Is it okay to prescribe Ferrous Sulfate Tablet Delayed Release, 325 milligrams, orally, twice a day for 30 days, with 60 tablets and up to 3 refills, for iron deficiency anemia?

Ferrous Sulfate Delayed Release for Iron Deficiency Anemia

Yes, it is appropriate to prescribe Ferrous Sulfate Tablet Delayed Release, 325 mg (65 mg elemental iron), 1 tablet orally twice daily for 30 days with 60 tablets and 3 refills for iron deficiency anemia. This dosing provides approximately 130 mg of elemental iron daily, which falls within the recommended therapeutic range for treating iron deficiency anemia.

Dosing Considerations

• Ferrous sulfate delayed release 325 mg tablets contain approximately 65 mg of elemental iron per tablet 1
• The recommended daily dose for iron deficiency anemia treatment is 50-100 mg of elemental iron once daily, though twice daily dosing may be used for more rapid correction of severe anemia 1
• The prescribed regimen of 65 mg twice daily (130 mg elemental iron total) is within therapeutic range for treating iron deficiency anemia 1

Monitoring and Duration of Therapy

• Monitor hemoglobin response after 2-4 weeks of therapy; absence of at least 10 g/L rise in hemoglobin after 2 weeks strongly predicts treatment failure (sensitivity 90.1%, specificity 79.3%) 1
• Continue iron therapy for approximately 3 months after normalization of hemoglobin to ensure adequate repletion of iron stores 1
• The initial 30-day supply with 3 refills provides approximately 4 months of therapy, which is appropriate for most cases of iron deficiency anemia 1

Potential Side Effects and Management

• Common side effects include gastrointestinal disturbances (nausea, constipation, diarrhea) 1
• If side effects occur, consider:
  • Taking with food (though this may reduce absorption)
  • Reducing to once daily dosing
  • Switching to alternate-day dosing (which may improve absorption and reduce side effects) 1
  • Considering parenteral iron if oral therapy is not tolerated or ineffective 1

Special Considerations

• Delayed-release preparations are indicated as "less suitable for prescribing" in the British National Formulary due to reduced iron absorption compared to standard preparations 1
• Standard immediate-release ferrous sulfate may provide better absorption and potentially better clinical response 1
• Avoid administering with tea, coffee, milk, or antacids which can reduce iron absorption 1

Alternative Options if Treatment Fails

• If no response after 4 weeks despite compliance, consider:
  • Further evaluation with additional laboratory tests (MCV, RDW, serum ferritin)
  • Investigating causes of treatment failure (ongoing blood loss, malabsorption, etc.)
  • Switching to parenteral iron therapy 1

Follow-up Recommendations

• Monitor hemoglobin at 4 weeks to assess initial response 1
• Continue monitoring every 4 weeks until hemoglobin normalizes 1
• After treatment completion, monitor periodically (every 6 months initially) to detect recurrent anemia 1