From the Guidelines
For iron deficiency anemia, I would prescribe oral iron supplements as the first line of treatment. The recommended medication is ferrous sulfate, with a dosage of one tablet per day, as suggested by the British Society of Gastroenterology guidelines 1. Alternatively, ferrous gluconate or ferrous fumarate can be used, with the dosage adjusted according to the patient's tolerance and response to treatment.
Key Considerations
- The treatment duration is typically 3 to 6 months to replenish iron stores, with follow-up blood tests to monitor hemoglobin and ferritin levels 1.
- In cases where oral iron supplements are not tolerated or ineffective, intravenous iron formulations such as iron sucrose or ferric carboxymaltose may be considered, with dosages and administration schedules determined on a case-by-case basis 1.
- The optimal dosage and administration schedule for intravenous iron formulations vary depending on the specific product and patient factors, such as body weight and hemoglobin level 1.
- Regular monitoring of hemoglobin and ferritin levels is essential to ensure an adequate response to treatment and to adjust the dosage and administration schedule as needed 1.
- Some studies suggest that intermittent oral iron therapy, such as alternate-day dosing, may be as effective as daily dosing in raising hemoglobin levels, with a lower incidence of gastrointestinal side effects 1.
- Parenteral iron should be considered when oral iron is contraindicated, ineffective, or not tolerated, and in patients with chronic disease, continuing blood loss, impaired absorption, or gastrointestinal inflammatory pathology 1.
From the FDA Drug Label
INJECTAFER is a prescription iron replacement medicine used for the treatment of: iron deficiency anemia (IDA) in: adults and children 1 year of age and older who cannot tolerate iron taken by mouth (oral) or who have not responded well to oral iron INJECTAFER is given into your vein (intravenously) by your healthcare provider INJECTAFER is usually given in 2 doses at least 7 days apart for IDA, or 6 weeks apart for iron deficiency with mild to moderate heart failure to improve exercise capacity.
- Medications for IDA:
- Ferric carboxymaltose (INJECTAFER)
- Iron sucrose (VENOFER)
- Dosages for IDA:
- Ferric carboxymaltose (INJECTAFER): usually given in 2 doses at least 7 days apart
- Iron sucrose (VENOFER): dosage forms and strengths include 50 mg/2.5 mL, 100 mg/5 mL, or 200 mg/10 mL (20 mg/mL) in single-dose vials 2 The information provided is based on the FDA drug labels for ferric carboxymaltose (INJECTAFER) 3 and iron sucrose (VENOFER) 2.
From the Research
Medications for Iron Deficiency Anemia (IDA)
- Ferrous sulfate is the simplest, least expensive, and most commonly prescribed drug for IDA 4
- Other ferrous salts and ferric complexes with polysaccharides or succinylated milk proteins are also widely used 4
- Novel iron formulations, such as ferric maltol and nanoparticle encapsulated sucrosomial iron, have been developed 4
Dosages for IDA
- The current recommended dosage for oral supplementation is 200 mg ferrous fumarate 3 times per day, but this is based on a single small study of poor quality 5
- 100 mg ferrous fumarate once a day may be sufficient for symptom-free patients with anemia 5
- 200 mg/day may be prescribed for patients with severe anemia or symptoms 5
- Alternate-day dosing may be effective in reducing side effects and improving compliance 6, 7, 8
- A morning dose of 60-120 mg iron as a ferrous salt given with ascorbic acid on alternate days may be an optimal oral dosing regimen for women with iron-deficiency and mild IDA 6
Parenteral Iron Therapy
- Parenteral iron therapy can rapidly achieve therapeutic targets without gastrointestinal complications when oral iron supplementation is contraindicated 4
- Parenteral supplementation is more effective than oral supplementation in specific conditions, such as dialysis-dependent renal insufficiency, heart failure, or active IBD 5