IJzer

Synoniem: 
Carbonaat de Fer Anhydre
Citrate de Fer
Elementair ijzer
Fer
Fer Élémentaire
Ferric Iron
Ferric Orthophosphate
watervrij ferraatcarbonaat
Ferrous Citrate
Ferrous Fumarate
Ferro Gluconate
Ferro-ijzer
Ferrous Pyrophosphate
Ferrous Sulfate
Ferrum Phosphoricum
Fumarate de Fer
Gluconate de Fer
Glycérophosphate de Fer
Heme Iron Polypeptide
Hierro
Iron Glycerophosphate
Orthophosphate de Fer
Orthophosphate Ferrique
Numéro Atomique 26
Polypeptide de Fer de Heme
Pyrophosphate de Fer
Sulfate de Fer

Wetenschappelijke naam

Iron, Fe, Atomic nummer 26.

IJzer

IJzer is een sporenmineraal dat wordt aangetroffen in twee ionische vormen in het lichaam. Het bestaat in een gereduceerde toestand als ferro-ijzer en in een geoxideerde toestand als ijzer. Het meeste ijzer in het lichaam wordt gevonden in het hemoglobine van rode bloedcellen en in het myoglobine van spiercellen waar het nodig is voor zuurstof- en koolstofdioxidetransport.

Gebruik

Oraal wordt ijzer gebruikt voor het voorkomen en behandelen van ijzerdeficiëntie en bloedarmoede met ijzertekort. Het wordt ook gebruikt voor aandachtstekortstoornissen met hyperactiviteit (ADHD), rustelozebenensyndroom (RLS), ACE-remmer-geassocieerde hoest, verbetering van de cognitieve functie, hartfalen, verbetering van atletische prestaties, ademhalingsaanvallen bij kinderen, ontwikkeling van kinderen, orale behandeling aften, de ziekte van Crohn, depressie, vermoeidheid, vrouwelijke onvruchtbaarheid en menorragie.

Veiligheid

WAARSCHIJNLIJK VEILIG: indien oraal en geschikt gebruikt. Voor mensen van 14 jaar en ouder met voldoende ijzeropslag, zijn ijzersupplementen veilig bij gebruik in doses lager dan het aanvaardbare bovengrensniveau (UL) van 45 mg per dag elementair ijzer. Het is niet de bedoeling dat de UL van toepassing is op degenen die ijzer onder medisch toezicht ontvangen. Om ijzertekort te behandelen, kunnen de meeste mensen veilig tot 300 mg elementair ijzer per dag innemen. Indien intraveneus en op de juiste manier gebruikt. Ferric carboxymaltose 200 mg en ijzersuccrose 200 mg zijn intraveneus gegeven voor maximaal 10 doses zonder ernstige bijwerkingen.

WAARSCHIJNLIJK ONVEILIG: bij orale toediening in overmatige doses. Doses van 30 mg / kg houden verband met acute toxiciteit. Langdurig gebruik van hoge doses ijzer kan hemosiderose en meervoudige orgaanschade veroorzaken. De geschatte dodelijke dosis ijzer is 180-300 mg/kg. Echter, doses zo laag als 60 mg/kg zijn ook dodelijk geweest.

KINDEREN: WAARSCHIJNLIJK VEILIG: wanneer oraal en op de juiste manier gebruikt.

WAARSCHIJNLIJK ONVEILIG: bij orale toediening in buitensporige hoeveelheden. Vertel patiënten die geen ijzertekort hebben geen doses boven het aanvaardbare bovengrensniveau (UL) van 40 mg per dag elementair ijzer te gebruiken voor zuigelingen en kinderen. Hogere doses veroorzaken vaak gastro-intestinale bijwerkingen zoals constipatie en misselijkheid. IJzer is de meest voorkomende oorzaak van sterfgevallen door pediatrische vergiftiging. Doses vanaf 60 mg/kg kunnen dodelijk zijn.

ZWANGERSCHAP EN LACTATIE: WAARSCHIJNLIJK VEILIG: indien oraal en op de juiste manier gebruikt. IJzer is veilig voor zwangere vrouwen en vrouwen die borstvoeding geven. WAARSCHIJNLIJK ONVEILIG: bij orale toediening in hoge doses. Vertel patiënten die geen ijzertekort hebben om te voorkomen dat de aanvaardbare bovengrensniveau (UL) van 45 mg per dag elementair ijzer wordt overschreden. Hogere doses veroorzaken vaak gastro-intestinale bijwerkingen zoals misselijkheid en braken. Hoge hemoglobineconcentraties op het moment van levering zijn geassocieerd met ongunstige zwangerschapsuitkomsten.

