From the Guidelines
Oral iron supplementation with ferrous sulfate, fumarate, or gluconate is the recommended initial treatment for iron deficiency anemia, with intravenous iron considered for those who cannot tolerate oral supplements or have severe deficiency. Treatment of low iron typically involves iron supplementation, either through oral or intravenous methods [ 1 ]. For most people with mild to moderate iron deficiency, oral iron supplements like ferrous sulfate, ferrous gluconate, or ferrous fumarate taken 1-3 times daily are recommended [ 1 ]. These should be taken on an empty stomach with vitamin C (like orange juice) to enhance absorption, though they can be taken with food if stomach upset occurs.
Key Considerations
- Treatment usually continues for 3-6 months to replenish iron stores completely, even after symptoms improve [ 1 ].
- For those who cannot tolerate oral supplements due to side effects like constipation, nausea, or abdominal pain, or in cases of severe deficiency, intravenous iron formulations may be necessary [ 1 ].
- Dietary changes are also important, incorporating iron-rich foods like red meat, spinach, beans, and fortified cereals.
- The underlying cause of iron deficiency should always be identified and addressed, whether it's blood loss, poor absorption, or inadequate intake [ 1 ].
Special Considerations
- In patients with iron-deficiency anemia and celiac disease, ensuring adherence to a gluten-free diet is crucial to improve iron absorption [ 1 ].
- Intravenous iron therapy should be considered if iron stores do not improve with oral iron supplementation [ 1 ].
From the FDA Drug Label
Intravenous or intramuscular injections of INFeD are indicated for treatment of patients with documented iron deficiency in whom oral administration is unsatisfactory or impossible. Ferrlecit is indicated for the treatment of iron deficiency anemia in adult patients and in pediatric patients age 6 years and older with chronic kidney disease receiving hemodialysis who are receiving supplemental epoetin therapy.
The treatment options for iron deficiency (ID) anemia include:
- Intravenous (IV) iron therapy: with medications such as iron dextran (INFeD) 2 or ferric gluconate (Ferrlecit) 3
- Oral iron administration: although the label notes that IV administration may be used when oral administration is unsatisfactory or impossible 2 Key considerations for therapy include:
- Hemoglobin levels: the goal of therapy is to restore hemoglobin concentration to normal or near normal levels, as well as replenish iron stores 2
- Patient population: treatment options may vary depending on the patient population, such as adult patients or pediatric patients with chronic kidney disease receiving hemodialysis 3
From the Research
Treatment Options for Iron Deficiency Anemia
The treatment options for iron deficiency anemia include:
- Oral iron supplementation, which is the first line of treatment 4
- Intravenous iron therapy, which can be used when oral iron supplementation is contraindicated or ineffective 4, 5, 6
Oral Iron Supplementation
Oral iron supplementation can be administered in various forms, including:
- Ferrous sulfate, which is the simplest, least expensive, and most commonly prescribed drug 4
- Other ferrous salts and ferric complexes with polysaccharides or succinylated milk proteins 4
- Novel iron formulations, such as ferric maltol or nanoparticle encapsulated sucrosomial iron 4
- Daily or every other day dosing, with studies suggesting that every other day dosing may improve patient compliance without compromising treatment effectiveness 7
Dosage and Frequency
The recommended dosage and frequency of oral iron supplementation vary, but common regimens include:
- 100-200 mg daily dose of elemental iron, with lower doses if side effects occur 5
- Daily divided doses of iron to increase absorption, although this may increase serum hepcidin and decrease iron absorption 7
Intravenous Iron Therapy
Intravenous iron therapy can be used to rapidly achieve therapeutic targets without gastrointestinal complications, and is often recommended for patients who: