From the Guidelines
Oral iron supplements should be considered as the first-line treatment for patients with mild anemia or iron deficiency, as they are effective and less expensive than intravenous iron, according to the most recent guideline 1. When treating anemia without iron infusions, several alternatives can be considered, including:
- Oral iron supplements, such as ferrous sulfate, ferrous gluconate, or ferrous fumarate, which are typically taken 1-3 times daily between meals with vitamin C to enhance absorption 1
- Dietary modifications, including consuming iron-rich foods like red meat, spinach, beans, and fortified cereals
- Other medications, depending on the cause of anemia, such as:
- Vitamin B12 injections for B12 deficiency
- Folic acid supplements for folate deficiency
- Erythropoiesis-stimulating agents like epoetin alfa for kidney disease-related anemia It is essential to continue oral iron supplements for 3-6 months after hemoglobin normalizes to replenish iron stores, as recommended by the ESPEN guideline 1. Additionally, starting with a lower dose and gradually increasing can improve tolerance to oral iron supplements, which may cause gastrointestinal side effects like constipation, nausea, and black stools 1. Iron infusions are typically reserved for cases where oral supplements are ineffective, poorly tolerated, or when rapid correction of iron deficiency is needed, as stated in the AGA clinical practice update 1.
From the FDA Drug Label
Evaluate iron status before and during treatment and maintain iron repletion. Correct or exclude other causes of anemia before initiating treatment RETACRIT is an erythropoiesis-stimulating agent (ESA) indicated for: • Treatment of anemia due to o Chronic Kidney Disease (CKD) in patients on dialysis and not on dialysis • Reduction of allogeneic red blood cell (RBC) transfusions in patients undergoing elective, noncardiac, nonvascular surgery
The alternatives to iron infusions for treating anemia include:
- Erythropoiesis-stimulating agents (ESAs), such as epoetin alfa, which can help increase red blood cell production and reduce the need for transfusions 2.
- Maintaining iron repletion and correcting or excluding other causes of anemia before initiating treatment 2.
- Treatment of underlying conditions, such as chronic kidney disease or cancer, that may be contributing to anemia 2 2.
From the Research
Alternatives to Iron Infusions for Treating Anemia
There are several alternatives to iron infusions for treating anemia, including:
- Oral iron supplementation, which is usually the first line of treatment for iron-deficiency anemia and pre-anemic iron deficiency 3
- Dietary changes, such as increasing iron intake through food sources like haem and free iron, and avoiding inhibitors of iron uptake 4
- Ferrous sulfate plus folic acid supplementation, which has been shown to be effective in treating anemia in children 5
Oral Iron Supplementation
Oral iron supplementation is a common alternative to iron infusions, and there are several different formulations available, including:
- Ferrous sulfate, which is the simplest and most commonly prescribed oral iron supplement 3
- Ferric maltol, which is a lipophilic iron donor that has been shown to be effective in correcting iron-deficiency anemia and replenishing iron stores 3
- Nanoparticle encapsulated sucrosomial iron, which is a novel iron formulation that has been developed in recent years 3
Dosage and Frequency of Oral Iron Supplementation
The dosage and frequency of oral iron supplementation can vary depending on the individual and the severity of their anemia. Some studies have suggested that:
- Alternate day dosing of oral iron supplements may be preferable to consecutive day dosing, as it can increase iron absorption by 40-50% 6
- Twice the daily target dose of iron should be given on alternate days to provide the same total amount of iron as consecutive day dosing 6
Monitoring and Follow-up
It is important to monitor and follow up with patients who are being treated for anemia with oral iron supplementation, including: