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

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

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 ( ) 700-900 mg FeCarb (ferric carboxymaltose) 15 mg/kg ( 66 kg ) 66 1000 mg 15 112 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.2

() 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 125 500 1000 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 3.3/1000000 0.9/1000000 0.6/1000000 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

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):2720-2725. 2. Beata Ineck, Barbara J., Mason and William Lyons:Iron deficiency anemia in pharmcotherapy: A Pathophysiologic Approach, Seventh edition. NEW YORK., 2008: 1647-1651. 3. 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: 1182-1192. 4. Katherine A, Lyseng Williamson and Gillian M. Keating: Ferric carboxymaltose. A review of its use in iron -deficiency anemia. Drug 2009; 69(6): 739-756. 5. Fernando Gomollon, Javier P. Gisbert. Anemia and inflammatory bowel diseases.world J Gastroenterol 2009 October 7; 15(37): 4659-4665. 6. Xiaolu Huang, Xinhua QU, Weili Yan, et al: Iron deficiency anemia can be improved after eradication of Helicobacter pylori. Postgard Med J 2010; 86 :272-278. 7. C Gasche, M C Lomer, L Cavill, G Weiss. Iron: Anaemia, and inflammatory bowl diseases. Gut 2004; 53:1190-1197. 8. David Gozzard:When is high-dose intravenous iron repletion needed?assessing new treatment Options? Drug design, development and therapy 2011; 5: 51-60. 9. 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: 496-501. 10. Michael Auerbach, Harold Ballard.Clinical use of intravenous iron: administration, efficacy, and safety. American Society Hematology 2010. 11. 2005: 16: 269-273 114 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.2

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