Anemia is a condition where there are not enough healthy red blood cells to carry oxygen to tissues, causing symptoms like fatigue and weakness. There are several types of anemia including iron deficiency, sickle cell, and vitamin deficiency anemias. Common anti-anemia drugs discussed include erythropoietin, ferrous sulfate, iron dextran, folic acid, and vitamin B12. These drugs work to stimulate red blood cell production, provide iron or vitamins needed to form hemoglobin, or treat underlying causes of megaloblastic anemia. Side effects depend on the specific drug but may include nausea, constipation, hypertension, or tissue staining from iron compounds.

1. Anemia & Anti-anemia Drugs
PRESENTED BY
SHUJAT MUZAFFAR
M.Sc. CLINICAL RESEARCH
SECOND SEMESTER

2. ANEMIA
Anemia is a condition in which lack enough healthy red blood cells to
carry adequate oxygen to body's tissues. Having anemia can make
feel tired and weak.

3. TYPES
1. Aplastic anemia
2. Iron deficiency anemia
3. Sickle cell anemia
4. Thalassemia
5. Vitamin deficiency anemia

4. SYMPTOMS
● Fatigue
● Weakness
● Pale or yellowish skin
● Irregular heartbeats
● Shortness of breath
● Dizziness or lightheadedness
● Chest pain
● Cold hands and feet
● Headaches

5. 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
Anti anemia Drugs

6. ■ Indications:
1. chronic renal failure patients
2. zidovudine-treated HIV-infected patients
3. cancer patients on chemotherapy
4. reduction of allogeneic blood transfusion in surgery patients.
■ Contraindications:
■ Uncontrolled hypertension or known hypersensitivity
■ 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:
■ Hypertension & thrombotic complications.

7. 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.
■ 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.

8. Side Effects:
■ Therapeutic doses - dose related 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

9. Iron Dextran
■ Trade Name: INFeD ®
■ Drug Class: Parental Iron Preparation
■ Mechanism of Action:
■ Same as ferrous sulfate (but has a different route of administration)
■ Indications:
■ Seldom used now (newer orally effective agents including iron sucrose &
ferric gluconate complex are most commonly used).
■ Reserved for patients with iron deficiency who:
■ are unable to tolerate oral iron
■ cannot absorb oral iron (e.g. due to inflammatory bowel
disease affecting the proximal small bowel, post-
gastrectomy conditions, or previous small bowel
resection).
■ Ferric gluconate & iron sucrose are two alternative parenteral forms
of iron that can be given i.v., but should NOT be given intramuscularly.

10. ■ Pharmacokinetics:
■ Given by deep i.m. injection or i.v.
■ Most adults with iron deficiency require 1-2 g of replacement iron, or
20-40 ml.
■ The favored route of administration is i.v. infusion in several hundred
mls of normal saline over 1-2 hrs.
■ Side Effects:
■ More dose-dependent side effects compared to administering
oral iron supplements, which limits the dose that can be
given. Side effects include:
■ Local pain & tissue staining (brown discoloration),
headache, light-headedness, fever, nausea, flushing,
urticaria, bronchospasm, and rarely anaphylaxis & death.

11. 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
■ A reduced form of folic acid known as citrovorum factor (or
leucovorin)
■ Contraindications:
■ Folic acid should not be given alone in patients with pernicioius anemia without
knowing whether they also have a Vit B12 deficiency.
■ The Shilling test can be used to test for abnormalities in Vit B12 absorption.

12. ■ 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
■ Folic acid deficiency is also known as Will's disease.

13. 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.

14. ■ 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.