How does it work?

Galfer FA capsules contain two active ingredients, ferrous fumarate and folic acid. Ferrous fumarate is a form of iron and folic acid is a member of the B group of vitamins.

Both iron and folic acid are needed by the body for the formation of red blood cells. If the body does not receive adequate amounts of these nutrients, anaemia can develop.

During pregnancy the daily requirement for both iron and folic acid increases. This is because the mother must increase her production of red blood cells to supply the foetus and, in addition, the foetus and placenta need their own supply of iron, which can only be obtained from the mother.

If a pregnant woman doesn't increase her iron and folic acid intake, either through her diet or by taking supplements, she may become anaemic. This medicine is used to supplement the diet with both iron and folic acid and thus help prevent anaemia.

The absorption of iron from the gut is decreased if it is taken at the same time as coffee, tea, eggs or milk. Its absorption is enhanced if it is taken at the same time as foods or supplements containing vitamin C (ascorbic acid).

What is it used for?

• Preventing iron and folic acid deficiency in pregnancy.

This iron and folic acid supplement is designed for use by pregnant women who are at high risk of developing iron and folic acid deficiency during the second and third trimesters of pregnancy. This may include women carrying twins or triplets and women who have had pregnancies close together. The supplement will also correct mild iron deficiency anaemia if this has already developed before the supplements are started. However, it does not contain a high enough dose to treat folic acid deficiency anaemia and should not be used for this purpose.

You shouldn't use this medicine as your folic acid supplement for the first trimester of pregnancy. Women are recommended to take 400 micrograms of folic acid daily both before conception and for the first 12 weeks of pregnancy, in order to reduce the risk of your baby having spina bifida or another neural tube defect. This medicine only contains 350 micrograms folic acid and so is not suitable for this purpose. Once you reach 12 weeks you can stop taking your 400 microgram folic acid and take this medicine instead, because your baby's nervous system is developed by this stage so you don't need as much folic acid.

Not every pregnant women needs to take an iron and folic acid supplement, so you should talk to your doctor, pharmacist or midwife about whether this medicine is suitable for you.

How do I take it?

• One Galfer FA capsule should be taken once a day, or as directed by your doctor. The medicine should be taken before food on an empty stomach. However, if the capsules upset your stomach, then you may take them with or after food.
• The absorption of iron may be reduced by tea, coffee, eggs and milk. You should avoid consuming these at the same time as taking Galfer FA capsules.
• The capsules should be swallowed whole and not chewed or broken.

Warning!

• This medicine may discolour the stools black or darker than usual. This is normal and not harmful.
• This medicine contains iron and so should be kept well out of the sight and reach of children, as iron overdose can be fatal in children.

Not to be used in

• People with anaemia due to vitamin B₁₂ deficiency (pernicious anaemia).
• People with anaemia due to folic acid deficiency.
• Genetic disease resulting in too much iron storage in the tissues (haemochromatosis).
• People with a disorder that affects storage of iron in the body (haemosiderosis).
• People with a condition where there is sudden loss of haemoglobin (oxygen carrying protein in the blood) in the urine at night (paroxysmal nocturnal haemoglobinuria).
• People with other disorders involving haemoglobin, such as sickle cell anaemia or thalassaemia.
• People receiving repeated blood transfusions.
• People with an active peptic ulcer.
• Inflammatory bowel disease such as ulcerative colitis or Crohn's disease.
• Children.

This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

• This medicine is safe to take during pregnancy. However, you should check with your doctor or midwife if it is necessary for you to take an iron and folic acid supplement during your pregnancy. Not all pregnant women need to take supplements; you may be getting enough nutrients from your diet.
• There are no known harmful effects when this medicine is used by breastfeeding mothers.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Abdominal pain.
• Constipation.
• Diarrhoea.
• Nausea and vomiting.
• Loss of appetite.
• Darkening of stools.

If you get an upset stomach after taking these capsules on an empty stomach this may be helped by taking the capsules with food.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.

Iron supplements can affect the absorption of a number of medicines from the gut, which can make these medicines less effective. For this reason, it is recommended that iron supplements are taken at least two hours before or two hours after other medicines, in order to minimise this effect. The medicines for which this is most important are listed below:

• bisphosphonates, eg alendronate
• eltrombopag
• entacapone
• levodopa
• levothyroxine
• methyldopa (iron tablets may also reduce the blood pressure lowering effect of methyldopa)
• penicillamine
• quinolone-type antibiotics, eg ciprofloxacin, norfloxacin, ofloxacin, levofloxacin
• tetracycline-type antibiotics, eg oxytetracycline, doxycycline, minocycline, tetracycline (these antibiotics also reduce the absorption of the iron supplements from the gut).

Zinc and calcium supplements reduce the absorption of iron supplements. Separate the medicines by at least two hours.

Antacids for heartburn or indigestion, such as magnesium carbonate, magnesium hydroxide, aluminium hydroxide and calcium carbonate may decrease the absorption of iron from the gut and thereby make the supplements less effective. Separate the medicines by at least two hours.

Trientene, used to treat Wilson's disease, also reduces the absorption of iron supplements from the gut, making them less effective unless the doses are separated by at least two hours.

Milk, milk-containing products, tea, coffee and eggs, may decrease iron absorption from the gut, while vitamin C (ascorbic acid) increases it.

Folic acid may reduce the blood levels of the antiepileptic medicines phenobarbital, phenytoin and primidone. If you take folic acid in combination with one of these antiepileptic medicines your doctor may need to increase the dose of the antiepileptic to make sure your seizures remain controlled.

Other medicines containing the same active ingredients