From the Guidelines
The initial treatment for Iron Deficiency Anemia (IDA) should be with one tablet per day of ferrous sulphate, fumarate or gluconate. This recommendation is based on the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults, which suggests that oral iron therapy is the first line of treatment 1.
Key Considerations
- The choice of oral iron preparation can be based on patient tolerance and side effect profile, with ferrous sulphate, fumarate, or gluconate being suitable options 1.
- If the patient is unable to tolerate the standard dose, a reduced dose of one tablet every other day or alternative oral preparations can be considered 1.
- Parenteral iron should be considered when oral iron is contraindicated, ineffective, or not tolerated 1.
Monitoring and Follow-up
- Patients should be monitored in the first 4 weeks for an Hb response to oral iron, and treatment should be continued for a period of around 3 months after normalization of the Hb level 1.
- After the restoration of Hb and iron stores with iron replacement therapy, the blood count should be monitored periodically to detect recurrent IDA 1.
From the FDA Drug Label
The safety and efficacy of Triferic in patients with HDD-CKD was assessed in two randomized, single blind, placebo-controlled clinical trials. The FDA drug label does not answer the question.
From the Research
Initial Treatment for Ida
The initial treatment for Iron Deficiency Anemia (IDA) typically involves iron supplementation. According to 2, oral iron supplementation can be an effective strategy to treat and prevent IDA. The recommended dose is 60-120 mg of iron as a ferrous salt given with ascorbic acid on alternate days.
Oral Iron Supplementation
- The fraction of iron absorbed from high doses of oral iron is low, and unabsorbed iron can cause gut irritation, inflammation, and dysbiosis, reducing compliance 2.
- Oral iron doses ≥60 mg in iron-deficient women, and doses ≥100 mg in women with IDA, stimulate an acute increase in hepcidin that persists 24 h after the dose, but subsides by 48 h 2.
- To maximize fractional iron absorption, oral doses ≥60 mg should be given on alternate days 2.
Diagnosis and Treatment
- Iron deficiency anemia is diagnosed by low serum ferritin (typically <30 ng/mL) in individuals without inflammatory conditions or by transferrin saturation (iron/total iron binding capacity × 100) less than 20% 3.
- Causes of iron deficiency should be identified and treated 3.
- Oral iron (ferrous sulfate 325 mg/d or on alternate days) is typically first-line therapy 3.
- Intravenous iron is indicated for patients with oral iron intolerance, poor absorption (celiac disease, post-bariatric surgical procedure), chronic inflammatory conditions (CKD, HF, IBD, cancer), ongoing blood loss, and during the second and third trimesters of pregnancy 3.
Patient Preference
- A patient-preference study found that the majority of patients (74.9%) preferred intravenous iron treatment over oral iron supplements 4.
- The reasons cited for preferring intravenous iron therapy included ease of administration, fewer side effects, and difficulty remembering to take oral iron tablets 4.