What is the treatment for iron deficiency anemia (IDA)?

From the Guidelines

Iron deficiency anemia is best treated with oral iron supplements, typically ferrous sulfate 200 mg taken daily between meals with vitamin C to enhance absorption, as recommended by the British Society of Gastroenterology guidelines 1.

Treatment Overview

The treatment of iron deficiency anemia (IDA) should focus on replenishing iron stores and addressing the underlying cause of the deficiency.

• Oral iron supplements are the first line of treatment, with ferrous sulfate being a commonly used option.
• The dose and duration of treatment may vary depending on the severity of the anemia and the individual's response to therapy.
• Intravenous iron formulations may be necessary for severe anemia or when oral therapy is not tolerated.

Oral Iron Supplements

• Ferrous sulfate 200 mg taken daily between meals with vitamin C is a recommended regimen 1.
• Other oral iron preparations, such as ferrous fumarate and ferrous gluconate, may also be effective and better tolerated by some individuals.
• The optimal duration of treatment is unclear, but it is generally recommended to continue oral iron for 3-6 months after the iron deficiency has been corrected to replenish body stores 1.

Monitoring and Follow-up

• Regular hemoglobin (Hb) monitoring is recommended to ensure an adequate response to treatment.
• The optimal interval for monitoring is unclear, but every 4 weeks until the Hb is in the normal range seems reasonable 1.
• Failure to respond to oral iron therapy should prompt further investigation to identify the underlying cause of the deficiency.

Parenteral Iron Formulations

• Intravenous iron formulations, such as iron sucrose and ferric carboxymaltose, may be necessary for severe anemia or when oral therapy is not tolerated.
• These formulations can provide a rapid increase in Hb levels, but their use should be reserved for cases where oral therapy is not effective or tolerated 1.

Underlying Cause

• The underlying cause of iron deficiency should always be identified and addressed, whether it's blood loss, poor absorption, or increased requirements.
• Unexplained IDA in adults over the age of 50 should be investigated to rule out underlying bleeding abnormalities or malignancies, as recommended by the British Society of Gastroenterology guidelines 1.

From the FDA Drug Label

1 INDICATIONS AND USAGE

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. adult patients who have non-dialysis dependent chronic kidney disease.

HIGHLIGHTS OF PRESCRIGING INFORMATION These highlights do not include all the information needed to use VENOFER ® safely and effectively. See full prescribing information for VENOFER. Venofer (iron sucrose) injection, for intravenous use Initial U. S. Approval: 2000 INDICATIONS AND USAGE Venofer is an iron replacement product indicated for the treatment of iron deficiency anemia (IDA) in patients with chronic kidney disease (CKD).

The treatment for iron deficiency anemia (IDA) is:

• Intravenous iron replacement with products such as ferric carboxymaltose (IV) or iron sucrose (IV), as indicated for patients with intolerance or unsatisfactory response to oral iron, or with non-dialysis dependent chronic kidney disease 23.
• Specifically, ferric carboxymaltose (IV) is indicated for adult and pediatric patients 1 year of age and older with IDA who have either intolerance or an unsatisfactory response to oral iron, or adult patients with non-dialysis dependent chronic kidney disease 2.
• Iron sucrose (IV) is indicated for the treatment of IDA in patients with chronic kidney disease (CKD) 3.

From the Research

Treatment Options for Iron Deficiency Anemia (IDA)

• The first line of treatment for IDA involves oral iron supplementation, with ferrous sulfate being the simplest, least expensive, and most commonly prescribed drug 4.
• Other ferrous salts and ferric complexes with polysaccharides or succinylated milk proteins are also widely used for oral iron supplementation 4.
• Novel iron formulations, such as ferric maltol and nanoparticle encapsulated sucrosomial iron, have been developed in recent years 4.
• Oral iron supplementation is usually efficacious in correcting IDA and replenishing iron stores, but it can cause gastrointestinal side effects that reduce compliance 4, 5, 6.

Dosage and Frequency of Oral Iron Supplementation

• Some experts recommend doses of 150-200 mg elemental iron per day, with the dose split throughout the day 5.
• However, recent studies suggest that doses of 60-120 mg iron as a ferrous salt given with ascorbic acid on alternate days may be an optimal oral dosing regimen for women with iron-deficiency and mild IDA 5.
• Daily dosing and divided doses may increase serum hepcidin and decrease iron absorption, making every other day treatment a potentially more effective option 5, 6.

Intravenous Iron Therapy

• When oral iron supplementation is contraindicated, intravenous iron therapy can rapidly achieve therapeutic targets without gastrointestinal complications 4, 7, 8.
• Intravenous iron sucrose increases the hemoglobin level more rapidly than oral ferrous sulphate in women with postpartum IDA and also appears to replenish iron stores more rapidly 8.
• A single dose of intravenous ferric derisomaltose may be an effective treatment option for IDA in pregnancy, with potential benefits including reduced risk of peripartum blood transfusion 7.