From the Guidelines
Iron deficiency supplementation should be initiated with oral ferrous sulfate, fumarate, or gluconate, one tablet per day, as the first-line treatment for iron deficiency anemia, as recommended by the British Society of Gastroenterology guidelines 1. The standard treatment for iron deficiency anemia is oral iron supplementation, which is effective in replenishing iron stores and improving hemoglobin levels.
- The initial treatment should be with one tablet per day of ferrous sulphate, fumarate, or gluconate, as recommended by the British Society of Gastroenterology guidelines 1.
- If not tolerated, a reduced dose of one tablet every other day, alternative oral preparations, or parenteral iron should be considered, as suggested by the guidelines 1.
- Treatment typically continues for 3-6 months after blood counts normalize to replenish iron stores, as recommended by the guidelines 1.
- For those who cannot tolerate oral supplements, intravenous iron formulations like iron sucrose or ferric carboxymaltose may be prescribed by healthcare providers, as recommended by the AGA clinical practice update 1.
- Regular monitoring of iron levels during treatment is important to ensure effectiveness and prevent iron overload, as recommended by the ESPEN guideline on clinical nutrition in inflammatory bowel disease 1.
- It is essential to recognize that patients with inflammatory conditions may have iron deficiency or iron deficiency anemia in the setting of a ferritin level greater than 45 mg/dL, and confirmatory testing with transferrin saturation, soluble transferrin receptor, or reticulocyte hemoglobin equivalent may be helpful in these situations, as suggested by the AGA clinical practice update 1.
From the FDA Drug Label
Each tablet contains 324 mg of ferrous gluconate, equivalent to 38 mg of elemental iron, providing 211% of the U.S. recommended daily intake (RDI) of iron for adults and children 4 and older. Adult Serving Size: 1 tablet three to four times daily. Each tablet contains 324mg of ferrous sulfate, equivalent to 65mg of elemental iron, providing 362% of the U.S. recommended daily intake (RDI) of iron for adults and children 4 and older. Each tablet contains 324 mg of ferrous sulfate, equivalent to 65 mg of elemental iron, providing 362% of the U.S. recommended daily intake (RDI) of iron for adults and children 4 and older.
For iron deficiency supplementation, the recommended adult serving size is 1 tablet of ferrous gluconate three to four times daily, providing 38 mg of elemental iron per tablet 2. Alternatively, ferrous sulfate can be used, with each tablet containing 65 mg of elemental iron 3 3.
- Key points:
- Ferrous gluconate: 38 mg of elemental iron per tablet
- Ferrous sulfate: 65 mg of elemental iron per tablet
- Adult serving size: 1 tablet three to four times daily for ferrous gluconate 2
From the Research
Iron Deficiency Supplementation
- Iron deficiency is the most common nutrient deficiency in the world, affecting over 20% of premenopausal women worldwide 4
- Oral iron supplementation is often the first-line treatment for the acute and chronic management of iron deficiency due to its ease and accessibility 4, 5
- The simplest, least expensive, and most commonly prescribed drug is ferrous sulfate, while other ferrous salts and ferric complexes with polysaccharides or succinylated milk proteins are also widely used 5
Oral Iron Supplementation
- Oral iron supplementation is usually efficacious in correcting iron-deficiency anemia and replenishing iron stores but causes gastrointestinal side effects that reduce compliance 5
- Daily low dose and every other day dosing protocols have attempted to bypass the physiologic bottleneck to allow for effective absorption and limit side effects; however, this approach has still resulted in low fractional iron absorption 4
- A study proposed to evaluate the feasibility of performing a study to examine the effectiveness and side-effect profile of oral iron once daily versus every other day 6
Factors Affecting Iron Absorption
- Gastric acid is one of the important factors for optimum absorption of iron 7
- Proton pump inhibitors, such as omeprazole, may decrease the absorption of oral iron supplementation 7
- Iron-deficient patients taking proton pump inhibitors may have to be treated with high dose iron therapy for a longer duration or with intravenous iron therapy 7
Alternative Treatment Options
- Intravenous iron therapy can rapidly achieve therapeutic targets without gastrointestinal complications 5, 8
- Intravenous iron is an effective and safe alternative treatment for iron deficiency anemia in more severely anemic or intolerant patients 8
- Anemia correction with iron treatment is associated with a relevant improvement in the patients' quality of life 8