From the Guidelines
The primary treatment for iron deficiency anemia should be with one tablet per day of ferrous sulphate, fumarate, or gluconate, as recommended by the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults 1. This approach is supported by the most recent and highest quality evidence, which emphasizes the importance of initiating treatment with oral iron supplements to correct anemia and replenish body stores.
Key Considerations
- The initial treatment dose is one tablet per day, with the option to reduce the dose to one tablet every other day if not tolerated, or to consider alternative oral preparations or parenteral iron 1.
- Treatment should continue for a period of around 3 months after normalization of the hemoglobin level to ensure adequate repletion of the marrow iron stores 1.
- Parenteral iron should be considered when oral iron is contraindicated, ineffective, or not tolerated 1.
- Addressing the underlying cause of iron deficiency, whether it's blood loss, poor dietary intake, or malabsorption, is crucial for effective management.
- Dietary changes to include iron-rich foods can support treatment, and iron supplements work by providing the body with the essential mineral needed for hemoglobin production, allowing red blood cells to effectively carry oxygen throughout the body and relieving symptoms like fatigue, weakness, and shortness of breath.
Monitoring and Follow-up
- Patients should be monitored in the first 4 weeks for a hemoglobin response to oral iron, and treatment should be continued as needed 1.
- After the restoration of hemoglobin and iron stores with iron replacement therapy, the blood count should be monitored periodically to detect recurrent iron deficiency anemia 1.
From the FDA Drug Label
Venofer is indicated for the treatment of iron deficiency anemia (IDA) in patients with chronic kidney disease (CKD). The treatment for iron deficiency anemia is iron sucrose (IV), specifically Venofer, which is indicated for patients with chronic kidney disease (CKD) 2.
- The dosage and administration of Venofer vary depending on the patient's condition, such as hemodialysis-dependent or non-dialysis-dependent CKD, and peritoneal dialysis-dependent CKD 2.
- Venofer is administered intravenously, either by slow injection or infusion, with dosages expressed in mg of elemental iron 2.
- It is essential to monitor patients for signs and symptoms of hypersensitivity, hypotension, and iron overload during and after Venofer administration 2.
From the Research
Treatment Options for Iron Deficiency Anemia
- Oral iron supplementation is the first line of treatment for iron deficiency anemia, with ferrous sulfate being the most commonly prescribed drug 3, 4.
- Other oral iron formulations, such as ferric maltol and nanoparticle encapsulated sucrosomial iron, have also been developed 3.
- Intravenous iron therapy is an alternative for patients who are intolerant to oral iron or have severe and/or symptomatic anemia 3, 4.
Oral Iron Supplementation Strategies
- Daily and alternate day oral iron supplementation strategies have been compared, with no significant difference in improving hemoglobin levels 5.
- Low-dose oral iron supplementation may be effective with fewer side effects, and a starting dose of one ferrous sulfate tablet per day may be considered 6.
- The optimal formulation and dosing strategy for oral iron supplementation are still unclear, and further study is needed to advance the care of individuals with iron deficiency 7.
Comparison of Oral and Intravenous Iron Therapy
- Both oral and intravenous iron can effectively raise hemoglobin levels in iron-deficiency anemia, but intravenous iron is more expensive and carries a risk of severe infusion-related hypersensitivity reactions 4, 6.
- Oral iron is often preferred due to its ease and accessibility, but its efficacy can be limited by the hepcidin-ferroportin iron regulatory pathway, which can lead to side effects such as dyspepsia and constipation 7.