What are the oral supplement recommendations for iron deficiency anemia?

From the Guidelines

For iron deficiency, I recommend starting with one tablet per day of ferrous sulphate, fumarate, or gluconate, as this is the most recent and evidence-based approach 1. This recommendation is based on the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults, which suggests that the initial treatment of IDA should be with one tablet per day of ferrous sulphate, fumarate, or gluconate, with a strong statement strength and medium evidence quality. Some key points to consider when taking iron supplements include:

• Taking supplements on an empty stomach, ideally 1 hour before or 2 hours after meals, to enhance absorption
• Avoiding taking iron supplements with calcium, dairy, coffee, tea, or antacids, which can reduce absorption
• Continuing supplementation for 3-6 months even after blood counts normalize to replenish iron stores
• Managing common side effects, such as constipation, nausea, and black stools, by starting with a lower dose and gradually increasing, taking with small amounts of food if necessary, or switching to a different iron formulation
• Considering alternative options, such as ferrous gluconate or ferrous fumarate, if ferrous sulphate causes gastrointestinal distress It's also important to note that vitamin C co-administration may improve oral absorption, although the evidence supporting this practice is limited 1. If symptoms like extreme fatigue, shortness of breath, or dizziness worsen despite supplementation, it's essential to consult a healthcare provider, as intravenous iron might be necessary 1.

From the FDA Drug Label

CONTAINS: Each tablet contains 324 mg of ferrous sulfate, equivalent to 65 mg of elemental iron, providing 362% of the U.S. recommended daily intake (RDI) of iron for adults and children 4 and older. DESCRIPTION Each tablet contains 324 mg of ferrous gluconate, equivalent to 38 mg of elemental iron, providing 211% of the U.S. recommended daily intake (RDI) of iron for adults and children 4 and older. Directions for Use Do not crush or chew tablets. Adult Serving Size: 1 tablet three to four times daily. Children: Consult a physician.

Oral Supplement Recommendations:

• For adults, the recommended serving size is 1 tablet three to four times daily for ferrous gluconate 2.
• The ferrous sulfate label does not provide explicit dosage instructions 3.
• Children: should consult a physician for dosage instructions 2.

From the Research

Iron Deficiency Oral Supplement Recommendations

• The current evidence suggests that oral iron supplementation is the first line of treatment to improve hemoglobin levels in patients with iron deficiency anemia (IDA) 4.
• Studies have compared the effectiveness of different oral iron supplements, including ferrous sulfate and iron polysaccharide complex, in improving hemoglobin concentrations in patients with IDA 5, 6, 7.
• Ferrous sulfate has been shown to be effective in increasing hemoglobin levels in patients with IDA, with a greater increase in hemoglobin concentration compared to iron polysaccharide complex 5.
• However, ferrous sulfate may cause more gastrointestinal side effects compared to other oral iron supplements, such as iron polysaccharide complex and lactoferrin 5, 6, 8.
• Lactoferrin has been shown to be a superior supplement to ferrous sulfate in improving serum iron parameters and hemoglobin levels, with fewer gastrointestinal side effects 8.
• The dosing regimen of oral iron supplements may also impact their effectiveness, with daily and every other day regimens being compared in several studies 4, 6.
• A low-dosage of iron treatment every other day may be used in place of providing iron once or twice every day, with similar effectiveness and lower rates of gastrointestinal side effects 6.

Key Findings

• Ferrous sulfate is effective in increasing hemoglobin levels in patients with IDA 5, 7.
• Lactoferrin is a superior supplement to ferrous sulfate in improving serum iron parameters and hemoglobin levels, with fewer gastrointestinal side effects 8.
• The dosing regimen of oral iron supplements may impact their effectiveness, with daily and every other day regimens being compared in several studies 4, 6.

Oral Iron Supplements

• Ferrous sulfate: effective in increasing hemoglobin levels, but may cause gastrointestinal side effects 5, 7.
• Iron polysaccharide complex: may be better tolerated than ferrous sulfate, but less effective in increasing hemoglobin levels 5.
• Lactoferrin: superior to ferrous sulfate in improving serum iron parameters and hemoglobin levels, with fewer gastrointestinal side effects 8.
• Ferrous gluconate: effective in improving iron status in toddlers, with a higher increase in hemoglobin and ferritin levels compared to ferrous sulfate 7.