What type of iron supplement is needed to treat iron deficiency anemia?

From the Guidelines

Oral iron supplements, specifically ferrous sulphate 200 mg twice daily, are the recommended first-line treatment for iron deficiency anemia. According to the most recent guidelines 1, this dosage is effective in correcting anemia and replenishing body stores. Other iron compounds like ferrous fumarate and ferrous gluconate may also be used, especially if patients do not tolerate ferrous sulphate.

Key considerations for treatment include:

• Taking oral iron supplements on an empty stomach with vitamin C (like orange juice) to enhance absorption, but if stomach upset occurs, they can be taken with food 1.
• Common side effects of oral iron supplements include constipation, nausea, and black stools.
• For patients who cannot tolerate oral iron due to side effects or have malabsorption issues, intravenous iron formulations like iron sucrose or ferric carboxymaltose may be necessary 1.
• The choice between oral and IV iron depends on the severity of anemia, patient tolerance, and how quickly iron repletion is needed.
• Treatment should continue for 3 months after the iron deficiency has been corrected to replenish stores 1.

It's crucial to monitor hemoglobin levels and adjust treatment as necessary to ensure iron stores are replenished and anemia is corrected, thereby improving morbidity, mortality, and quality of life outcomes.

From the FDA Drug Label

Injectafer is indicated for the treatment of: • iron deficiency anemia (IDA) in: adult and pediatric patients 1 year of age and older who have either intolerance or an unsatisfactory response to oral iron. The type of iron supplement needed to treat iron deficiency anemia is intravenous ferric carboxymaltose, as indicated in the drug label 2 and 2.

• Key points:
  • Ferric carboxymaltose is administered intravenously.
  • It is used for patients with intolerance or unsatisfactory response to oral iron.
  • The recommended dosage varies based on patient weight and medical condition, as outlined in the drug label 2 and 2.

From the Research

Types of Iron Supplements

• Ferrous sulfate is the simplest, least expensive, and most commonly prescribed drug for treating iron deficiency anemia 3
• Other ferrous salts and ferric complexes with polysaccharides or succinylated milk proteins are also widely used 3
• Novel iron formulations have been developed, such as the lipophilic iron donor ferric maltol, or nanoparticle encapsulated sucrosomial® iron 3
• Ferrous sulphate preparations remain the established and standard treatment of iron deficiency, given their good bioavailability, efficacy, and acceptable tolerability 4

Dosage and Frequency

• The optimal dosage and frequency of iron supplementation are unclear, with some studies indicating better fractional iron absorption with alternate day supplementation 5
• A study comparing daily versus alternate day supplementation of oral iron for treatment of iron deficiency anemia found no significant difference between the two arms 5
• Low-dose iron supplementation (<5 mg/kg/day) combined with treatment durations of either less than 3 months or more than 6 months, is optimal for improving Hb levels in children and adolescents with IDA 6
• A pilot randomized controlled trial is being conducted to evaluate the feasibility of performing a study to examine the effectiveness and side-effect profile of oral iron once daily versus every other day 7

Forms of Iron

• Oral ferrous sulphate has a significant effect on improving Hb levels 6
• Parenteral ferric Carboxymaltose shows consistent efficacy in improving Hb levels 6
• Ferrous versus ferric oral iron formulations have been compared, with ferrous sulphate preparations remaining the established and standard treatment of iron deficiency 4