From the Guidelines
The first line treatment for iron deficiency anemia is oral iron supplementation, as recommended by the most recent guideline 1. This approach is supported by the latest evidence, which suggests that oral iron should be considered as first-line treatment in patients with iron deficiency or mild anemia, whose disease is clinically inactive, and who have not been previously intolerant to oral iron 1.
- Key points to consider when prescribing oral iron supplementation include:
- Typical dosing with ferrous sulfate 325 mg taken 1-3 times daily, providing 65 mg of elemental iron per tablet
- Alternative formulations such as ferrous gluconate or ferrous fumarate may also be used
- Supplements should be taken on an empty stomach or with vitamin C to enhance absorption
- Patients should avoid taking iron supplements with calcium, antacids, tea, coffee, and dairy products, which can inhibit absorption
- Treatment duration should be 3-6 months, with 2-3 months to correct the anemia and an additional 3-4 months to replenish iron stores 1.
- Common side effects of oral iron supplementation include constipation, nausea, and black stools, which can be minimized by starting with a lower dose and gradually increasing as needed.
- Patients should be advised that improvement in hemoglobin levels typically begins within 1-2 weeks, but complete resolution of symptoms may take longer, as iron supplementation works by providing the essential building block for hemoglobin synthesis, allowing the bone marrow to produce more red blood cells and correct the oxygen-carrying capacity of the blood. While an earlier guideline also recommended oral iron as first-line treatment 1, the most recent guideline 1 provides the strongest and most up-to-date evidence to support this approach.
From the FDA Drug Label
Injectafer is indicated for the treatment of: • iron deficiency anemia (IDA) in: adult and pediatric patients 1 year of age and older who have either intolerance or an unsatisfactory response to oral iron. The first line treatment for iron deficiency anemia is not explicitly stated in the provided drug labels. However, it can be inferred that ferric carboxymaltose (IV) is an option for patients who have either intolerance or an unsatisfactory response to oral iron 2, 2, 2.
- Key points:
- Indication: Iron deficiency anemia (IDA) in adult and pediatric patients.
- Administration: Intravenously, either as an undiluted slow intravenous push or by infusion.
- Dosage: Varies based on patient weight and medical condition. It is essential to consult the drug label and medical professionals for the most appropriate treatment plan.
From the Research
Iron Deficiency Anemia Treatment
The first line treatment for iron deficiency anemia involves oral iron supplementation, as stated in the study 3. This treatment is usually efficacious in correcting iron-deficiency anemia and replenishing iron stores.
Oral Iron Supplementation
- The simplest, least expensive, and most commonly prescribed drug is ferrous sulfate, while other ferrous salts and ferric complexes with polysaccharides or succinylated milk proteins are also widely used 3.
- Daily doses of oral iron supplementation range between 80 mg and 200 mg of elemental iron 4.
- Iron protein succinylate (Ferplex®) is an alternative to ferrous sulphate (FeSO4) with a better tolerability profile, and is equally effective in the treatment of IDA 4.
- Oral iron-replacement therapy is the mainstay of treatment for iron-deficiency anemia, but it is often poorly tolerated or ineffective 5.
Dosage and Frequency
- A study suggests that oral iron doses ≥60 mg in iron-deficient women, and doses ≥100 mg in women with IDA, stimulate an acute increase in hepcidin that persists 24 h after the dose, but subsides by 48 h 6.
- To maximize fractional iron absorption, oral doses ≥60 mg should be given on alternate days 6.
- Providing morning 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 6.
Transition to Intravenous Iron
- When oral iron supplementation is contraindicated, intravenous iron therapy can rapidly achieve therapeutic targets without gastrointestinal complications 3.
- Hemoglobin responses <1.0 g/dL at day 14 of oral iron identify subjects with iron-deficiency anemia who should be transitioned to IV iron supplementation 5.