What is the recommended treatment for iron deficiency anemia?

From the Guidelines

The recommended treatment for iron deficiency anemia is oral iron supplementation, typically with ferrous sulfate 200 mg taken twice daily, as this is the most recent and highest quality recommendation from the available evidence 1.

Key Considerations

• The goal of treatment is to correct anemia and replenish body iron stores, which can be achieved with oral iron supplementation in most cases.
• Ferrous sulfate is a commonly used and effective oral iron formulation, and the dose of 200 mg twice daily is recommended as it is well-tolerated and effective in correcting iron deficiency anemia 1.
• Other oral iron formulations, such as ferrous fumarate or ferrous gluconate, may also be used, but ferrous sulfate is generally considered the first-line treatment.
• Treatment should continue for at least 3 months after hemoglobin normalizes to replenish iron stores, as recommended by the guidelines 1.

Addressing Underlying Causes

• It is essential to identify and address the underlying cause of iron deficiency, which may include blood loss (menstrual, gastrointestinal), poor dietary intake, or malabsorption.
• Dietary changes to include iron-rich foods like red meat, beans, and leafy greens can complement supplementation therapy.
• In cases where oral iron is not tolerated or effective, intravenous iron formulations like iron sucrose or ferric carboxymaltose may be considered, as recommended by the guidelines 1.

Monitoring and Follow-up

• Serum ferritin levels should be monitored to assess the effectiveness of treatment and to avoid iron overload, especially in children and adolescents 1.
• Regular follow-up appointments are necessary to monitor the patient's response to treatment and to adjust the treatment plan as needed.

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. The FDA drug label does not answer the question.

From the Research

Iron Deficiency Anemia Treatment

The recommended treatment for iron deficiency anemia includes:

• Oral iron supplementation as the first line of treatment 2, 3, 4, 5
• Ferrous sulfate is a commonly used iron supplement, but it can cause gastrointestinal side effects 4, 6
• Alternative iron formulations, such as ferric maltol or nanoparticle encapsulated sucrosomial iron, may be better tolerated 4
• Lactoferrin supplementation may be a superior option to ferrous sulfate, with better effects on serum iron, ferritin, and hemoglobin levels, as well as anti-inflammatory effects 6

Oral Iron Supplementation Dosage and Frequency

• The optimal dosage and frequency of oral iron supplementation are still debated, but studies suggest:
  • Doses of 60-120 mg iron as a ferrous salt given with ascorbic acid on alternate days may be an optimal oral dosing regimen for women with iron-deficiency and mild IDA 2
  • Total iron absorption may be higher if twice the target daily iron dose is given on alternate days 2
  • Morning doses may be more effective than afternoon or evening doses due to the circadian increase in plasma hepcidin 2

Special Considerations

• Underlying causes of iron deficiency should be sought in all patients, including screening for coeliac disease and endoscopic investigation to exclude bleeding gastrointestinal lesions 3
• Intravenous iron therapy may be necessary in cases where oral iron supplementation is contraindicated or ineffective 3, 4, 5
• Patient populations, such as pregnant individuals, children, and adolescents, may require special consideration and tailored treatment approaches 5