What is the treatment for iron deficiency anemia?

Treatment for Iron Deficiency Anemia

The first-line treatment for iron deficiency anemia is oral iron supplementation with ferrous sulfate 200 mg (providing 65 mg of elemental iron) taken once or twice daily for 3 months after hemoglobin normalization to replenish iron stores. 1

Oral Iron Therapy

Recommended Formulation and Dosing

• Ferrous sulfate is the preferred formulation due to being the least expensive while providing good bioavailability (65 mg elemental iron per 325 mg tablet) 1
• Dosing options:
  • Standard dosing: 200 mg of elemental iron daily in 2-3 divided doses 1
  • Alternative dosing: Single daily dose of ferrous sulfate 200 mg (65 mg elemental iron) 1
  • Recent evidence suggests alternate-day dosing may improve absorption and reduce side effects 2

Administration Tips to Maximize Absorption

• Take iron on an empty stomach (2 hours before or 1 hour after meals) 1
• Add vitamin C (250-500 mg) to enhance absorption 3, 1
• Morning administration is preferred over afternoon/evening dosing 2
• Avoid taking with calcium, fiber, tea, coffee, or antacids which can inhibit absorption 1

Duration of Treatment

• Continue treatment for 3 months after hemoglobin normalization to replenish iron stores 3, 1
• Monitor hemoglobin after 2-4 weeks of treatment (expect ~2 g/dL increase) 1
• Follow-up monitoring of hemoglobin and red cell indices every 3 months for 1 year, then after another year 3

Alternative Oral Iron Formulations

For patients who cannot tolerate ferrous sulfate:

• Other ferrous salts (ferrous fumarate, ferrous gluconate) 3
• Iron suspensions 3
• Lower doses may be better tolerated while still effective 3

Intravenous Iron Therapy

Indications for IV Iron

IV iron should be considered first-line in patients with:

• Intolerance to oral iron 1
• Poor response to oral iron 1
• Hemoglobin below 10 g/dL requiring rapid correction 1
• Active inflammatory bowel disease or after bariatric surgery 1
• Chronic kidney disease with ferritin >100 ng/mL 1, 4

Available IV Iron Formulations

• Ferric carboxymaltose (Ferinject): Up to 1000 mg in a single 15-minute infusion 3, 1
• Iron sucrose (Venofer): 200 mg over 10 minutes 3
• Iron dextran (Cosmofer): 20 mg/kg over 6 hours (can also be given intramuscularly) 3

Dosing of IV Iron

Based on weight and hemoglobin level 1:

Hemoglobin g/dL	Body weight <70 kg	Body weight ≥70 kg
10-12 [women]	1000 mg	1500 mg
10-13 [men]	1500 mg	1500 mg
7-10	1500 mg	2000 mg

Common Pitfalls and How to Avoid Them

1. Stopping treatment too early: Continue treatment for 3 months after hemoglobin normalization 3, 1
2. Poor adherence due to side effects: Consider alternate-day dosing, lower doses, or different formulations 2, 5
3. Failure to add vitamin C: Always recommend vitamin C supplementation with iron 3, 1
4. Taking iron with absorption inhibitors: Advise patients to avoid calcium, fiber, tea, coffee, or antacids when taking iron 1
5. Inadequate monitoring: Check hemoglobin after 2-4 weeks and continue monitoring every 3 months for 1 year 3, 1
6. Failure to investigate underlying causes: Always identify and treat the underlying cause of iron deficiency, especially in men and postmenopausal women 1

Special Considerations

• Athletes and active women: May require higher daily iron intake (22 mg/day) 1
• Inflammatory conditions: Ferritin up to 100 μg/L may still indicate iron deficiency; consider transferrin saturation or other markers 1
• Dietary recommendations: Increase intake of iron-rich foods (red meat, poultry, fish, leafy greens, legumes) and vitamin C-rich foods 1
• Plant-based diets: Require approximately 1.8 times more dietary iron due to lower bioavailability 1

By following these evidence-based recommendations, iron deficiency anemia can be effectively treated while minimizing side effects and improving patient adherence to therapy.