Effectiviteit

Bloedarmoede door chronische ziekte: het gebruik van ijzersupplementen oraal met epoëtine alfa (erytropoëtine, EPO, Epogen, Procrit) is effectief voor de behandeling van anemie geassocieerd met chronisch nierfalen en chemotherapie. Epoëtine alfa is nodig om ervoor te zorgen dat de respons niet wordt beperkt door gebrek aan ijzer voor erytropoëse. Intraveneus ijzer is effectiever dan orale supplementen.

IJzergebreksanemie: het ijzersupplementen oraal innemen, voornamelijk als ijzersulfaat, is effectief voor de behandeling en preventie van bloedarmoede door ijzertekort en bloedarmoede door ijzertekort bij volwassenen, kinderen en baby's. Andere vormen zijn ook effectief, waaronder natriumijzerethyleendiaminetetra-acetaat (NaFeEDTA), ijzer (III) -hydroxide-polymaltosecomplex (IPC) en ijzerproteïnepuccinylaat.

Sommige artsen gebruiken af ​​en toe ijzersupplementen voor de behandeling en preventie van bloedarmoede. Een gepoolde analyse toont aan dat het één of twee keer per week nemen van ijzersupplementen minder effectief is dan dagelijkse ijzersuppletie voor het behandelen en voorkomen van bloedarmoede. Een klein klinisch onderzoek toont echter aan dat het nemen van ijzersulfaat 60 mg op afwisselende dagen in enkelvoudige doses de ijzerabsorptie verbetert in vergelijking met eenmaal daagse dosering. Meer onderzoek is nodig om de optimale doseringsfrequentie van orale ijzersupplementen te bevestigen.

Bloedtransfusie kan nodig zijn bij sommige patiënten met ernstige bloedarmoede met ijzertekort, die symptomen hebben zoals dyspneu en vermoeidheid.

Behandeling met ijzersupplementen zou de hemoglobinewaarden elke 2-3 weken met 1 gram / dl moeten verhogen. Zelfs nadat hemoglobine is genormaliseerd, kan het tot 4 maanden duren voordat ijzervoorraden zijn bijgevuld.

Intraveneus ijzer moet worden overwogen bij patiënten die geen oraal ijzer kunnen verdragen of bij patiënten met chronische bloedingen of intestinale malabsorptie.

Hoewel ijzersupplementen nodig zijn om bloedarmoede gerelateerd aan ijzerdeficiëntie te behandelen, kunnen patiënten met asymptomatisch ijzertekort hun ijzerstatus verbeteren door veranderingen in het voedingspatroon. Consumptie van meer ijzerrijk voedsel kan het ijzergehalte verhogen, hoewel verbetering van de ijzerstatus minder is bij voedingsmiddelen in vergelijking met ijzersupplementen. Hoog ijzerhoudend voedsel omvat rundvlees, lever en lam. Middelrijk ijzervoedsel omvat varkensvlees, ham, kip, vis en bonen.

ACE-remmer-geassocieerde hoest: sommige klinische onderzoeken tonen aan dat het dagelijks innemen van ferrosulfaat 256 mg hoest geassocieerd met ACE-remmers zoals captopril (Capoten), enalapril (Vasotec), Lisinopril (Prinivil, Zestril) en andere vermindert of elimineert.

Cognitieve functie: de orale inname van ijzer lijkt de cognitieve functie te verbeteren bij kinderen en adolescenten met ijzerdeficiëntie. Aanvullend ijzer 650 mg tweemaal daags gedurende 8 weken verbeterde bijvoorbeeld verbaal leren en het geheugen bij niet-anemische ijzerdeficiënte adolescente meisjes. Aanvullend ijzer 50 mg tweemaal per week gedurende 16 weken bleek de aandacht te verbeteren bij adolescente vrouwen met mogelijke bloedarmoede. IJzer lijkt ook ontwikkelings- en leerachterstanden ten gevolge van ijzertekort bij anemische baby's om te keren.

