What are the medication recommendations for home iron replacement therapy?

Home Iron Replacement Therapy Recommendations

For iron deficiency anemia, oral iron therapy with ferrous sulfate 200 mg once daily is recommended as first-line treatment, with therapy continued for 3 months after normalization of hemoglobin to ensure adequate replenishment of iron stores. 1

Oral Iron Therapy Options

First-line Therapy

• Ferrous sulfate: 200 mg once daily (contains 65 mg elemental iron) 1, 2
  • Most cost-effective option at approximately £1.00 for 28 days of treatment 1
  • Higher doses (twice daily) may not improve absorption due to hepcidin upregulation 1

Alternative Oral Formulations (if intolerance occurs)

• Ferrous fumarate: 210 mg daily (contains 69 mg elemental iron) 1
• Ferrous gluconate: 300 mg daily (contains 37 mg elemental iron) 1, 3
• Ferric maltol: 30 mg twice daily - better tolerated but more expensive option 1

Administration Recommendations

Dosing Strategy

• Consider alternate-day dosing if daily dosing causes side effects, as this may improve fractional iron absorption 1
• Take on empty stomach (1 hour before or 2 hours after meals) to maximize absorption
• Avoid taking with tea, coffee, milk, or antacids which can reduce absorption
• Consider adding vitamin C (250-500 mg) with iron to enhance absorption 1

Duration of Therapy

• Monitor hemoglobin response after 4 weeks of starting therapy 1
• Continue treatment for 3 months after hemoglobin normalizes to replenish iron stores 1, 4

Special Considerations

When to Consider IV Iron Instead of Oral Iron

Intravenous iron should be considered when:

1. Oral iron is contraindicated, ineffective, or not tolerated 1
2. Rapid correction of anemia is needed 5
3. Patient has active GI bleeding where oral iron cannot compensate for blood loss 6
4. Patient has inflammatory bowel disease or other GI disorders that may be aggravated by oral iron 6
5. Patient is taking proton pump inhibitors (like omeprazole) which can significantly reduce oral iron absorption 7

Monitoring Protocol

• Check hemoglobin after 4 weeks to assess initial response 1
• After correction of anemia, monitor blood counts periodically (every 6 months initially) to detect recurrent iron deficiency anemia 1
• If inadequate response to oral therapy after 4-8 weeks, consider:
  • Adherence issues
  • Ongoing blood loss
  • Malabsorption
  • Need for IV iron therapy 6

Common Pitfalls to Avoid

1. Excessive dosing: Higher doses (>200 mg daily) may not improve absorption and can increase side effects 1
2. Premature discontinuation: Stopping therapy once hemoglobin normalizes without replenishing iron stores 4
3. Ignoring poor response: Failure to investigate underlying causes if no improvement after 4 weeks 1
4. Overlooking drug interactions: Certain medications (antacids, tetracyclines, proton pump inhibitors) can reduce iron absorption 7
5. Missing underlying causes: Failing to investigate the cause of iron deficiency while treating with supplementation 1, 5

By following these recommendations, most patients with iron deficiency anemia can be effectively treated at home with oral iron therapy, improving morbidity, mortality, and quality of life outcomes.