My serum iron is 342 µg/dL with a normal ferritin of 50 ng/mL while taking a daily oral iron tablet (≈65 mg elemental iron); should I discontinue the iron supplement?

Should You Stop Your Daily Iron Supplement?

Yes, you should discontinue your daily iron supplement immediately. With a serum iron of 342 µg/dL (significantly elevated above the normal range of 50-175 µg/dL) and a ferritin of 50 ng/mL, continuing supplementation risks iron overload without providing additional benefit 1.

Why You Should Stop

Your Iron Status Indicates No Need for Supplementation

• Serum iron of 342 µg/dL is nearly double the upper limit of normal (50-175 µg/dL), indicating your body currently has excessive circulating iron 1.
• Ferritin of 50 ng/mL represents adequate iron stores for a healthy adult, as guidelines define iron deficiency as ferritin <30 ng/mL in general populations 1.
• Continuing supplementation at 65 mg elemental iron daily when serum iron is already elevated creates unnecessary risk of progressive iron accumulation 1.

Risk of Iron Overload

• Iron supplementation above 3 times the recommended dietary allowance (RDA) in healthy adults is associated with significantly elevated iron stores, and your current dose of 65 mg exceeds 8 times the RDA for men (8 mg/day) 2.
• The hemochromatosis guidelines explicitly state that patients should avoid vitamin C supplements and iron supplements when iron stores are adequate, as there are no regulated excretion mechanisms for excess iron 1.
• Iron overload can lead to organ damage including liver disease, cardiac complications, and endocrine dysfunction when ferritin levels continue to rise unchecked 1.

What to Do Next

Immediate Action

• Stop taking the iron supplement today 1.
• Avoid vitamin C supplements, as they accelerate iron mobilization and can increase pro-oxidant activity 1.
• No dietary restrictions are necessary—normal food intake will not cause problematic iron accumulation 1.

Monitoring Plan

• Recheck serum iron, ferritin, and transferrin saturation in 8-10 weeks to assess how your iron status responds after discontinuation 1.
• If ferritin drops below 30 ng/mL or you develop symptoms of anemia, then reconsider supplementation at that time 1.
• Do not recheck iron parameters immediately after stopping, as ferritin levels can remain falsely elevated for weeks after recent supplementation 1.

Common Pitfalls to Avoid

• Do not assume "more is better" with iron supplementation—unlike water-soluble vitamins, excess iron accumulates in tissues and cannot be easily excreted 1.
• Do not continue supplementation based solely on a "normal" ferritin of 50 ng/mL when your serum iron is markedly elevated, as this indicates functional iron excess 1.
• Do not ignore the elevated serum iron value—this is the most direct indicator that you currently have too much circulating iron 1.
• Investigate why you were taking iron supplements in the first place—if it was for documented anemia or low ferritin previously, ensure the underlying cause (such as gastrointestinal bleeding or malabsorption) has been addressed 3.

When to Consider Restarting

Only restart iron supplementation if future testing shows:

• Ferritin drops below 30 ng/mL 1
• Transferrin saturation falls below 20% 1
• Hemoglobin decreases below normal range with confirmed iron deficiency 1

If supplementation becomes necessary again in the future, use the lowest effective dose (typically 30-60 mg elemental iron on alternate days rather than daily) to minimize gastrointestinal side effects and reduce risk of over-supplementation 1, 4.