From the Guidelines
The recommended treatment for patients with low ferritin levels (iron deficiency) is oral iron supplementation, typically with ferrous sulfate 325 mg taken 1-3 times daily between meals with vitamin C to enhance absorption. Alternative formulations include ferrous gluconate 300 mg or ferrous fumarate 200 mg if ferrous sulfate causes intolerable gastrointestinal side effects such as constipation, nausea, or abdominal pain 1. Treatment should continue for 3-6 months even after blood counts normalize to replenish iron stores. For severe cases or those who cannot tolerate oral supplements, intravenous iron formulations like iron sucrose, ferric carboxymaltose, or iron dextran may be necessary, as suggested by the AGA clinical practice update on management of iron deficiency anemia 1.
Some key points to consider when treating iron deficiency include:
- Addressing the underlying cause of iron deficiency, whether it's blood loss, poor dietary intake, or malabsorption
- Dietary modifications to increase iron-rich foods (red meat, spinach, beans, fortified cereals) should complement supplementation
- Iron supplements work by providing the essential element needed for hemoglobin production in red blood cells, allowing proper oxygen transport throughout the body and restoring depleted iron stores in the bone marrow and liver
- The goal of treatment is to improve quality of life and decrease the risk of complications related to anemia, as emphasized in the recent clinical practice guidelines 1
It's also important to note that intravenous iron administration is used to replace iron losses rapidly in patients not reaching target therapeutic goal with oral supplementation, those requiring a fast supplementation, or in case of repeated failure of first-step oral therapy 1. The choice of intravenous iron formulation should be based on the patient's individual needs and medical history, with ferric carboxymaltose being a well-studied option 1.
Overall, the treatment of iron deficiency should be tailored to the individual patient's needs, with a focus on improving quality of life and reducing the risk of complications related to anemia.
From the FDA Drug Label
Injectafer is indicated for the treatment of: • iron deficiency anemia (IDA) in: adult and pediatric patients 1 year of age and older who have either intolerance or an unsatisfactory response to oral iron. For patients weighing 50 kg or more, the recommended dosage is: Injectafer 750 mg intravenously in two doses separated by at least 7 days for a total cumulative dose of 1,500 mg of iron per course
The recommended iron supplement for low ferritin levels is Injectafer (ferric carboxymaltose), administered intravenously. The dosage is based on the patient's weight, with a total cumulative dose of 1,500 mg of iron per course for patients weighing 50 kg or more.
- Key considerations:
- Patient weight
- Intolerance or unsatisfactory response to oral iron
- Dosage separated by at least 7 days 2
From the Research
Treatment Options for Low Ferritin Levels
- Iron deficiency and iron-deficiency anemia can be treated effectively with oral iron supplementation, but in patients who are unable to take or who do not respond to oral iron therapy, intravenous iron administration is recommended 3, 4.
- Intravenous iron preparations, such as iron sucrose, ferric carboxymaltose, and iron dextran, can be used to rapidly increase hemoglobin, ferritin, and transferrin saturation levels 3, 4, 5.
- Ferric carboxymaltose is an effective therapy in patients with iron-deficiency anemia who have gastrointestinal disorders and has a safety profile comparable to that of other IV iron agents 5, 6.
Oral Iron Supplementation
- Oral iron treatment can be effective in increasing hemoglobin and ferritin levels, but may cause gastrointestinal side effects 7.
- 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 7.
Intravenous Iron Therapy
- Intravenous iron therapy is reserved for iron deficiency anemia patients with intolerance or unresponsiveness to oral iron 4.
- The main treatment target for intravenous iron therapy is an improvement of the quality of life, for which hemoglobin is a surrogate marker 4.
- Individual selection of the appropriate iron therapy and evaluation of treatment response are mandatory to safely deliver improved outcomes through intravenous iron therapies 4.