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Should iron and calcium tablets be taken together in pregnancy?

Wednesday, 15 September 2004
Answered by: Chandra M. Gulhati
Editor,
MIMS,
New Delhi
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Q. I am pregnant. My doctor has given me iron and calcium tablets. I take folic acid, iron and calcium tablets after my breakfast with one glass of milk. Recently I heard that iron and calcium should not be taken at the same time and iron should not be taken with milk. Please suggest me the favourable time and proportion, which I should take.

A.  Iron and calcium are generic, non-specific terms. Which iron? Ferrous fumarate or gluconate or glycine sulphate or succinate or sulphate? Similarly calcium can be carbonate, tribasic phosphate or hydroxyapatite etc. Though these molecules are generally similar, there are fine distinctions when it comes to interactions with other agents. For example when calcium carbonate is taken concurrently with ferrous sulphate, the iron absorption can be reduced by two-thirds. In other words, the patient is actually benefiting from one-third dose only. The effect of calcium and milk is similar because milk contains calcium. I hope your doctor has told you not to consume coffee. It interferes in the way the body handles iron and can itself lead to anaemia due to iron deficiency. Many women can not tolerate iron when given for prolonged periods due to side effects such as nausea, constipation, some times even diarrhoea. These side effects can be avoided by taking sustained-release preparations such as Fecontin-F Continus (marketed by Modi-Mundipharma). It also contains 500mcg (0.5mg) of folic acid. So there is no need to take additional dosage. Most commercial preparations of folic acid in India contain 5 mg while the actual need is no more than 0.5 mg. Thus excessive dose is taken. A high dose of 5 mg is indicated only for those women who have a family history of neural tube defect. For calcium it is preferable to take products that contain the ingredient derived from oyster shells such as Logical-250 (marketed by Serum Institute).

A.  Iron and calcium are generic, non-specific terms. Which iron? Ferrous fumarate or gluconate or glycine sulphate or succinate or sulphate? Similarly calcium can be carbonate, tribasic phosphate or hydroxyapatite etc. Though these molecules are generally similar, there are fine distinctions when it comes to interactions with other agents. For example when calcium carbonate is taken concurrently with ferrous sulphate, the iron absorption can be reduced by two-thirds. In other words, the patient is actually benefiting from one-third dose only. The effect of calcium and milk is similar because milk contains calcium. I hope your doctor has told you not to consume coffee. It interferes in the way the body handles iron and can itself lead to anaemia due to iron deficiency. Many women can not tolerate iron when given for prolonged periods due to side effects such as nausea, constipation, some times even diarrhoea. These side effects can be avoided by taking sustained-release preparations such as Fecontin-F Continus (marketed by Modi-Mundipharma). It also contains 500mcg (0.5mg) of folic acid. So there is no need to take additional dosage. Most commercial preparations of folic acid in India contain 5 mg while the actual need is no more than 0.5 mg. Thus excessive dose is taken. A high dose of 5 mg is indicated only for those women who have a family history of neural tube defect. For calcium it is preferable to take products that contain the ingredient derived from oyster shells such as Logical-250 (marketed by Serum Institute).

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