Patient/caregiver was educated on contraindications for using Feratab as follows:

  1. Feratab must be avoided or administered with extreme caution in individuals with history of hemochromatosis, an inherited condition that results in the body absorbing dietary iron in significantly large amounts than normal. Excess of dietary iron absorbed results in iron overload and accumulation in various vital organs, such as, nervous tissues, liver, skin, pancreas, and heart, leading to the symptoms of tissue iron toxicity. This results in compromised organ function and debility. Toxic iron overload and accumulation in the liver can result in long-term changes like chronic abdominal pain, hepatitis, cirrhosis, liver failure, and even hepatocellular carcinoma. Iron overload and accumulation in the heart can result in arrhythmias and congestive heart failure. Deposition of iron in the pancreas can lead to inflammation of pancreas, deficient secretion of digestive pancreatic enzymes with compromised digestion and overall metabolism, and reduced insulin secretion, leading to diabetes. Accumulation of iron in nervous tissues can result in neuropathy with pain, altered sensation, and tingling and numbness in the extremities. Individuals with iron accumulation in the nervous tissues can also present with altered cognition, reduced memory, episodes of confusion and loss of consciousness, and in severe cases can result in seizures. Administering Feratab in these individuals can worsen the toxicity with iron overload.
  2. Feratab must be administered with extreme caution in individuals with history of hemolytic anemias, such as, sickle cell or thalassemia. Hemolytic anemias usually are inherited genetic defects, resulting in poor structural stability of the red blood cells. Structurally deficient red blood cells are prone to damage and lysis, before completion of their lifespan. Hemolytic anemia can also be secondary to autoimmunity, when individuals can develop antibodies acting against their own red blood cells, thus resulting in damage of lysis of the cells. Irrespective to the basic pathology, individuals with history of hemolysis can present with findings of anemia. As blood cells are lysed in these individuals, the released heme and iron accumulate in the body in various vital organs, leading to the symptoms of tissue iron toxicity. Administering Feratab in these individuals, to offset anemic symptoms, can worsen the toxicity with iron overload and so, must be done with extreme caution.