From the Guidelines
Iron supplements are recommended for treating anemia caused by iron deficiency, with the most recent guidelines suggesting oral iron supplements as the first line of treatment. The standard treatment is ferrous sulfate 200 mg taken orally twice daily, as recommended by 1, which provides about 65 mg of elemental iron per dose. Alternatively, ferrous gluconate or ferrous fumarate can be used, with typical doses of oral iron supplements being 100-200 mg/day, in divided doses, as suggested by 1.
Key Considerations
- Take iron supplements on an empty stomach with vitamin C (like orange juice) to enhance absorption, though they can be taken with food if stomach upset occurs.
- Treatment typically continues for 3-6 months to replenish iron stores, even after hemoglobin levels normalize, as recommended by 1.
- Common side effects include constipation, black stools, and stomach discomfort.
- Iron supplements work by providing the essential building blocks for hemoglobin production, allowing the body to create more red blood cells to transport oxygen effectively.
Special Considerations
- For severe anemia (hemoglobin <7 g/dL) or when oral therapy isn't tolerated, intravenous iron formulations may be necessary under medical supervision, as suggested by 1 and 1.
- In individuals with portal hypertensive gastropathy and iron-deficiency anemia, oral iron supplements should be used initially to replenish iron stores, with intravenous iron therapy reserved for patients with ongoing bleeding who do not respond to oral iron therapy, as recommended by 1.
- Regular blood tests are important to monitor response to treatment and to avoid toxicity of iron overload, especially in children and adolescents, with serum ferritin levels preferably not exceeding 500 mg/L, as suggested by 1.
From the Research
Iron Supplementation for Anemia
- Iron deficiency is a common cause of morbidity and can arise as a consequence or complication from many diseases 2
- The use of intravenous iron has increased significantly in the last decade, but concerns remain about indications and administration 2
Oral Iron Supplementation
- Oral iron is the mainstay of treating iron deficiency anemia 3
- Recent studies indicate better fractional iron absorption with alternate day supplementation 3
- A randomized controlled trial compared the effectiveness of daily versus alternate day supplementation of oral iron for treatment of iron deficiency anemia, and found no significant difference between the two groups 3
- Another study found that a low-dosage of iron treatment every other day may be used in the place of providing iron once or twice every day with similar effectiveness and lower rates of gastrointestinal side effects 4
Comparison of Iron Supplements
- A systematic review and meta-analysis compared the effects of oral lactoferrin and ferrous sulfate supplementation on iron-deficiency anemia, and found that lactoferrin had better effects on serum iron, ferritin, and hemoglobin concentration 5
- Lactoferrin supplementation also had a reducing effect on fractional iron absorption and IL-6 levels compared with ferrous sulfate 5
Administration and Side Effects
- Intravenous iron preparations are indicated for the treatment of iron deficiency when oral preparations are ineffective or cannot be used 2
- Adverse events occurring with intravenous iron can be anticipated according to when they typically occur, which provides a basis for educating and preparing staff and patients on how iron infusions can be administered safely and efficiently 2
- Gastrointestinal side effects were significantly higher in patients receiving high doses of iron compared to those receiving low doses 4