What is the recommended dosing for Tardyferon (iron polymaltose) in patients with iron deficiency without anemia?

Tardyferon Dosing for Iron Deficiency Without Anemia

Direct Recommendation

For iron deficiency without anemia, administer one Tardyferon tablet (80 mg elemental iron) daily, taken on an empty stomach, or consider 500-1000 mg of intravenous iron as a single dose if oral therapy is not tolerated or contraindicated. 1, 2

Oral Iron Dosing Strategy

Standard Dosing for Non-Anemic Iron Deficiency

• Administer 50-100 mg elemental iron once daily for patients with iron deficiency without anemia, which translates to one Tardyferon 80 mg tablet daily 2
• Take the tablet on an empty stomach to maximize absorption, as food can significantly reduce iron uptake 3
• Do not exceed 100 mg elemental iron daily in patients with inactive inflammatory conditions, as higher doses do not improve absorption and increase side effects 2

Timing and Absorption Considerations

• Tardyferon provides sustained iron release for up to 12 hours after administration, with peak serum concentrations occurring at 4 hours post-dose 3
• If gastrointestinal side effects occur, switch to alternate-day dosing (one tablet every other day), which maintains similar total iron absorption while reducing adverse effects 2, 4
• The prolonged-release formulation maintains elevated serum iron levels between 2-8 hours post-dosing with only 20% fluctuation 3

When to Choose Intravenous Iron Instead

Clear Indications for IV Iron

• Active inflammatory disease (elevated CRP), as systemic inflammation inhibits oral iron absorption through hepcidin upregulation 2
• Previous intolerance to oral iron preparations 2
• Malabsorption disorders affecting the gastrointestinal tract 5
• Need for rapid iron repletion 2

IV Iron Dosing for Non-Anemic Iron Deficiency

• Administer 500-1000 mg of intravenous iron as a single dose for iron deficiency without anemia 2
• Ferric carboxymaltose can be given as 1000 mg over 15 minutes for patients ≥50 kg 2
• For patients <50 kg, administer 500 mg as a single dose 5

Monitoring and Follow-Up

Initial Response Assessment

• Check hemoglobin and ferritin after 8-10 weeks of oral iron therapy, not earlier, as ferritin levels remain falsely elevated immediately after iron supplementation 2
• For IV iron, wait at least 4 weeks before checking iron parameters, as circulating iron interferes with assay results 5

Long-Term Monitoring

• Monitor ferritin every 3 months for the first year after correction, then every 6-12 months thereafter 5
• Re-initiate treatment when ferritin drops below 100 μg/L 5
• Continue oral iron for approximately 3 months after ferritin normalization to ensure adequate store repletion 2

Critical Pitfalls to Avoid

• Do not use modified-release preparations other than Tardyferon, as they are considered less suitable for prescribing due to unpredictable iron release 2
• Do not switch between different ferrous salts (sulfate, fumarate, gluconate) if side effects occur, as this is not evidence-based; instead, reduce frequency to alternate-day dosing 2
• Do not give oral iron during active inflammation, as hepcidin elevation blocks absorption and may worsen intestinal inflammation 2
• Do not administer IV iron if hemoglobin >15 g/dL, as this indicates adequate iron stores 5

Special Considerations

• Iron polymaltose (the formulation in Tardyferon) shows equivalent bioavailability to ferrous salts at therapeutic doses, with absorption rates of 27-33% at 50-100 mg doses 6
• The bioavailability of iron polymaltose is significantly enhanced when taken with vitamin C-containing meals, though fasting administration remains preferred 7
• In patients with depleted iron stores but no anemia, the same dosing principles apply as for mild anemia (Hb 11-12.9 g/dL in men, 11-11.9 g/dL in women) 2