What is the recommended treatment and dosage for iron deficiency anemia using Ferrous (Iron) bisglycinate chelate?

Treatment of Iron Deficiency Anemia with Ferrous Bisglycinate Chelate

For iron deficiency anemia, ferrous bisglycinate chelate can be used at a dose of 25 mg of elemental iron per day, but traditional ferrous salts (sulfate, fumarate, or gluconate) at a dose of 50-100 mg elemental iron once daily remain the first-line treatment due to better evidence supporting their efficacy and lower cost. 1

First-Line Treatment Options

• Oral iron supplementation is the initial treatment of choice for most patients with iron deficiency anemia (IDA) 1
• Traditional ferrous salts are recommended as first-line therapy due to their established efficacy and lower cost 1:
  • Ferrous sulfate: 200 mg tablet (65 mg elemental iron)
  • Ferrous fumarate: 210 mg tablet (69 mg elemental iron)
  • Ferrous gluconate: 300 mg tablet (37 mg elemental iron)

Ferrous Bisglycinate Chelate

• Ferrous bisglycinate chelate is available as 25 mg elemental iron per tablet 1
• May be better tolerated than traditional iron salts in some patients, though evidence of superior efficacy is lacking in clinical trials 1
• Costs approximately $2.40 for 30 tablets, which is more expensive than ferrous sulfate ($0.30-$4.50) but may be justified if traditional preparations aren't tolerated 1

Dosing Recommendations

• For traditional iron salts: One tablet daily (providing 50-100 mg elemental iron) 1
• For ferrous bisglycinate: 25 mg elemental iron daily 1, 2
• If not tolerated, consider:
  • Reduced dosing frequency (every other day) 1
  • Alternative oral preparations like ferrous bisglycinate 1
  • Parenteral iron if oral therapy fails 1

Administration Guidelines

• Take iron on an empty stomach for optimal absorption 1
• If not tolerated, can be taken with meals, though absorption may be reduced 1
• Taking iron with meat protein improves absorption 1
• Adding 500 mg vitamin C can enhance absorption, especially when taken with calcium or fiber 1
• Avoid tea and coffee within one hour of taking iron supplements as they inhibit absorption 1
• Do not take more than once daily, as increased hepcidin levels will block further iron absorption for up to 48 hours 1

Monitoring and Duration of Treatment

• Monitor hemoglobin response within 4 weeks of starting therapy 1
• Expect hemoglobin to increase by 1 g/dL within 2 weeks of supplementation 1
• Continue treatment for approximately 3 months after hemoglobin normalization to replenish iron stores 1
• Monitor blood counts every 3 months for the first year after normalization, then after another year, and if symptoms of anemia recur 1

Special Considerations

• For patients with inflammatory bowel disease (IBD):
  • Oral iron may be used in patients with mild anemia whose disease is clinically inactive 1
  • Intravenous iron is preferred for patients with active IBD, previous intolerance to oral iron, or hemoglobin below 10 g/dL 1
• For post-gastrectomy patients, ferrous sulfate may be more effective than ferrous glycinate chelate 3
• Long-term use of amino acid chelated iron supplements should be monitored as there have been rare reports of iron overload 4

When to Consider Parenteral Iron

• Intolerance to oral iron preparations 1
• Inadequate response to oral iron despite adherence 1
• Active inflammatory bowel disease 1
• After bariatric surgery or other conditions with impaired absorption 1
• Hemoglobin below 10 g/dL 1

While ferrous bisglycinate chelate represents an alternative for patients who cannot tolerate traditional iron salts, the evidence supporting its superior efficacy is limited, and it comes at a higher cost. Traditional ferrous salts remain the standard first-line therapy for most patients with iron deficiency anemia.