Maximum Dose of Feramax
The standard maximum dose of Feramax (polysaccharide iron complex) is 1 tablet daily (150 mg elemental iron), as indicated by FDA labeling for adults and children 12 years and over. 1
Standard Dosing Guidelines
- For adults and children 12 years and over, the recommended dose is 1 tablet daily or as directed by a physician. 1
- Children under 12 years should consult a physician before use. 1
Context: Optimal Oral Iron Dosing Strategy
While the FDA label specifies the maximum dose, recent evidence suggests that higher doses do not necessarily improve outcomes and may reduce absorption:
- Oral iron doses ≥60 mg in iron-deficient individuals stimulate an acute increase in hepcidin that persists for 24 hours, reducing absorption from subsequent doses by 35-45%. 2, 3
- Alternate-day dosing (rather than daily) significantly increases fractional iron absorption - in iron-depleted women, alternate-day dosing resulted in 21.8% absorption versus 16.3% with consecutive daily dosing (p=0.0013). 3
- Single morning doses are superior to divided doses - twice-daily split dosing increases serum hepcidin more than once-daily dosing without improving total iron absorption. 3
Practical Dosing Recommendations Based on Clinical Context
For standard iron deficiency anemia treatment:
- 50-100 mg elemental iron once daily is the recommended dose for most adults, with 100 mg being the maximum for routine supplementation. 4
- If gastrointestinal side effects occur, alternate-day dosing (120 mg every other day) may provide better absorption and tolerability than daily lower doses. 2, 3
For chronic kidney disease patients:
- Higher doses up to 200 mg elemental iron daily may be used, but this is not standard for most patients. 4
- Most hemodialysis patients require intravenous iron rather than oral supplementation to maintain adequate iron status. 5
Important Caveats
- Doses above 60-100 mg daily do not proportionally increase absorption - the fractional absorption from high doses is low, and unabsorbed iron causes gastrointestinal irritation, inflammation, and dysbiosis. 2
- Avoid afternoon or evening dosing after a morning dose - the circadian increase in plasma hepcidin is augmented by morning iron, making subsequent same-day doses poorly absorbed. 2
- Do not exceed 1 tablet (150 mg) daily of Feramax without physician supervision, as this is the FDA-approved maximum dose. 1