What is the best oral iron supplement for a patient with iron deficiency anemia?

From the Guidelines

Ferrous sulfate is the best oral iron supplement for patients with iron deficiency anemia, given its low cost and equivalent effectiveness to other formulations 1. The typical recommended dose is 325 mg (65 mg elemental iron) taken once daily, as taking it more than once a day does not improve absorption but may increase side effects 1. To enhance absorption, ferrous sulfate should be taken with vitamin C (such as orange juice) and avoided within 2 hours of calcium supplements, dairy products, coffee, tea, or antacids 1. Common side effects include constipation, nausea, and black stools. If ferrous sulfate isn't tolerated, alternatives include ferrous gluconate (less elemental iron but potentially better tolerated) or ferrous fumarate. Treatment should continue for 3-6 months after hemoglobin normalizes to replenish iron stores completely. Regular monitoring of hemoglobin levels is important to assess response to treatment. Some patients may better tolerate every-other-day iron dosing, which may have similar or equal rates of iron absorption as daily dosing 1.

Key considerations for the patient with a colostomy and a hemoglobin of 8.6 in a rehab setting include:

• Starting with a low dose of ferrous sulfate and gradually increasing as needed and tolerated
• Monitoring for gastrointestinal side effects, which may be more pronounced in patients with a colostomy
• Ensuring adequate vitamin C intake to enhance iron absorption
• Avoiding concurrent administration of medications or substances that may inhibit iron absorption, such as calcium supplements, dairy products, coffee, and tea.

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.

The best oral iron supplement for a patient with iron deficiency anemia is ferrous sulfate because it contains a higher amount of elemental iron (65 mg) compared to ferrous gluconate (38 mg) 2. This makes ferrous sulfate a more potent option for treating iron deficiency anemia. The patient should take one tablet of ferrous sulfate as directed by a physician, likely three to four times daily, to help increase their hemoglobin level.

From the Research

Oral Iron Supplements for Iron Deficiency Anemia

The patient's condition of iron deficiency anemia, indicated by a hemoglobin level of 8.6, requires prompt treatment. Given the unavailability of IV iron, oral iron supplements are the best alternative.

• Ferrous sulfate is the most commonly prescribed oral iron supplement, due to its efficacy, low cost, and wide availability 3, 4.
• Other oral iron formulations, such as ferric maltol, nanoparticle encapsulated sucrosomial® iron, and iron polysaccharide complex, are also available 3, 5.
• Sucrosomial® iron has been shown to have higher iron intestinal absorption and excellent gastrointestinal tolerance compared to oral iron salts, making it a valid first option for patients who are intolerant or refractory to conventional iron salts 5.
• Ferrous sulfate has been compared to iron polysaccharide complex in a randomized clinical trial, which found that ferrous sulfate resulted in a greater increase in hemoglobin concentration at 12 weeks 6.

Considerations for Oral Iron Supplementation

When selecting an oral iron supplement, considerations should include:

• Efficacy in increasing hemoglobin levels and replenishing iron stores
• Tolerability and potential for gastrointestinal side effects
• Cost and availability
• Patient-specific factors, such as age, sex, and underlying medical conditions

Recommendations

Based on the available evidence, ferrous sulfate is a suitable option for oral iron supplementation in patients with iron deficiency anemia, including those with a colostomy 3, 4, 6. However, for patients who are intolerant or refractory to conventional iron salts, Sucrosomial® iron may be a valid alternative 5.