Should I take ferrous sulfate or other iron supplements instead of the purchased Carbonyl iron (elemental iron) 65 mg plus vitamin C for my iron deficiency anemia?

Your Carbonyl Iron Product is Acceptable, But Ferrous Sulfate is the Preferred First-Line Choice

The American Gastroenterological Association and British Society of Gastroenterology recommend ferrous sulfate as the gold standard for oral iron therapy due to its proven efficacy, cost-effectiveness (£1.00 vs significantly higher for alternatives per 28-day supply), and extensive clinical experience, though your carbonyl iron 65 mg with vitamin C is a reasonable alternative that may offer better safety in households with children. 1

Why Ferrous Sulfate Remains the Standard

• Ferrous sulfate 200 mg tablets provide 65 mg elemental iron per tablet—the same amount as your carbonyl iron—and cost approximately £1.00 for a 28-day supply, making them the most cost-effective option. 1

• The American College of Gastroenterology confirms that no single iron formulation has proven advantages over others in terms of tolerability, meaning your carbonyl iron should work similarly to ferrous sulfate. 1

• Ferrous sulfate has decades of clinical evidence supporting its efficacy for correcting iron deficiency anemia, with expected hemoglobin increases of approximately 1 g/dL within 2 weeks in responding patients. 1

The Case for Keeping Your Carbonyl Iron

• Carbonyl iron has a unique safety advantage: it substantially reduces or eliminates the risk of iron poisoning in children compared to iron salts, as single doses of 1,000-10,000 mg (15-150 times the usual ferrous sulfate dose) were tolerated without toxicity. 2

• Studies demonstrate that carbonyl iron effectively corrects anemia at rates similar to oral iron salts and parenteral iron dextran, with 29 of 32 anemic patients achieving correction after treatment. 2

• Your product already includes vitamin C, which the American Gastroenterological Association recommends as Best Practice Advice for enhancing non-heme iron absorption—the most potent absorption enhancer available. 3, 4

• Gastrointestinal side effects with carbonyl iron are comparable to ferrous sulfate, so you're not sacrificing tolerability. 2, 5

Optimal Dosing Strategy for Either Product

• Take your iron once daily in the morning on an empty stomach when hepcidin levels (which block iron absorption) are lowest, as recommended by the American Gastroenterological Association. 1, 4

• The target is 50-100 mg elemental iron daily, so your 65 mg carbonyl iron dose falls perfectly within this range. 1

• Avoid taking multiple doses per day—doses ≥60 mg stimulate hepcidin elevation that persists for 24 hours and blocks subsequent iron absorption, reducing the second dose absorption by 35-45%. 1, 6

• If daily dosing causes intolerable side effects, consider alternate-day dosing with 100-130 mg elemental iron (two tablets), which leads to significantly increased fractional iron absorption compared to daily dosing. 1, 6

Maximizing Absorption with Your Current Product

• Since your product includes vitamin C, you're already optimizing absorption—vitamin C forms a chelate with iron that prevents formation of insoluble iron compounds and reduces ferric to ferrous iron. 3

• Take iron on an empty stomach, 1-2 hours before or after meals, to maximize absorption. 1, 4

• Avoid taking iron with tea or coffee (coffee decreases absorption by 54%), calcium supplements, or dairy products—separate these by at least 1-2 hours. 3, 1, 4

• If you must take iron with food due to stomach upset, accept that absorption will decrease but adherence improves—this trade-off may be necessary. 3, 1

Expected Timeline and Monitoring

• Your hemoglobin should rise by at least 10 g/L (1 g/dL) within 2 weeks of starting daily iron therapy; failure to achieve this strongly predicts treatment failure (sensitivity 90.1%, specificity 79.3%). 1

• Continue treatment for approximately 3 months after hemoglobin normalizes to ensure adequate repletion of iron stores. 1, 4

• Monitor hemoglobin response within the first 4 weeks to confirm adequate response. 1

Critical Contraindication

• If you have hemochromatosis or iron overload, you must completely avoid vitamin C supplements, as vitamin C accelerates iron mobilization and can cause cardiac arrhythmias, cardiomyopathy, and sudden death. 3, 4

Bottom Line Decision

Keep your carbonyl iron 65 mg with vitamin C if you have young children at home (safety advantage) or if you've already purchased it—it will work effectively. However, if cost is a concern or you need to purchase more iron in the future, switch to generic ferrous sulfate 200 mg tablets (65 mg elemental iron) and add 250-500 mg vitamin C or take it with orange juice. 1, 4 Both approaches will correct your iron deficiency anemia at similar rates when taken once daily in the morning on an empty stomach. 1, 2, 5