Hartfalen: tot 20% van patiënten met hartfalen heeft ijzerdeficiëntie. Klinisch onderzoek toont aan dat het toedienen van intraveneus ijzercarboxymaltose 200 mg of ijzer sucrose 200 mg geassocieerd is met een verbetering van de kwaliteit van leven, inspanningscapaciteit en minder ziekenhuisopnamen bij patiënten met lichte hartstoornissen.

Rusteloze benen syndroom (RLS): het rusteloze benen syndroom wordt vaak geassocieerd met bloedarmoede door ijzertekort. Sommige klinische onderzoeken tonen aan dat het nemen van ijzer in de vorm van ferrosulfaat 325 mg tweemaal daags gedurende 12 weken, de symptomen verlaagt vergeleken met het gebruik van pramipexol voor het rusteloze benen syndroom. Symptomen zoals beenongemakken, behoefte om te bewegen en slaapstoornissen verbeterden aanzienlijk bij ongeveer de helft van de patiënten die een van beide behandelingen gebruikten.

Aanvullend klinisch onderzoek toont aan dat het nemen van ferrosulfaat 325 mg tweemaal daags samen met vitamine C 100 mg tweemaal daags gedurende 12 weken de symptomen van RLS verlaagt vergeleken met vitamine C alleen bij patiënten met RLS en laag-normale serumferritinespiegels. Op basis van deze resultaten rapporteren klinische praktijkrichtlijnen van de American Academy of Neurology dat het nemen van deze combinatie van oraal ferrosulfaat en vitamine C waarschijnlijk de symptomen verbetert bij patiënten met RLS en laagnormaal serumferritine.

IJzer kan ook de symptomen van RLS verminderen wanneer het intraveneus wordt toegediend. Klinische praktijkrichtlijnen van de American Academy of Neurology melden dat twee doses intraveneus carboxymaltose 500 mg met een tussenpoos van 5 dagen de symptomen en de kwaliteit van leven waarschijnlijk met 28 dagen zullen verbeteren bij patiënten met matige tot ernstige RLS, ongeacht de serum-ferritinespiegels. Intraveneuze ijzer sucrose is ook geëvalueerd bij patiënten met RLS, maar er is momenteel onvoldoende bewijs beschikbaar om het gebruik van deze vorm van ijzer voor de behandeling van RLS te ondersteunen of weerleggen.

Dosering & gebruik

Volwassen

Oraal:

Algemeen: voor volwassenen is de aanbevolen dagelijkse hoeveelheid (RI) voor ijzer 8 mg/dag voor mannen van 19 jaar en ouder en vrouwen van 51 jaar en ouder. Voor vrouwen van 19 tot 50 jaar is de RI 18 mg/dag. Voor zwangere vrouwen is de ADH 27 mg/dag. Voor vrouwen die borstvoeding geven is de ADH 10 mg/dag voor kinderen van 14 tot 18 jaar, en 9 mg/dag voor de leeftijd van 19 tot 50. Aanvaardbare bovengrens van inname voor ijzer bij personen van 14 jaar en ouder (inclusief zwangerschap en borstvoeding) is 45 mg/dag. Bovengrens aanbevelingen zijn niet van toepassing op mensen onder medisch toezicht voor ijzertekort.

Bloedarmoede door chronische ziekte: ijzer suppletie dagelijks 4-3 mg/kg tot 325 mg per dag gedurende maximaal 6 maanden is gebruikt voor chronische nieraandoeningen.

IJzergebreksanemie: voor de behandeling van ijzerdeficiëntie bij volwassenen wordt meestal driemaal per dag elementair ijzer van 50-100 mg gebruikt. Voor profylaxe bij volwassenen is elementair ijzer 60 mg per dag gebruikt. Intermitterende ijzerdoses van 30-120 mg per week zijn ook gebruikt voor het voorkomen en behandelen van bloedarmoede door ijzertekort bij menstruerende vrouwen. Twee tot drie maanden behandeling kan bloedarmoede met ijzertekort omkeren zonder de ijzervoorraad aan te vullen. Daarom wordt de behandeling gewoonlijk 6 maanden voortgezet om ijzervoorraden bij te vullen. IJzer sulfaat 60 mg op afwisselende dagen is gebruikt.

ACE-remmer-geassocieerde hoest: Ferrosulfaat 256 mg per dag is gebruikt.

Aan zwangerschap gerelateerd ijzertekort: elementair ijzer 20-225 mg is dagelijks gebruikt.

