What is the recommended treatment and dosage for iron deficiency anemia using iron glycinate?

Treatment of Iron Deficiency Anemia Using Iron Glycinate

For iron deficiency anemia treatment, oral ferrous sulfate, fumarate, or gluconate at a dose of 60-120 mg elemental iron daily is the recommended first-line therapy, rather than iron glycinate which has limited evidence supporting its use. 1

Diagnosis Confirmation

Before initiating treatment, confirm iron deficiency anemia with:

• Hemoglobin levels: <13.0 g/dL in men, <12.0 g/dL in non-pregnant women, <11.0 g/dL in pregnant women 2
• Iron studies: ferritin <30 ng/mL (or <100 ng/mL with inflammation) and transferrin saturation <20% 2

Treatment Recommendations

First-Line Therapy

• Oral iron salts (ferrous sulfate, fumarate, or gluconate):
  • Dosage: 60-120 mg elemental iron daily 1
  • One tablet of ferrous sulfate (200 mg) contains approximately 65 mg of elemental iron 1
  • Duration: Continue for 3 months after hemoglobin normalizes to replenish iron stores 1

Alternative Dosing Strategy

• Consider alternate-day dosing (one tablet every other day) if daily dosing causes side effects 1, 3
• Morning administration may improve absorption compared to afternoon/evening dosing 3
• Taking with vitamin C (ascorbic acid) may enhance absorption 1

Iron Glycinate Considerations

• Limited evidence supports iron glycinate for iron deficiency anemia treatment
• One study comparing ferrous sulfate with ferrous glycinate in gastrectomized patients showed better results with ferrous sulfate 4
• Iron glycinate is available in liquid form for infants and children, but not specifically recommended for adult IDA treatment 5

Monitoring Response

1. Check hemoglobin after 4 weeks of treatment 1, 2

   • Expected response: Increase in Hb of approximately 1 g/dL 1
   • If no improvement despite compliance, further evaluation is needed

2. Continue treatment for 2-3 months after hemoglobin normalizes 1

3. Monitor periodically (every 6 months initially) after treatment completion to detect recurrence 1

When to Consider Parenteral Iron

Switch to intravenous iron when oral iron is:

• Contraindicated
• Ineffective despite compliance
• Not tolerated due to side effects 1

Additional indications for IV iron include:

• Moderate-severe anemia (Hb <10 g/dL)
• Active inflammatory disease
• Malabsorption conditions
• Ongoing blood loss 2, 6, 7

Common Pitfalls to Avoid

• Inadequate dosing or premature discontinuation before iron stores are replenished
• Overlooking the underlying cause of iron deficiency
• Failing to recognize that non-response may indicate an alternative diagnosis (e.g., thalassemia, anemia of chronic disease) 1, 2
• Not considering alternate-day dosing when side effects occur 3

Iron deficiency anemia requires adequate treatment duration and appropriate follow-up to ensure complete resolution and prevent recurrence.