TOT’Hma

Uses

Iron-deficiency anemia.

Manganese gluconate is an ingredient found in a variety of supplements and vitamins.

Manganese gluconate is currently only available in combination products. It is indicated for the prophylactic or nutritional supplementation of Manganese [FDA Label].

TOT’Hma is also used to associated treatment for these conditions: Folate deficiency, Iron Deficiency (ID), Iron Deficiency Anemia (IDA), Zinc Deficiency, Mineral supplementationTrace Element Deficiency, Dietary and Nutritional Therapies, Parenteral Nutrition

How TOT’Hma works

Iron is necessary for the production of hemoglobin. Iron-deficiency can lead to decreased production of hemoglobin and a microcytic, hypochromic anemia.

Acts as a Manganese supplement. See Manganese for information on its role in the body.

Dosage

TOT’Hma dosage

Iron-deficiency anaemia:

• Adult:60 mg bid up to 60 mg 4 times daily. Prevention: 60 mg daily.
• Child:Severe: 4-6 mg/kg/day in 3 divided doses; Mild to moderate: 3 mg/kg/day in 1-2 divided doses. Prevention: 1-2 mg/ kg/ day.

Should be taken on an empty stomach. Best taken on an empty stomach. May be taken with meals to reduce GI discomfort.

Side Effects

GI symptoms e.g. stomach cramping, constipation, nausea, vomiting, dark stools, heartburn, diarrhea, teeth staining, urine discoloration.

Toxicity

Acute iron overdosage can be divided into four stages. In the first stage, which occurs up to six hours after ingestion, the principal symptoms are vomiting and diarrhea. Other symptoms include hypotension, tachycardia and CNS depression ranging from lethargy to coma. The second phase may occur at 6-24 hours after ingestion and is characterized by a temporary remission. In the third phase, gastrointestinal symptoms recur accompanied by shock, metabolic acidosis, coma, hepatic necrosis and jaundice, hypoglycemia, renal failure and pulmonary edema. The fourth phase may occur several weeks after ingestion and is characterized by gastrointestinal obstruction and liver damage. In a young child, 75 milligrams per kilogram is considered extremely dangerous. A dose of 30 milligrams per kilogram can lead to symptoms of toxicity. Estimates of a lethal dosage range from 180 milligrams per kilogram and upwards. A peak serum iron concentration of five micrograms or more per ml is associated with moderate to severe poisoning in many.

Precaution

Avoid in patients with peptic ulcer, enteritis, or ulcerative colitis and those who receive frequent blood transfusions. Not to be used in premature infants until the vitamin E stores (deficient at birth) are replenished. Avoid prolonged treatment (>6 mth) except in patients with continuous menorrhagia or bleeding.

Interaction

Concurrent admin with antacids/ H2 antagonists may reduce absorption of iron. Chloramphenicol may delay response to iron. Iron may reduce the absorption of levodopa, methyldopa and penicillamine when given together. Absorption may be reduced when used with quinolones or tetracyclines. Concurrent admin with vitamin C may increase iron absorption.

Elimination Route

The efficiency of absorption depends on the salt form, the amount administered, the dosing regimen and the size of iron stores. Subjects with normal iron stores absorb 10% to 35% of an iron dose. Those who are iron deficient may absorb up to 95% of an iron dose.

Pregnancy & Breastfeeding use

Pregnancy Category- A. Adequate and well-controlled human studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).

Contraindication

Haemochromatosis, haemolytic anemia.

Acute Overdose

Overdose may lead to severe iron toxicity, espcially in children.

Innovators Monograph

You find simplified version here TOT’Hma