From the Guidelines
The treatment of choice for iron deficiency anemia is oral iron supplementation, typically with ferrous sulfate 100-200 mg/day, in divided doses, as recommended by the most recent ESPEN micronutrient guideline 1. The patient's symptoms, including glossitis with loss of tongue papillae, xerosis of the skin, and koilonychia, are consistent with iron deficiency anemia.
- The recommended treatment should continue for 3-6 months to correct the anemia and replenish iron stores.
- Iron supplements should be taken on an empty stomach or with vitamin C to enhance absorption, while avoiding concurrent intake of calcium, dairy, tea, coffee, or antacids which can reduce absorption.
- Common side effects include constipation, nausea, and black stools, and starting with a lower dose and gradually increasing can improve tolerance.
- For patients who cannot tolerate oral iron or have malabsorption disorders, intravenous iron formulations (such as iron sucrose or ferric carboxymaltose) may be necessary, as suggested by the European Crohn's and Colitis Organization guidelines 1 and the ESPEN guideline on clinical nutrition in inflammatory bowel disease 1.
- The underlying cause of iron deficiency should always be identified and addressed, whether it's blood loss, poor dietary intake, or malabsorption, and treatment effectiveness can be monitored by checking hemoglobin levels after 2-4 weeks, with an expected rise of approximately 1-2 g/dL per month. Among the options provided, Fer-in-sol is an oral iron supplement, which is the preferred initial treatment, whereas Injectafer is an intravenous iron formulation that may be considered for patients who cannot tolerate oral iron or have malabsorption disorders. Dodex and Epogen are not typically used as first-line treatments for iron deficiency anemia.
From the FDA Drug Label
1 INDICATIONS & USAGE Venofer is indicated for the treatment of iron deficiency anemia (IDA) in patients with chronic kidney disease (CKD).
The treatment of choice for iron deficiency anemia is iron supplementation.
- The patient's symptoms such as glossitis with loss of tongue papillae, xerosis of the skin, and koilonychia are consistent with iron deficiency anemia.
- Among the options provided, Fer-in-sol is an oral iron supplement, and Injectafer is an intravenous iron supplement.
- Based on the drug label information, intravenous iron (2) is a suitable treatment option for iron deficiency anemia.
- Therefore, the treatment of choice for this patient would be Injectafer, which is an intravenous iron supplement.
From the Research
Treatment Options for Iron Deficiency Anemia
The patient's symptoms, including glossitis with loss of tongue papillae, xerosis of the skin, and koilonychia, are indicative of iron deficiency anemia. The treatment of choice for iron deficiency anemia is:
- Oral iron supplementation, which is the first line of treatment 3
- Ferrous sulfate is the simplest, least expensive, and most commonly prescribed oral iron supplement 3
Intravenous Iron Therapy
Intravenous iron therapy can be used when:
- Oral iron supplementation is contraindicated 3
- Oral iron supplementation is ineffective or not tolerated 4, 5
- Rapid correction of iron deficit is required 6
Available Treatment Options
The available treatment options for iron deficiency anemia include:
- Fer-in-sol (oral iron supplement)
- Injectafer (intravenous iron supplement)
- Dodex (not a commonly used treatment for iron deficiency anemia)
- Epogen (not a treatment for iron deficiency anemia, but rather a treatment for anemia related to chronic kidney disease)
Recommended Treatment
Based on the available evidence, the recommended treatment for iron deficiency anemia is oral iron supplementation, with ferrous sulfate being a commonly prescribed option 3. If oral iron supplementation is not effective or tolerated, intravenous iron therapy can be considered 4, 5, 6.