h No No No Direct iron donation to 1~2 5~6 4~5 1~2 transferrin Pregnancy category C B B N/A Life threatening 3.3/ / / N/A ADEs LMWID: low molecular weight iron dextran FeCarb: ferric carboxymaltose IV: intravenous ADE: adverse drug event NS: normal saline N/A: not available 肆疾病的考量一發炎性腸道疾病 17% 16% 68% 5 Lindgren et al 24 % 1 () 10 g/dl 藥學雜誌第 111 冊 113

4 用藥安全 Drug Safety 1 二幽門螺旋桿菌感染 6 bismuth PPI (proton pump inhibitors) 6 伍討論 6 參考資料 : 1. Bayraktar UD, Bayraktar S: Treatment of iron deficiency anemia associated with gastrointestinal tract disease.world J Gastroenterology 2010 June 14; 16(22): Beata Ineck, Barbara J., Mason and William Lyons:Iron deficiency anemia in pharmcotherapy: A Pathophysiologic Approach, Seventh edition. NEW YORK., 2008: Stefanie Kulnigg,Simeon Stoinon,Vladimir Simanekov, et al: A Novel intravenous iron formulation for traeatment of anemia in inflammatory bowel disease: The Ferric carboxymaltose (FERINJECT) randomizide controlled trial. American Journal of Gastroenterology 2008; 103: Katherine A, Lyseng Williamson and Gillian M. Keating: Ferric carboxymaltose. A review of its use in iron -deficiency anemia. Drug 2009; 69(6): Fernando Gomollon, Javier P. Gisbert. Anemia and inflammatory bowel diseases.world J Gastroenterol 2009 October 7; 15(37): Xiaolu Huang, Xinhua QU, Weili Yan, et al: Iron deficiency anemia can be improved after eradication of Helicobacter pylori. Postgard Med J 2010; 86 : C Gasche, M C Lomer, L Cavill, G Weiss. Iron: Anaemia, and inflammatory bowl diseases. Gut 2004; 53: David Gozzard:When is high-dose intravenous iron repletion needed?assessing new treatment Options? Drug design, development and therapy 2011; 5: B Annibale, G Capurso, E hahner et al: Concomitant alterations in intragastic ph and ascorbic acid concentration in patient's with helicobactor pylori gastritis and associatediron deficiency anemia. Gut 2003; 52: Michael Auerbach, Harold Ballard.Clinical use of intravenous iron: administration, efficacy, and safety. American Society Hematology : 16: THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.2

5 Management of Iron Deficiency Anemia Associated with Gastrointestinal Tract Diseases Hui-Chen Lo Tainan Municipal Hospital, Department of Pharmacy Abstract The gastrointestinal tract is a common site of bleeding that may lead to iron deficiency anemia. Many risk factors for iron deficiency anemia have been identified. Most of them are related to dietary habits. The treatment of iron deficiency anemia including nutrition and medicine, identified the cause of iron deficiency anemia is important. Oral iron preparations are efficacious but poorly tolerated due to non-absorbed iron mediated gastrointestinal side effects. Parenteral iron replacement is an alternative choice. Hypersensitivity reactions is a question of intravenous iron, but newer parenteral iron complexes can deal with the problem. Gastrointestinal tract diseases induce iron deficiency anemia. It depends on the severity of clinical symptoms to decide to give oral iron or parenteral iron replacement. 藥學雜誌第 111 冊 115

慢性腎臟病患貧血的特徵貧血的定義 : 血紅素在男性 <13 g/dl, 女性 <12 g/dl (1968 WHO) 慢性腎臟病的貧血屬於正血球性紅血球增生不良貧血 (MCV 80-100) 當 GFR < 60

慢性腎臟病患貧血的特徵貧血的定義 : 血紅素在男性 <13 g/dl, 女性 <12 g/dl (1968 WHO) 慢性腎臟病的貧血屬於正血球性紅血球增生不良貧血 (MCV 80-100) 當 GFR < 60 慢性腎臟病患貧血治療新趨勢李文欽醫師台南市立醫院醫療副院長中台科技大學助理教授慢性腎臟病患貧血的特徵貧血的定義 : 血紅素在男性

用 藥 安 全 Drug Safety 1 表 一 導 致 缺 鐵 性 貧 血 的 胃 腸 道 疾 病 ( ) 參 缺 鐵 性 貧 血 的 治 療 ( ) () ( ) ( vascular lesions) ( v a s c u l a r lesions ) C ( ) 1 一 口 服 鐵 劑

用藥安全 Drug Safety 1 表一導致缺鐵性貧血的胃腸道疾病 ( ) 參缺鐵性貧血的治療 ( ) () ( ) ( vascular lesions) ( v a s c u l a r lesions ) C ( ) 1 一口服鐵劑