Rusteloze benen syndroom (RLS): Ferrous sulfaat 325 mg tweemaal daags gedurende 12 weken is gebruikt.

Vermoeidheid: Ferrosulfaat 80 mg per dag gedurende 4-12 weken werd gebruikt.

Lichamelijke prestaties: ijzersupplementen of verrijkte voedingsmiddelen die 30 - 200 mg ijzer bevatten, werden dagelijks gedurende 1-2 maanden gebruikt.

Postpartumdepressie: elementair ijzer 50 mg per dag is gebruikt.

Kinderen

Oraal:

Algemeen: de referentie inname (RI) van ijzer voor zuigelingen van 6 maanden en minder is 0,27 mg/dag. Voor oudere baby's en kinderen zijn de aanbevolen dagelijkse hoeveelheden voor ijzer: zuigelingen 7 tot 12 maanden, 11 mg/dag; kinderen van 1 tot 3 jaar, 7 mg/dag; 4 tot 8 jaar, 10 mg/dag; 9 tot 13 jaar, 8 mg/dag; jongens 14 tot 18 jaar, 11 mg/dag; meisjes 14 tot 18 jaar, 15 mg/dag. Aanvaardbare bovenste inname niveaus voor ijzer zijn: baby's en kinderen tot 13 jaar, 40 mg/dag; mensen van 14 jaar en ouder (inclusief zwangerschap en borstvoeding), 45 mg/dag.

ADHD: voor aandachtstekortstoornissen met hyperactiviteit (ADHD) is ijzersulfaat (Ferrocal) oraal, 5 mg/kg per dag gebruikt. Er is ook dagelijks een dosis ijzersulfaat (Tardyferon) 80 gebruikt.

Ademhalingsaanvallen: ijzersulfaat 5 mg/kg per dag werd gedurende 16 weken gebruikt.

Cognitieve functie: ferrous sulfate 650 mg tweemaal daags is gebruikt bij adolescenten met ijzertekort. Ferrous sulfaat 50 mg via de mond tweemaal per week gedurende 16 weken is gebruikt bij vrouwelijke middelbare scholieren.

HIV-gerelateerde anemie: elementair ijzer 3 mg/kg per dag samen met geconcentreerde multivitaminedruppels werd gedurende 3 maanden gebruikt bij kinderen van 6 maanden tot 10 jaar.

IJzergebreksanemie: voor de behandeling van kinderen met bloedarmoede met ijzertekort werd elementair ijzer van 2-6 mg/kg per dag, verdeeld in drie doses, gebruikt. Twee tot drie maanden behandeling kan bloedarmoede met ijzertekort omkeren zonder ijzervoorraden aan te vullen. Daarom wordt de behandeling gewoonlijk 6 maanden voortgezet om ijzervoorraden bij te vullen.

Voor het voorkomen van ijzertekort bij kinderen beveelt de Amerikaanse Academie voor Pediatrie richtlijnen aan voor sommige groepen. Voor zuigelingen die borstvoeding krijgen, wordt elementair ijzer 1 mg/kg/dag aanbevolen in de leeftijd van 4-6 maanden. Baby's van 6-12 maanden moeten 11 mg/dag krijgen uit voedsel of supplementen. Voor kinderen die te vroeg geboren zijn wordt 2 mg/kg/dag aanbevolen voor het eerste jaar. Kleuters van 1-3 jaar oud krijgen meestal genoeg ijzer uit voedsel om aan de aanbevolen dagelijkse hoeveelheid van 7 mg/dag te voldoen; er kan echter een supplement worden toegevoegd als dat nodig is.

Bijwerkingen

Oraal kan ijzer gastro-intestinale irritatie, buikpijn, obstipatie, diarree, misselijkheid en braken veroorzaken. Deze gastro-intestinale bijwerkingen komen soms voor bij doses lager dan de aanvaardbare bovengrens van inname van 45 mg per dag elementair ijzer bij volwassenen met normale ijzervoorraden. Deze gevallen zijn echter zeldzaam.

Interactie

Medicijnen

BISFOSFONATEN

Divalente kationen, waaronder ijzer, kunnen de absorptie van bisfosfonaten verminderen door onoplosbare complexen in het maagdarmkanaal te vormen. Adviseer patiënten bisfosfonaten te nemen ten minste twee uur na inname van alle andere medicijnen, waaronder supplementen zoals ijzer. De bisfosfonaten omvatten alendronaat (Fosamax), etidronaat (Didronel), risedronaat (Actonel) en tiludronaat (Skelid).

