Anti-anemic

drugs.
ANEMIA:
Anemia is a condition that develops when your blood
lacks enough healthy red blood cells or hemoglobin.
Hemoglobin is a main part of red blood cells and binds
oxygen. If you have too few or abnormal red blood cells,
or your hemoglobin is abnormal or low, the cells in your
body will not get enough oxygen.
Anemia is measured according to the amount of
hemoglobin, which is the protein within red blood cells
that carries oxygen from the lungs to the body’s tissues.
According to the Cleveland Clinic, about 3.4 million
Americans suffer from anemia. Women and people with
chronic diseases such as cancer have the highest risk of
developing anemia.
.What causes anemia?
Dietary iron, vitamin B-12, and folate are essential for
red blood cells to mature in the body. Normally, 0.8 to 1
percent of the body’s red blood cells are replaced every
day, and the average lifespan for red cells is 100 to 120
days. In general, any process that has a negative effect on
this balance between red blood cell production and
destruction can cause anemia.
Causes of anemia are generally divided into those that
decrease red blood cell production and those that
increase red blood cell destruction.
Factors that decrease red blood cell production include:
 inadequate stimulation of red blood cell
production by the hormone erythropoietin, which is
produced by the kidneys
 inadequate dietary intake of iron, vitamin B-12,
or folate
 hypothyroidism
On the other hand, any disorder that destroys red blood
cells at a rate that’s faster than they’re made can cause
anemia. Factors that increase red blood cell destruction
include:
 hemorrhage from:
 accidents
 gastrointestinal lesions
 menstruation
 childbirth
 excessive uterine bleeding
 surgery
 cirrhosis, which involves scarring of the
liver
 fibrosis, or scar tissue, within the bone
marrow
 hemolysis, which is the rupture of red
 blood cells that can occur with some
medications or Rh incompatibility
 disorders of the liver and spleen
 genetic disorders such as:
 glucose-6-phosphate dehydrogenase
(G6PD) deficiency
 thalassemia
 sickle cell anemia

After diagnosis the anemia, om basic tests like,

.CBC Count,

.folic acid test,

.stool test, etc.

We must want to treat the anemia for anti-anemic drugs,

Erythropoietin (Epoetin
alpha).
 Trade Names: erythropoietin, Epo, Epogen, Procrit ®
 Drug Class: Drug Used in Anemia (normocytic)
 Mechanism of Action:
 a glycoprotein that stimulates red blood cell production.
Epoetin alfa is a 165 amino acid glycoprotein manufactured by
recombinant DNA technology, and has the same biological effects as
endogenous erythropoietin
 Hypoxia is the primary physiological stimulus for
erythropoietin production in the body
 Indications:
  treatment of anemia in:
chronic renal failure patients
zidovudine-treated HIV-infected patients
cancer patients on chemotherapy
reduction of allogeneic blood transfusion in surgery patients.
Erythropoietin deficiency can result from compromised renal
function (it's primary site of production). Erythropoietin
deficiency results in a normocytic anemia.
 Contraindications:
 Uncontrolled hypertension or known hypersensitivity to either
mammalian cell-derived products or to human albumin.
 Pharmacokinetics:
 given i.v. or s.c. Half life of 4-13 hrs in patients with chronic
renal failure. It is measured in international units (IU).
 Side Effects:
 a rapid increase in hematocrit & hemoglobin may cause
hypertension & thrombotic complications. These can be minimized by
raising the hematocrit slowly and treating the hypertension.

Ferrous Sulfate.
 Trade Name: generic
 Drug Class: Drug Used in Anemia (microcytic)
 Mechanism of Action:
 Iron combines with porphyrin and globin chains to form
hemoglobin, which is critical for oxygen delivery from the lungs to
other tissues.
 Iron deficiency causes a microcytic anemia due to the
formation of small erythrocytes with insufficient hemoglobin.
 Indications:
 Iron deficiency anemia, blood loss related to pregnancy or GI
bleeding (NSAIDs), hookworm infestation, or excess coffee
 Contraindications:
 Patients with hemochromatosis, hemosiderosis or hemolytic
anemia
 Pharmacokinetics:
 An oral (absorbable) iron formulation.
  Side Effects:
 Therapeutic doses - nausea, upper abdominal pain, constipation
or diarrhea
 Iron overdose (1-2 g) can lead to circulatory collapse and
death. Non-intentional iron overdose has been a leading cause of
fatal poisoning in children <6 years old. Keep out of reach of
children.
 Iron overdose can be treated by gastric lavage with a phosphate
solution and deferoxamine (iron chelator).
 Drug interactions:
 it may decrease the absorption of other medications

