How to increase low ferritin levels?

From the Guidelines

To increase low ferritin levels, it is recommended to take an oral iron supplement, such as ferrous sulfate (325 mg), ferrous gluconate (300 mg), or ferrous fumarate (100 mg), once or twice daily, as this has been shown to be effective in raising ferritin levels 1. When taking oral iron supplements, it is essential to take them on an empty stomach with vitamin C, such as orange juice, to enhance absorption, and avoid taking them with calcium, dairy, coffee, tea, or antacids, which can reduce absorption 1. Some key points to consider when increasing ferritin levels include:

• Consuming iron-rich foods, such as red meat, liver, oysters, beans, lentils, spinach, and fortified cereals
• Cooking in cast iron pans to add iron to food
• Avoiding digestive issues by taking supplements with food, switching to a lower dose, or asking a doctor about a gentler formulation like iron bisglycinate
• Considering intravenous iron infusions for severe iron deficiency, as recommended by a doctor 1 It is also important to note that iron supplements typically take 3-6 months to significantly raise ferritin levels, and the goal ferritin level is 50 ng/mL, regardless of sex at birth, in the absence of inflammation 1. Regular laboratory monitoring, including CBC and iron parameters, such as ferritin and transferrin saturation, is necessary to evaluate the response to iron supplementation and adjust treatment as needed 1.

From the FDA Drug Label

Serum ferritin increased at endpoint of study from baseline in the Venofer-treated population (165.3 ± 24.2 ng/mL) compared to the historical control population (-27.6 ± 9. 5 ng/mL). Increases in mean hemoglobin (1.1 ± 0.2 g/dL), hematocrit (3.6 ± 0.6%), serum ferritin (266.3 ± 30.3 ng/mL) and transferrin saturation (8.7 ± 2.0%) were observed from baseline to end of treatment. Increases from baseline in mean hemoglobin (1. 7 g/dL), hematocrit (5%), serum ferritin (434.6 ng/mL), and serum transferrin saturation (14%) were observed at week 2 of the observation period and these values remained increased at week 4 of the observation period.

To increase low ferritin levels, intravenous iron supplementation with Venofer (iron sucrose) can be effective. The studies show that Venofer treatment resulted in significant increases in serum ferritin levels, ranging from 165.3 ng/mL to 434.6 ng/mL, depending on the study and population. Key points to consider:

• Dosing and administration: Venofer was administered in doses of 100 mg during sequential dialysis sessions until a pre-determined total dose of iron was administered.
• Population: The studies included patients with hemodialysis-dependent or non-dialysis-dependent chronic kidney disease, as well as pediatric patients with chronic kidney disease.
• Efficacy: The studies demonstrated significant increases in hemoglobin, hematocrit, serum ferritin, and transferrin saturation in patients treated with Venofer compared to historical controls or oral iron supplementation. 2

From the Research

Increasing Ferritin Levels

To increase low ferritin levels, several options can be considered:

• Iron supplementation: Studies have shown that iron supplements, such as ferrous sulfate 3 and ferric gluconate 4, 5, can effectively increase ferritin levels.
• Lactoferrin: Research has demonstrated that lactoferrin is a more effective and safer alternative to ferrous sulfate for treating iron deficiency and iron deficiency anemia in pregnant women, leading to increased ferritin levels 6.
• Dietary changes: Although not directly mentioned in the studies, a diet rich in iron can help increase ferritin levels.

Treatment Options

Different treatment options are available:

• Oral iron supplements: Ferrous gluconate 7 and ferrous sulfate 3, 5 have been shown to be effective in increasing ferritin levels.
• Intravenous iron supplements: Ferric gluconate 4, 5 has been demonstrated to be effective in increasing ferritin levels, particularly in patients with high serum ferritin and low transferrin saturation.
• Lactoferrin: As mentioned earlier, lactoferrin has been shown to be a more effective and safer alternative to ferrous sulfate for treating iron deficiency and iron deficiency anemia in pregnant women 6.

Patient Response

Patient response to treatment may vary:

• Increase in ferritin levels: Studies have shown that treatment with iron supplements and lactoferrin can lead to significant increases in ferritin levels 3, 6, 4, 7, 5.
• Hemoglobin response: Treatment with intravenous ferric gluconate has been shown to produce a significantly greater increase in hemoglobin and hemoglobin response compared to oral iron or no iron 5.