CHLOORAMFENICOL

Chlooramfenicol kan het effect van ijzertherapie verminderen, omdat het de rijping van erytrocyten verstoort. Omdat chlooramfenicol meestal niet gedurende langere tijd wordt ingenomen, is dit waarschijnlijk niet klinisch significant.

DOLUTEGRAVIR (Tivicay)

Farmacokinetisch onderzoek toont aan dat ijzer de absorptie van Dolutegravir uit het maagdarmkanaal door chelatie kan verminderen, waardoor de niveaus van Dolutegravir worden verlaagd. Om deze interactie te voorkomen, adviseren we patiënten om Dolutegravir minstens 2 uur vóór of 6 uur na het gebruik van ijzer in te nemen.

INTEGRASE REMMERS

IJzer is een tweewaardig kation. Er bestaat bezorgdheid dat ijzer de absorptie van Integraseremmers uit het maagdarmkanaal door chelatie kan verminderen. Dit zou de effectiviteit van deze geneesmiddelen verminderen. Eén farmacokinetische studie toont aan dat ijzer de bloedspiegels van de specifieke integraseremmer dolutegravir door chelatie kan verlagen. Ook toont ander farmacokinetisch onderzoek aan dat andere tweewaardige kationen zoals calcium de absorptie en niveaus van sommige integraseremmers door chelatie kunnen verlagen. Theoretisch zou het innemen van zink samen met integraseremmers de niveaus en effecten van deze geneesmiddelen kunnen verminderen. Integraseremmers omvatten dolutegravir (Tivicay), elvitegravir (Vitekta) en raltegravir (Isentress).

LEVODOPA

Er is enig bewijs bij gezonde mensen dat ijzer chelaten vormt met levodopa, waardoor de opname van levodopa wordt verminderd. De klinische betekenis hiervan is niet vastgesteld. Adviseer patiënten om de inname van levodopa en ijzer te scheiden.

LEVOTHYROXINE (Synthroid, Levothroid, Levoxyl en anderen)

IJzer kan de absorptie en werkzaamheid van levothyroxine verminderen door onoplosbare complexen in het maagdarmkanaal te vormen. Adviseer patiënten om levothyroxine en ijzerdoses met minimaal twee uur te scheiden.

METHYLDOPA (Aldomet)

Gelijktijdig gebruik van ijzer en methyldopa kan de absorptie van methyldopa verminderen, resulterend in een toename van de bloeddruk. Adviseer patiënten om de inname van ijzer- en methyldopa met minstens twee uur te scheiden.

MYCOPHENOLATE MOFETIL (CellCept)

Het effect van orale ijzersupplementen op de absorptie van mycofenolaatmofetil is onduidelijk. Er is gesuggereerd dat een afname van absorptie mogelijk is, waarschijnlijk door niet-absorbeerbare chelaten te vormen. De farmacokinetiek van mycofenolaat wordt echter niet beïnvloed door ijzersuppletie in beschikbaar klinisch onderzoek. Tot meer bekend is, als gelijktijdige therapie essentieel is, adviseren we patiënten om ijzer vier tot zes uur vóór of twee uur na mycofenolaat mofetil te nemen.

PENICILLAMINE (Cuprimine, Depen)

Orale ijzersupplementen kunnen de opname van penicillamine met 30% tot 70% verminderen, waarschijnlijk als gevolg van de vorming van chelaat. De werkzaamheid van penicillamine is verminderd bij de ziekte van Wilson; de klinische significantie bij mensen met reumatoïde artritis is niet bepaald. Adviseer patiënten om ten minste twee uur vóór of twee uur na het gebruik van ijzerhoudende supplementen penicillamine in te nemen.

QUINOLONE ANTIBIOTICA

IJzer vermindert de absorptie van chinolonen door de vorming van onoplosbare complexen in het maagdarmkanaal. Adviseer patiënten om deze antibiotica ten minste 2 uur vóór of 2 uur na ijzerhoudende supplementen in te nemen. Chinolonen omvatten ciprofloxacine (Cipro), levofloxacine (Levaquin), ofloxacine (Floxin) en anderen.

