Should oral iron supplements be discontinued in patients receiving intravenous Venofer (iron sucrose) for iron deficiency anemia?

From the Guidelines

Oral iron supplements should be discontinued in patients receiving intravenous Venofer (iron sucrose) for iron deficiency anemia, as administering both simultaneously is redundant and potentially counterproductive. The most recent and highest quality study, published in 2024 in the Clinical Gastroenterology and Hepatology journal 1, suggests that IV iron is indicated when oral iron is not effective or tolerated. This implies that oral iron can be stopped when IV iron is initiated.

The use of IV iron, such as Venofer, is preferred in situations where oral iron is unlikely to be effective, such as in patients with impaired absorption or those who require rapid iron repletion 1. Continuing oral iron during IV iron therapy may increase the risk of iron overload and associated side effects, such as gastrointestinal disturbances like constipation, nausea, and abdominal discomfort.

Key points to consider:

• IV iron is used to bypass the gastrointestinal tract and provide iron directly to the bloodstream
• Oral iron can cause gastrointestinal side effects that can be avoided by discontinuing them during IV iron therapy
• The healthcare provider will determine whether to resume oral iron based on follow-up iron studies and the patient's specific needs after the IV iron course is completed
• The most recent guidelines suggest using IV iron when oral iron is not effective or tolerated, implying that oral iron can be stopped when IV iron is initiated 1.

From the Research

Discontinuation of Oral Iron Supplements

• The decision to discontinue oral iron supplements in patients receiving intravenous Venofer (iron sucrose) for iron deficiency anemia depends on several factors, including the presence of inflammation, the time available for iron replenishment, and the anticipated risk of side-effects or intolerance 2.
• Intravenous iron preparations, such as Venofer, are indicated for the treatment of iron deficiency when oral preparations are ineffective or cannot be used 2, 3.
• Studies have shown that intravenous iron therapy can be effective and safe for the management of iron deficiency anemia, with some patients achieving faster and more significant improvements in hemoglobin and serum ferritin levels compared to oral iron therapy 4, 5.

Considerations for Discontinuing Oral Iron Supplements

• The use of intravenous iron does not necessarily mean that oral iron supplements should be discontinued, as the two forms of iron therapy can be used concurrently or sequentially depending on the patient's needs and response to treatment 2, 3.
• Factors to consider when deciding whether to discontinue oral iron supplements include the patient's iron deficiency status, the presence of inflammation or other conditions that may affect iron absorption, and the potential for side effects or interactions with other medications 2, 3.
• More research is needed to determine the optimal approach to iron therapy in patients with iron deficiency anemia, including the use of intravenous iron and oral iron supplements 4, 6.

Potential Benefits and Risks

• Intravenous iron therapy can provide rapid iron repletion and improve symptoms of iron deficiency anemia, but it can also be associated with potential side effects, such as infusion-related reactions, skin staining, and hypophosphataemia 3, 5.
• Oral iron supplements can be effective for mild to moderate iron deficiency anemia, but they may be associated with gastrointestinal side effects, such as constipation, diarrhea, and nausea 5.
• The choice between intravenous iron and oral iron supplements should be individualized based on the patient's specific needs and circumstances, and should take into account the potential benefits and risks of each form of therapy 2, 3.