Deferoxamine.
 Trade Name: Desferal ®
 Drug Class: Iron Chelator
 Mechanism of Action:
 Binds iron avidly, but poorly binds other essential trace metals
 It competes in binding loosely bound iron, but fails to bind iron
that is biologically chelated, such as in microsomal and mitrochondrial
cytochromes and hemoproteins
 Indications:
 Iron poisoning. Used for treating both acute iron intoxication
and in patients with secondary iron overload from multiple
transfusions.
 Deferoxamine plus hemodialysis may also be useful in
treatment of aluminum toxicity in renal failure. (It is not indicated for
the treatment of primary hemochromatosis, since phlebotomy is the
method of choice for removing excess iron in this disorder.)
 Contraindications:
 Patients with severe renal disease or anuria, since the drug and
the iron chelate are excreted primarily by the kidney
 Pharmacokinetics:
 Given parentally (i.m., s.c. or i.v.)
 It is poorly absorbed if taken orally, and may actually increase
iron absorption if given orally
 Iron-chelator complexes are excreted in the urine, often turning
the urine an orange-red color
  Side Effects:
 Rapid i.v. administration may cause hypotension
 Idiosyncratic responses such as flushing, rash, abdominal
discomfort may occur

Folic acid.
 Trade Name: Folvite ®
 Drug Class: Drug used in anemia (megaloblastic)
 Mechanism of Action:
 Essential cofactor for synthesis of amino acids, purines and
DNA
 Indications:
 Treatment of megaloblastic anemias due to a deficiency of
folic acid as may be seen in tropical or non-tropical sprue, in anemias
of nutritional origin, pregnancy, infancy, or childhood
 A reduced form of folic acid known as citrovorum factor (or
leucovorin) is given to replenish endogenous folic acid in patients on
methotrexate (which inhibits dihydrofolate reductase). Citrovorin
(leucovorin) is better absorbed compared to folic acid.
 Contraindications:
 Folic acid should not be given alone in patients with
pernicioius anemia without knowing whether they also have a Vit
B12 deficiency. The danger is that folic acid supplements can mask the
signs of Vit B 12 deficiency, yet not prevent the development of
irreversible neurological disease due to Vit B12 deficiency.
 The Shilling test can be used to test for abnormalities in Vit
B12 absorption.
 Pharmacokinetics:
 1 mg of folic acid orally daily is typically sufficient to reverse
megaloblastic anemia & restore normal folate levels.
 Side Effects:
 Allergic sensitization
 Notes:
 Folate deficiency (in pregnant women) is implicated as a cause
of congenital malformations in newborns
 Folate may also play a beneficial role in preventing the
development vascular disease such as ischemic heart disease & stroke.
  Folic acid supplements may mask the signs of Vit B 12
deficiency, which can produce neurological disease if undetected

Vitamin B12.
 Generic Names: generic, cyanocobalamin, hydroxocobalamin
 Drug Class: Vitamin
 Mechanism of Action:
 A cofactor for several essential biochemical reactions.
 Indications:
 Used to treat or prevent deficiency of Vit B12.
 The most common causes of Vit B12 deficiency are:
 Pernicious anemia (results from defective secretion of
intrinsic factor by the gastric mucosal cells)
 Fish tapeworm infection
 Partial or total gastrectomy
 Various intestinal disorders that impair absorption of Vit
B12.
 Pharmacokinetics:
 Different formulations can be administered orally, or by
parenteral injection.
 Notes:
 Vit B12 deficiency leads to megaloblastic anemia, GI
symptoms & neurological abnormalities including degeneration of
myelin sheaths in axons of the spinal cord & peripheral nerves.
 Vit B12 deficiency symptoms: paresthesias & weakness in
peripheral nerves, progressing to spasticity, ataxia & other CNS
dysfunctions.
Vit B12 deficiency in elderly patients due to abnormal absorption of
dietary Vit B12 is relatively common and easily treated.