TETRACYCLINE ANTIBIOTICA

Gelijktijdig gebruik met ijzer kan de absorptie van tetracyclines in het maagdarmkanaal met 50% tot 90% verminderen. Adviseer patiënten om minstens 2 uur voor of 4 uur na tetracycline-antibiotica ijzer te gebruiken. Sommige van deze geneesmiddelen omvatten doxycycline (Vibramycin), minocycline (Minocin), tetracycline (Achromycin) en anderen.

Kruiden en supplementen

ACACIA: Acacia vormt een onoplosbare gel met ijzer. Het is niet bekend of dit leidt tot een significante interactie wanneer de twee samen worden ingenomen.

BETA-CAROTEEN/VITAMINE A: vitamine A lijkt betrokken te zijn bij het mobiliseren van ijzer uit weefselopslagplaatsen voor afgifte aan ontwikkelende rode bloedcellen in het beenmerg. Verbeteringen in de hemoglobinewaarden kunnen optreden bij mensen met anemie en lage serum-retinolspiegels als ze vitamine A-supplementen krijgen. Vitamine A kan ook een rol spelen bij de differentiatie en proliferatie van bloedstamcellen in het beenmerg en bij de synthese van erytropoëtine. Voorlopig bewijs suggereert ook dat vitamine A en bèta-caroteen de ijzerabsorptie van met ijzer verrijkte tarwe, maïsmeel en rijst kunnen verbeteren. Er wordt gesuggereerd dat deze vitaminen binden aan ijzer in de darm, waardoor de oplosbaarheid ervan verbetert en binding door polyfenolen en fytaat in het dieet wordt voorkomen. Polyfenolen en fytaat verminderen de ijzerabsorptie. Het is onwaarschijnlijk dat vitamine A-supplementen significante effecten zouden hebben op de ijzerstatus bij mensen zonder vitamine A-tekort.

CALCIUM: calcium remt de opname van via de voeding voorkomend heemijzer. Bij mensen met voldoende ijzervoorraden lijkt dit echter niet klinisch significant te zijn. Adviseer mensen die risico lopen op ijzertekort om calciumsupplementen te nemen voor het slapengaan, in plaats van bij maaltijden, om te voorkomen dat de ijzeropname door het dieet wordt geremd. Calciumsupplementen kunnen ook de opname van ijzersupplementen remmen. Het effect is echter zeer variabel en hangt af van de gebruikte zoutvorm, de aanwezigheid of afwezigheid van voedsel en het type voedsel. De klinische betekenis is onduidelijk, maar adviseer patiënten om calcium- en ijzersupplementen op verschillende momenten van de dag te nemen, indien mogelijk.

LACTOBACILLUS: bepaald klinisch onderzoek toont aan dat een fruitdrank die ijzer en 1 miljard kolonievormende eenheden van Lactobacillus plantarum 299v bevat, de opname van ijzer met ongeveer 9% verhoogt in vergelijking met een controle fruitdrank. De klinische betekenis van dit effect is onduidelijk.

RIBOFLAVINE: riboflavinesupplementen kunnen de hematologische respons op ijzersupplementen verbeteren bij sommige mensen met anemie. Er wordt gedacht dat riboflavine betrokken is bij de mobilisatie van ijzer voor heem-synthese uit de opslagvorm, ferritine en in globinesynthese. Dit effect is waarschijnlijk alleen significant bij mensen met riboflavinedeficiëntie.

SOJA: sojaproteïne vermindert de opname van voedingsarm non-heem (van planten afkomstig) ijzer, waarschijnlijk vanwege de binding van ijzer door fytaat en calcium in soja. Gefermenteerde sojaproducten lijken de ijzerabsorptie minder te remmen. De klinische betekenis van deze effecten is niet vastgesteld.

VITAMINE C: supplementaire of dieetvitamine C verbetert de opname van extra of voedingsrijk niet-heem (van planten afgeleid) ijzer dat tegelijkertijd wordt ingenomen. De hoeveelheid vitamine C in het dieet is een factor in de ijzeropname van het dieet en de ijzerstatus. Vitamine C kan de effecten tegengaan van stoffen die de ijzerabsorptie remmen, zoals fytaten, polyfenolen en tannines, mogelijk door ijzer chemisch te verminderen en de vorming van minder oplosbare ijzer (III) stoffen te voorkomen. Het innemen van een vitamine C-supplement om de opname van voedings- of supplementair ijzer te verbeteren is waarschijnlijk niet nodig voor de meeste mensen, vooral als hun dieet veel vitamine C bevat. Ook toont een aantal klinisch onderzoek aan dat het innemen van koper in combinatie met ijzer en ascorbinezuur de absorptiebevorderende effecten van vitamine C ontkracht.

