Investigation of the side effects that cause the change of treatment plans in women receiving iron treatment

Women are prone to iron deficiency anaemia. Since iron deficiency anaemia is common in pregnant women due to increased demand, prophylactic iron preparations are started. The bioavailability of the preparations used is different and various side effects are observed. Iron treatments are given in various forms such as iv, drip, tablet, oral suspension. These treatments contain various active substances such as iron carboxymaltose, ferro furamate, ferrous sulphate, iron (II) glycine-sulphate complex, iron (III) hydroxide polymaltose, iron (III) isomaltose. In this study, we aimed to investigate the most common side effects by comparing the iron preparations used in treatment and to investigate which side effects led to drug changes in the patient during the continuation of treatment. This study included 270 female patients who applied to the obstetrics and gynaecology hospital pregnancy outpatient clinic and general hospital general internal medicine outpatient clinic in Ankara Bilkent City Hospital between 1 October 2023 and 30 November 2023. Our study is a cross-sectional descriptive survey study. The questionnaire form made by the researchers was applied to the patients by face-to-face interview. A questionnaire form consisting of 20 questions was used. The questionnaire form included questions about the sociodemographic characteristics of the participants, reasons for drug use, duration, habits; the form of the drug, side effects, reasons for drug discontinuation, drug changes. This information was obtained by using the interview form developed by the researcher. Data were analysed with IBM-SPSS (Version 24.0) programme and statistical significance was taken as p<0.05. The study included 270 patients receiving iron replacement therapy. Iron (III) hydroxide polymaltose complex was most commonly used by 27.4% of the participants. Nausea was the most common complaint with 35.9%. 34.8% of the patients reported that they had changed their current iron treatment, and 37% had stopped iron medication for some reason. The most common reason for both was nausea (73.4%, 84%), respectively. In patients who changed their medication, the rate of experiencing side effects with the previous medication was found to be statistically significantly higher (p<0.05). The rates of discontinuation and change of medication in patients who used iron (III) polymaltose complex (88.9%, 88.9%) were statistically significant and high (p<0.05). When the distribution of side effects according to the drug used was analysed, the rate of dyspeptic complaints in patients using iron (III) polymaltose complex (55.6%) was found to be significantly higher than the rate of this side effect in other drugs. The rate of drug discontinuation due to nausea in iron (III) polymaltose complex users (88.9%) was found to be statistically significantly higher compared to other drugs (p<0.05). The rate of drug discontinuation due to heartburn in patients using iron (III) polymaltose complex (22.2%) was found to be statistically significantly higher than those using ferro fumarate and iron (III) hydroxide polymaltose complex (p<0.05). In patients using iron preparations, it was statistically significant that either the medication was changed or the patient discontinued the treatment due to gastrointestinal side effects. The most common symptom affecting the results such as drug change and discontinuation of treatment was nausea with 73.4% and 84%, respectively. When we look at the side effects, only nausea was statistically more common in the non-pregnant group (p<0.005). Iron (III) hydroxide polymaltose complex was the most commonly used treatment with 74% of the patients. Side effects were also observed after the change of treatment and the most common side effect was nausea with 60%. The choice of preparations that can be used in iron deficiency should be based on the patient's tolerability and comorbidities, and the treatment of each patient should be individualised accordingly. The patient should be reminded that she can change her treatment by contacting her physician again in case of a condition that she cannot tolerate.