Is ferrous gluconate the same as Palafer (iron supplement)?

Is Ferrous Gluconate the Same as Palafer?

No, ferrous gluconate is not the same as Palafer, but Palafer is a brand name product that contains ferrous gluconate as its active ingredient. They are therapeutically equivalent in terms of the iron salt used, but may differ in formulation, dosage strength, and excipients.

Understanding the Relationship

Ferrous gluconate is the generic chemical compound (an iron salt), while Palafer is a proprietary brand name for a specific ferrous gluconate formulation. This is analogous to how acetaminophen is the generic drug and Tylenol is a brand name—the active ingredient is the same, but the commercial product may have different inactive ingredients, coating, or release characteristics 1.

Clinical Equivalence for Iron Deficiency Anemia

Therapeutic Effectiveness

• Ferrous gluconate is as effective as other ferrous salts (ferrous sulfate, ferrous fumarate) for treating iron deficiency anemia 1.
• All ferrous preparations achieve similar hemoglobin increases when used at appropriate elemental iron doses 1.
• The standard recommendation is ferrous sulfate 200 mg three times daily as the cheapest option, though ferrous gluconate and ferrous fumarate are equally effective alternatives 1.

Dosing Considerations

• Ferrous gluconate contains 38 mg of elemental iron per 325 mg tablet, requiring a recommended dose of 1600 mg/day for iron deficiency anemia in CKD patients 1.
• This lower elemental iron content per tablet compared to ferrous sulfate (65 mg per 325 mg tablet) means more tablets are needed to achieve equivalent elemental iron dosing 1.

Tolerability Profile

Gastrointestinal Side Effects

• Ferrous gluconate may be better tolerated than ferrous sulfate, particularly in liquid formulations 2, 3.
• In pregnancy studies, liquid ferrous gluconate produced no side effects or dropouts, while ferrous sulfate caused gastrointestinal complaints and treatment discontinuation 2.
• In peritoneal dialysis patients, ferrous gluconate was better absorbed and tolerated than ferrous sulfate at high doses 3.

Absorption Characteristics

• Ferrous salts (+2 valence) like ferrous gluconate are more readily absorbed than ferric salts (+3 valence) because they can be immediately absorbed by the duodenal mucosa 2.
• Conventional-release ferrous preparations dissolve rapidly (48-64 minutes) and demonstrate higher iron absorption compared to modified-release formulations 4.

Practical Clinical Guidance

When to Choose Ferrous Gluconate (or Palafer)

• Consider ferrous gluconate as a first-line alternative when patients experience intolerance to ferrous sulfate 1.
• Liquid ferrous gluconate formulations may be particularly useful in patients who cannot tolerate tablets 1.
• Lower doses (twice daily instead of three times daily) may be as effective and better tolerated, regardless of the specific ferrous salt used 1.

Important Caveats

• Iron supplementation should continue for 3 months after correction of anemia to replenish iron stores 1.
• Expected hemoglobin rise is 2 g/dL after 3-4 weeks of treatment; failure to achieve this suggests poor compliance, continued blood loss, malabsorption, or misdiagnosis 1.
• Ascorbic acid (250-500 mg) may enhance iron absorption when taken with ferrous preparations, though evidence for effectiveness in treating IDA is limited 1.

Bottom Line for Clinical Practice

If a patient is prescribed Palafer, any ferrous gluconate product at equivalent elemental iron dosing will provide the same therapeutic benefit. The choice between brand name (Palafer) and generic ferrous gluconate should be based on cost, availability, formulation preference (tablet vs. liquid), and individual patient tolerability rather than efficacy concerns 1.