What is Ferosul (iron supplement)?

Ferosul (Ferrous Sulfate): An Iron Supplement for Iron Deficiency Anemia

Ferosul is an oral iron supplement containing ferrous sulfate (325 mg tablet providing 65 mg of elemental iron) used primarily for the treatment and prevention of iron deficiency anemia. 1

Composition and Formulation

• Each tablet typically contains 324-325 mg of ferrous sulfate, equivalent to 65 mg of elemental iron
• Provides approximately 362% of the U.S. recommended daily intake (RDI) of iron for adults and children 4 and older 1
• Available in tablet form for oral administration

Clinical Use and Indications

Primary Indications

• Treatment of iron deficiency anemia
• Prevention of iron deficiency in high-risk patients
• Replenishment of iron stores after correction of anemia

Dosing Recommendations

• Standard dosing: 325 mg (65 mg elemental iron) daily or on alternate days 2
• Alternate-day dosing may improve absorption and reduce gastrointestinal side effects 2
• Treatment should continue for 3 months after correction of anemia to adequately replenish iron stores 2

Efficacy

• Effective in treating iron deficiency anemia in patients with mild anemia and clinically inactive disease 3
• Expected response: Hemoglobin increase of at least 2 g/dL within 4 weeks of treatment 3
• Treatment goals include:
  • Normalization of hemoglobin levels
  • Ferritin >50 μg/L
  • Transferrin saturation >20% 2

Side Effects and Tolerability

• Common gastrointestinal side effects:
  • Constipation
  • Nausea
  • Abdominal discomfort
  • Diarrhea
• Meta-analysis shows significantly increased risk of GI side effects compared to placebo (OR: 2.32) and IV iron (OR: 3.05) 4
• Side effects are dose-dependent but not necessarily dose-related 3
• GI side effects may reduce patient compliance with treatment 5

Clinical Considerations and Patient Selection

Preferred Candidates for Oral Ferrous Sulfate

• Patients with mild anemia (Hb 11.0-11.9 g/dL in women, 11.0-12.9 g/dL in men) 3
• Patients with clinically inactive disease 3
• Patients without previous intolerance to oral iron 3

When to Consider Alternative Iron Formulations

• Clinically active inflammatory bowel disease 3
• Previous intolerance to oral iron 3
• Hemoglobin below 10 g/dL 3
• Patients requiring erythropoiesis-stimulating agents 3
• In these cases, intravenous iron should be considered as first-line treatment 3

Monitoring Recommendations

• Hemoglobin levels should be checked after 3-4 weeks to assess treatment response 2
• Iron parameters (ferritin, transferrin saturation) should be monitored after 4-8 weeks of treatment 2
• Long-term monitoring: hemoglobin and red cell indices every three months for one year, then after a further year 2

Potential Pitfalls

• Inadequate duration of treatment leading to incomplete replenishment of iron stores 2
• Failing to investigate underlying causes of iron deficiency 2
• Misinterpreting iron studies during inflammation (ferritin may be falsely normal) 2
• Ignoring gastrointestinal side effects that may reduce compliance 2

Practical Tips

• Taking with meals may reduce gastrointestinal side effects but can decrease absorption by 40-50%
• Consider alternate-day dosing to improve absorption and tolerability 2
• No more than 100 mg elemental iron per day is recommended in patients with inflammatory bowel disease 3
• After successful treatment, re-treatment should be initiated as soon as serum ferritin drops below 100 μg/L or hemoglobin falls below gender-specific thresholds (12 g/dL for women, 13 g/dL for men) 3

Ferosul represents a cost-effective first-line option for treating iron deficiency in appropriate patients, though clinicians should be vigilant about monitoring for side effects and ensuring adequate treatment duration to achieve optimal outcomes.