ZINK: onder sommige omstandigheden kunnen ijzer en zink de absorptie van elkaar verstoren. Wanneer hoge supplementaire doses zink worden ingenomen op een lege maag, is er een meetbare vermindering van de ijzerabsorptie. Dit komt waarschijnlijk omdat de dragers voor ijzer en zink in de darm verzadigd raken in hoge doses en de ionen concurreren dan om niet-specifieke dragers. Als een van de ionen in overmaat aanwezig is, neemt de absorptie van de andere af. Wanneer voedsel aanwezig is, worden de ionen gecomplexeerd met voedselcomponenten en concurreren ze niet om absorptie. Daarom is er geen significante interactie tussen voedingsijzer en -zink, of tussen extra ijzer en zink bij inname met voedsel. Adviseer patiënten om deze supplementen met voedsel in te nemen.

Voedsel

KOFFIE EN THEE: Deze dranken kunnen de absorptie van zowel voedings- als extra ijzer verminderen wanneer ze tegelijkertijd worden ingenomen. Dit komt waarschijnlijk door de binding van ijzer in de darm door polyfenolen en tannines in thee en koffie. Deze effecten kunnen mogelijk bijdragen aan ijzergebreksanemie, vooral bij mensen met andere risicofactoren.

ZUIVELPRODUCTEN: calcium in zuivelproducten zoals melk en kaas kan de opname van ijzer verminderen. Het is onwaarschijnlijk dat dit klinisch significant is bij mensen met voldoende ijzervoorraden. Maximale absorptie van ijzersupplementen treedt op wanneer het op een lege maag wordt ingenomen. Dit verhoogt echter het risico op maagirritatie. Als een patiënt ijzer moet nemen met voedsel om irritatie te verminderen adviseren we om zuivelproducten te vermijden.

VOEDSEL: het nemen van ijzersupplementen met voedsel kan de ijzeropname met 40% tot 50% verminderen. Verschillende bestanddelen van voedsel kunnen aan ijzer binden en de absorptie verminderen. Voor maximale absorptie moeten patiënten ijzer op een lege maag innemen. Sommige patiënten kunnen dit echter niet verdragen vanwege gastro-intestinale bijwerkingen. Adviseer patiënten die ijzer met voedsel innemen om zuivelproducten, koffie, thee en ontbijtgranen te vermijden.

Lab testen

Geen bijwerkingen bekend.

Ziektes

ACHLORHYDRIË: een verminderde maagzuurgraad kan de ijzerabsorptie schaden.

DIABETES: er bestaat bezorgdheid dat een hoge inname van ijzer door eten gepaard gaat met een verhoogd risico op hartaandoeningen bij vrouwen met type 2-diabetes. Vrouwen met diabetes type 2, die een hoge inname van heemijzer hebben uit voedingsbronnen zoals rood vlees, hebben een 50% groter risico op coronaire hartziekten vergeleken met vrouwen met een lage inname. Dit risico lijkt ook hoger te zijn bij postmenopauzale vrouwen in vergelijking met premenopauzale vrouwen met type 2-diabetes. De rol van ijzer bij hartziekten is controversieel. Sommige onderzoekers speculeren dat diabetespatiënten mogelijk meer vatbaar zijn voor de nadelige effecten van ijzer. De metabole afwijkingen die optreden bij mensen met diabetes, zoals dyslipidemie, kunnen de nadelige cardiovasculaire effecten van ijzer verhogen.

GASTROENTERITIS: ijzer kan maagirritatie veroorzaken en deze aandoening verergeren.

HEMODIALYSE: aanvullende ijzerabsorptie is verminderd bij personen die chronische hemodialyse nodig hebben.

HEMOGLOBINEZIEKTEN: ijzeroverbelasting zal zich waarschijnlijk voordoen bij mensen met hemoglobinopathieën of andere anemieën die ten onrechte als bloedarmoede met ijzertekort zijn gediagnosticeerd.

HEMATOLOGISCHE OMSTANDIGHEDEN: ijzersuppletie gaat gepaard met een verhoogd risico op bloedneuzen bij patiënten met erfelijke hemorrhagische telangiëctasieën; voorzichtig gebruiken.

