From the Guidelines
Oral iron supplements, particularly ferrous sulfate, are the first-line treatment for iron deficiency anemia, with a recommended dose of 50-100 mg of elemental iron daily. The choice of oral iron preparation is largely based on cost, side effects, and patient tolerance 1. According to the British Society of Gastroenterology guidelines, a once daily dose of 50-100 mg of elemental iron, such as one ferrous sulfate 200 mg tablet a day, taken in the fasting state may be the best compromise option for initial treatment 1.
Some key points to consider when prescribing oral iron supplements include:
- Take iron supplements on an empty stomach with vitamin C (like orange juice) to enhance absorption, though they can be taken with food if stomach upset occurs 1
- Avoid taking iron with calcium, dairy, coffee, tea, or antacids, which reduce absorption 1
- Common side effects include constipation, nausea, and black stools 1
- For patients who cannot tolerate oral iron due to side effects or have malabsorption issues, intravenous iron formulations like iron sucrose or ferric carboxymaltose may be necessary 1
It's also important to note that the optimal duration of treatment is unclear, but it's recommended to continue oral iron for 2-3 months after hemoglobin normalizes to replenish iron stores 1. Regular hemoglobin monitoring is recommended to ensure an ultimately satisfactory response, with an optimal interval of every 4 weeks until the hemoglobin is in the normal range 1.
In cases where oral iron is not effective or tolerated, intravenous iron supplementation may be necessary, with formulations that can replace iron deficits with 1 to 2 infusions preferred 1. However, intravenous iron is substantially more expensive than oral formulations, and its use should be reserved for situations where oral iron is unlikely to be effective or has failed 1.
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 medication that should be given for iron deficiency anemia is ferrous sulfate (PO), as it contains 65 mg of elemental iron per tablet, which is 362% of the U.S. recommended daily intake (RDI) of iron for adults and children 4 and older 2.
- The key ingredient is ferrous sulfate.
- The dosage form is oral tablets.
From the Research
Medication Options for Iron Deficiency Anemia
The following medications are commonly used to treat iron deficiency anemia:
- Ferrous sulfate: a widely prescribed and inexpensive oral iron supplement 3
- Ferric salts: also used as oral iron supplements, with some studies suggesting they may have fewer gastrointestinal side effects than ferrous salts 4
- Ferric complexes with polysaccharides or succinylated milk proteins: alternative oral iron supplements 3
- Sucrosomial iron: a new oral iron formulation that may be effective in correcting iron deficiency anemia at higher doses than other oral iron formulations 5
- Intravenous iron therapy: used when oral iron supplementation is contraindicated, as it can rapidly achieve therapeutic targets without gastrointestinal complications 3, 5
- Carbonyl iron: an elemental iron powder that has been shown to be safe and effective in treating iron deficiency anemia, with minimal gastrointestinal side effects 6
Treatment Regimens
Different treatment regimens have been studied, including:
- Daily oral iron replacement therapy: commonly recommended to increase absorption 7
- Every other day oral iron replacement therapy: may be equally effective as daily therapy, with improved patient compliance 7
- High-dose oral iron therapy: may be effective in correcting iron deficiency anemia, especially in patients who are refractory or intolerant to standard oral iron therapy 5