What is a commonly recommended oral iron solution for patients with iron deficiency?

Recommended Oral Iron Solution for Iron Deficiency

Ferrous sulfate is the preferred oral iron solution for patients with iron deficiency due to its effectiveness, low cost, and wide availability. 1, 2

First-Line Oral Iron Therapy

• Ferrous sulfate 200-325 mg once daily (providing 65 mg elemental iron) is the recommended initial treatment for iron deficiency anemia 1, 2, 3
• Treatment should continue for 3 months after hemoglobin normalizes to ensure adequate repletion of iron stores 2
• Once-daily dosing is as effective as multiple daily doses and may be better tolerated 1, 2
• Every-other-day iron dosing may be considered for patients with poor tolerance as it provides similar or equal rates of iron absorption 1, 2

Alternative Iron Formulations

• If ferrous sulfate is not tolerated, alternative formulations include:
  • Ferrous fumarate (provides 69-106 mg elemental iron per tablet) 2
  • Ferrous gluconate (provides 38 mg elemental iron per tablet) 2, 4
• No single formulation of oral iron has proven advantages over others in terms of efficacy 1, 5

Optimizing Iron Absorption

• Add vitamin C (ascorbic acid) to oral iron supplementation to improve absorption 1, 2
• Take iron supplements on an empty stomach to maximize absorption 2
• Avoid tea or coffee within one hour of taking iron supplements as these inhibit iron absorption 2
• Be aware that proton pump inhibitors may reduce iron absorption and necessitate higher doses or longer treatment duration 6

Managing Side Effects

• Common side effects include constipation, diarrhea, and nausea 2
• If standard doses are not tolerated:
  • Consider reduced dosing
  • Try taking with food (though this may reduce absorption)
  • Switch to an alternative iron formulation 2

When to Consider Parenteral Iron

• Intravenous iron should be used when: 1, 2
  • Oral iron is not tolerated despite adjustments
  • Ferritin levels do not improve with oral iron trial
  • Patient has a condition in which oral iron absorption is impaired (e.g., bariatric surgery, inflammatory bowel disease)
  • There is ongoing blood loss

Monitoring Response

• Monitor hemoglobin response within 4 weeks of starting treatment 2
• Expect hemoglobin to increase by approximately 1 g/dL within 2 weeks in patients responding to therapy 2, 7
• After restoration of hemoglobin and iron stores, monitor blood counts periodically to detect recurrent iron deficiency 2

Special Considerations

• For patients with inflammatory bowel disease, determine whether iron deficiency is due to inadequate intake/absorption or blood loss 1
• In patients with portal hypertensive gastropathy, start with oral iron supplements but consider IV iron if there's no response 1
• Multivitamin preparations should not be used as the sole source of iron supplementation due to insufficient elemental iron content 2