Bizfer XT (Ferrous Sulfate) in Iron Deficiency Anemia
Bizfer XT, containing ferrous sulfate, is the preferred first-line oral iron supplement for treating iron deficiency anemia (IDA) due to its proven efficacy, low cost, and established safety profile. 1
Dosing and Administration
Start with one tablet of ferrous sulfate (200 mg, providing 65 mg elemental iron) once daily, taken on an empty stomach. 1, 2 This represents a significant departure from older regimens that recommended multiple daily doses.
- Once-daily dosing (50-100 mg elemental iron) is as effective as split dosing while causing fewer gastrointestinal side effects 1
- If not tolerated, reduce to every-other-day dosing rather than switching iron salts, as alternate-day administration increases fractional iron absorption and reduces nausea 1
- Add vitamin C supplementation to enhance iron absorption 1
- Taking iron in the fasting state optimizes absorption 1
Monitoring Response
Check hemoglobin at 2 weeks and then every 4 weeks until normalization. 1
- An increase of at least 10 g/L after 2 weeks predicts successful treatment (sensitivity 90.1%, specificity 79.3%) 1
- Failure to achieve this rise indicates need for alternative therapy 1
- Continue treatment for 3 months after hemoglobin normalizes to replenish iron stores 1
When to Switch from Oral Iron
Consider intravenous iron if: 1
- Patient cannot tolerate oral iron despite dose reduction or alternate-day dosing
- No hemoglobin response after 2 weeks of adequate oral therapy
- Active inflammatory bowel disease with compromised absorption 1
- Post-bariatric surgery patients with disrupted duodenal absorption 1
- Ongoing blood loss with inadequate oral iron response 1
Common Pitfalls to Avoid
Do not switch between different ferrous salts (sulfate, fumarate, gluconate) for intolerance - there is no evidence supporting superiority of one over another, and this practice is not evidence-based 1. Instead, try alternate-day dosing or proceed to intravenous iron.
Do not use modified-release preparations - these are considered less suitable for prescribing as iron may be released beyond the duodenum where absorption is optimal 1
Do not delay treatment while awaiting diagnostic workup unless colonoscopy is imminent 1
Comparative Efficacy
Ferrous sulfate demonstrates superior efficacy compared to alternative formulations. In a randomized trial of children with IDA, ferrous sulfate at 3 mg/kg once daily increased hemoglobin by 4.0 g/dL versus 3.4 g/dL with iron polysaccharide complex (difference 1.0 g/dL, 95% CI 0.4-1.6, P<0.001), with higher rates of complete IDA resolution (29% vs 6%, P=0.04) 3. In heart failure patients with IDA, oral ferrous sulfate 200 mg three times daily significantly improved functional capacity compared to placebo (46.23±35 m vs -13.7±46 m, p<0.001) 4.
Cost Considerations
Ferrous sulfate is the most cost-effective option at approximately £1.00-£2.50 per 28 days, compared to ferric maltol at £47.60 per 28 days 1. While newer formulations exist, no oral iron preparation has demonstrated advantages over ferrous sulfate that justify higher costs 1.