Greater Glasgow and Clyde Medicines

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The Emergency Care Summary (ECS) for patients with a diagnosis of schizophrenia may show no record of any antipsychotic prescription; this may indicate they are prescribed a specialist medicine such as clozapine or an antipsychotic depot.

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• Serum ferritin (SF) is the most useful test for iron deficiency.
• Serum iron, transferrin levels and transferrin saturation (TSAT) are labile measurements and not reliable indicators of low iron stores. Their role should be limited to investigation of high SF values and possible iron overload.
• Low SF (<15micrograms/L) provides absolute evidence of iron deficiency.
• Ferritin levels can be elevated by inflammatory processes and can mask iron deficiency.
• SF >100micrograms/L generally rules out IDA even in the presence of inflammatory disease.
• If SF results are equivocal, practitioners should consider monitoring the haemoglobin (Hb) concentration in response to a trial of oral iron.

• Patients diagnosed with clinically significant IDA should have iron replacement therapy to correct anaemia and replenish iron stores.
• Treatment should normally be conducted in parallel with investigations to determine the underlying cause. However, for some patients such as those with complex multi-morbidity or approaching end of life, such investigations may not be appropriate.
• Oral iron is the first line treatment of choice*.
• Prescribe ferrous fumarate 210mg or ferrous sulfate 200mg once a day as initial therapy (see below for information on dosing).
• Oral iron therapy should be continued for 3 months after haemoglobin (Hb) optimised and then stopped (consider ongoing prophylaxis in at risk patients).
• The irritant adverse effects of oral iron are related to the amount of elemental iron taken rather than the type of preparation.
• Iron preparations with a low content of elemental iron must be tried (with food) before acceptance of genuine intolerance to oral iron.

 * see inclusion criteria for IV iron therapy in full guideline, including use as first line agent in certain clinical settings.

IV iron:

• Should be reserved as a second line treatment choice in the management of IDA.*
• Does not produce a faster Hb response than oral iron (provided that the oral iron preparation is taken reliably and is absorbed adequately).
• Can cause hypersensitivity reactions which may be life-threatening or fatal (only administer during working hours when adequate supervision is available).
• Paravenous leakage may lead to permanent staining at the site of infusion.

 * see inclusion criteria for IV iron therapy in full guideline, including use as first line agent in certain clinical settings.

• Oral iron is the first line treatment of choice.
• Investigations to determine the underlying cause should be considered in parallel with treatment.
• IV iron should be reserved as a second line treatment option.*

* see inclusion criteria for IV iron therapy in full guideline, including use as first line agent in certain clinical settings.

To access the full blog via Microsoft Sway, click here

To access the full blog via Microsoft Sway, click here

Key Messages

• Non-pharmacological approaches should be used first-line to manage stress and distress in dementia.
• Psychotropic medications carry the risk of side effects which may cause serious avoidable harms (e.g. falls, sedation, etc) and should be used as a last resort in the management of stress and distress - other causes should be ruled out including infection, constipation, and pain.
• If required, the lowest effective dose of psychotropic medication should be prescribed for the shortest possible period with regular review.
• For patients under Community Mental Health Teams (CMHT) psychotropic medication changes should be made in collaboration with their CMHT.