What is the recommended oral dosing of Ranferon (iron supplementation) for pediatric patients?

Oral Ranferon (Iron Supplementation) Dosing for Pediatric Patients

The recommended oral dosing of elemental iron for pediatric patients with iron deficiency anemia is 3-6 mg/kg/day divided into 2-3 doses, with specific age-based recommendations ranging from 2-4 mg/kg/day for infants to 60-120 mg/day for adolescents. 1

Age-Specific Dosing Recommendations

Infants and Young Children

• Preterm or low birthweight infants: 2-4 mg/kg/day (maximum 15 mg/day) starting at 1 month after birth and continuing until 12 months 1
• Term infants to 3 years: 3 mg/kg/day of elemental iron 1
• Infants (0-12 months): 2-3 mg/kg/day of elemental iron divided into 2-3 doses 1
• Children (1-5 years): 3 mg/kg/day of elemental iron drops 1

Older Children and Adolescents

• School-age children (5-12 years): 60 mg elemental iron daily 1
• Adolescent boys: 120 mg elemental iron daily 1
• Adolescent girls: 60-120 mg elemental iron daily 1
• Children under 12 years: Consult a physician (per FDA labeling) 2
• Children 12 years and over: Take 1 tablet daily or as directed by a doctor 2

Administration Guidelines

Optimal Timing and Absorption

• Administer between meals or on an empty stomach for optimal absorption 1
• Food can reduce iron absorption by up to 50% if eaten within 2 hours before or 1 hour after an iron supplement 1
• If gastrointestinal side effects occur, iron can be taken with meals, though absorption will be reduced 1

Formulation Considerations

• Ferrous sulfate is the most effective form of oral iron supplementation for children with nutritional iron deficiency anemia 3
• In a randomized clinical trial comparing ferrous sulfate with iron polysaccharide complex, ferrous sulfate resulted in a greater increase in hemoglobin concentration (1.0 g/dL higher) after 12 weeks of treatment 3
• Common iron preparations and their elemental iron content:

  Iron Preparation	Tablet Size (mg)	Elemental Iron Content (mg)
  Ferrous fumarate	325	108
  Ferrous sulfate	325	65
  Ferrous gluconate	325	35
  Iron polysaccharide	-	150

Treatment Duration and Monitoring

• Initial treatment should continue for at least 4 weeks 1
• Assess response after 4 weeks by measuring hemoglobin or hematocrit 1
• An increase in hemoglobin ≥1 g/dL or hematocrit ≥3% confirms iron deficiency anemia 1
• Continue iron therapy for 2-3 months after normalization of hemoglobin to replenish iron stores 1
• Follow-up should include reassessing hemoglobin or hematocrit approximately 6 months after successful treatment 1

Common Pitfalls and Considerations

• Dosing frequency: Both frequent (3-7/week) and intermittent (1-2/week) iron regimens are similarly effective at decreasing anemia, though serum ferritin levels increase more with frequent supplementation 4
• Duration: Shorter (1-3 months) versus longer (7+ months) durations of supplementation show similar benefits after controlling for baseline anemia status, except for ferritin which increases more with longer duration 4
• Dose: Moderate and high-dose supplements are more effective than low-dose supplements at improving hemoglobin, ferritin, and iron deficiency anemia 4
• Co-supplementation: Iron provides similar benefits when administered alone or with vitamin A, but may have an attenuated effect on overall anemia when co-supplemented with zinc 4
• Side effects: Diarrhea is more common with iron polysaccharide complex than with ferrous sulfate (58% vs 35%) 3
• Compliance issues: Starting with lower doses and gradually increasing, dividing into smaller, more frequent doses, or trying different iron formulations may help manage common side effects like nausea, constipation, and abdominal discomfort 1

Special Considerations

• Children consuming more than 24 oz of cow's milk daily are at higher risk for iron deficiency and may require more careful monitoring 1
• For patients with severe anemia or those unable to tolerate oral iron, parenteral iron may be considered, with iron sucrose being a safe option for children 1
• Neurodevelopmental and cognitive deficits can result from severe and prolonged iron deficiency anemia in early childhood, which may not always be fully reversible even after correction 5