MALABSORPTIE SYNDROMEN: orale-ijzertherapie kan ineffectief zijn bij personen met diarree, post-gastrectomie of andere malabsorptiesyndromen.

PEPTIC ULCER-ZIEKTE: ijzer kan irritatie veroorzaken en deze aandoening verergeren.

FYSIEKE INSPANNING: aanvullende ijzerabsorptie lijkt af te nemen bij jonge vrouwen die deelnemen aan fysieke training, gemeten aan de hand van serum-ferritinespiegels.

VOORTIJDIGE ZUIGELINGEN: gebruik van orale ijzerpreparaten bij te vroeg geboren kinderen met lage vitamine E-spiegels kan hemolyse en hemolytische anemie veroorzaken; vitamine E-tekorten moeten worden gecorrigeerd voordat extra ijzer wordt toegediend.

ULCERATIEVE COLITIS: ijzer kan gastro-intestinale irritatie veroorzaken en deze aandoening verergeren.

Werkingsmechanisme

IJzer is een sporenmineraal dat wordt aangetroffen in twee ionische vormen in het lichaam. Het meeste ijzer in het lichaam wordt gevonden in het hemoglobine van rode bloedcellen en in het myoglobine van spiercellen waar het nodig is voor het transport van zuurstof en kooldioxide. IJzer functioneert ook in de elektronentransportketen als een elektronendrager in cytochromen. Het wordt ook gevonden in de functionele groepen van de meeste enzymen in de Krebs-cyclus (945). IJzer is een essentiële cofactor in de synthese van neurotransmitters zoals dopamine, norepinephrine en serotonine.

Vlees, zoals rood vlees, gevogelte en vis, levert ijzer in heem- en non-heemvormen. Vlees bevat ongeveer 40% heemijzer en 60% non-heemijzer. Heemijzer wordt geabsorbeerd met een snelheid van 23% vergeleken met 2% tot 20% voor non-heemijzer. IJzer uit plantenbronnen bestaat alleen in de vorm van non-heem. Ascorbinezuur en ferri-reductase in de twaalfvingerige darm helpen bij de absorptie van non-heemijzer. De biologische beschikbaarheid van ijzer van een vegetarisch dieet wordt geschat op 5% tot 10%. Vlees en vis lijken de opname van non-heemijzer te verbeteren.

Bloedarmoede met ijzertekort lijkt in het vroege leven een negatief effect te hebben op gedrag en de neurale ontwikkeling. Tekenen en symptomen van een tekort omvatten onder andere microcytische en hypochrome anemie, lethargie, cognitieve stoornissen, ontwikkelingsachterstand, amenorroe, haaruitval en een vergrote lever. IJzerdeficiëntie tijdens de zwangerschap is in verband gebracht met ongunstige zwangerschapsuitkomsten en verhoogde perinatale maternale mortaliteit.

Neurologische effecten: er is interesse in het gebruik van ijzer om aandachtstekortstoornissen met hyperactiviteit (ADHD) te behandelen. Onderzoek suggereert dat kinderen met ADHD vaker ijzertekort hebben. Het niveau van ijzerdeficiëntie lijkt positief te correleren met de ernst van ADHD-symptomen. ADHD-symptomen houden verband met dopamine-disfunctie waar ijzer een rol lijkt te spelen. IJzer beïnvloedt de dopaminesynthese en lijkt een rol te spelen in de dopaminereceptordichtheid.

Ademhalingseffecten: hoest geassocieerd met (ACE) -remmers kan in verband worden gebracht met de ophoping van stikstofmonoxide. Aangezien ijzer de productie van stikstofmonoxide lijkt te verminderen, kan dit effect klinisch nuttig zijn bij de onderdrukking van hoest geassocieerd met ACE-remmers.

Bovenstaande monografie is geschreven aan de hand van de onderstaande referenties.

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Gerelateerde aandoeningen

Aandoening Dagdosering*
Bloedarmoede 1 x daags 10 mg
Gastritis 2 x daags 7 mg
Rusteloze benen Uitsluitend op basis van bloedonderzoek indien er een ijzertekort is
Vruchtbaarheid vrouwen, verminderd Uitsluitend op basis van bloedonderzoek indien er een ijzertekort is
Zwangerschap 25 mg