Is it appropriate to prescribe iron syrup (220 mg ferrous sulfate per 5 mL, providing 44 mg elemental iron) to a 13‑year‑old child?

Iron 220mg (44mg Fe)/5mL for a 13-Year-Old: Dosing Appropriateness

Yes, iron syrup providing 44 mg elemental iron per 5 mL can be safely prescribed to a 13-year-old child, but the total daily dose must be calculated based on the child's weight using 3 mg/kg/day of elemental iron for treatment of iron-deficiency anemia, not given as a fixed 5 mL dose. 1

Weight-Based Dosing Calculation

• The standard therapeutic dose for treating iron-deficiency anemia in children is 3 mg/kg/day of elemental iron given as ferrous sulfate 1
• For a typical 13-year-old weighing approximately 40-50 kg, this translates to 120-150 mg of elemental iron daily 1
• Using your formulation (44 mg elemental iron per 5 mL), this would require approximately 13.6-17 mL daily for a child in this weight range 1
• The dose should never exceed 6 mg/kg/day even for treatment purposes, as higher doses increase toxicity risk without improving efficacy 2

Administration Guidelines for Optimal Absorption

• Iron must be given between meals (on an empty stomach) to maximize absorption, as food can reduce bioavailability by up to 50% 1, 3
• Specifically, administer at least 2 hours before or 1 hour after meals 3
• Avoid concurrent administration with tea, coffee, dairy products, or aluminum-based medications, all of which significantly impair iron absorption 3

Treatment Duration and Monitoring Protocol

• Continue initial therapy for 4 weeks, then recheck hemoglobin 1
• An increase of ≥1 g/dL in hemoglobin after 4 weeks confirms iron-deficiency anemia and adequate response 1
• If response is confirmed, extend treatment for an additional 2 months (total ~3 months) to replenish iron stores 1
• Recheck hemoglobin after completing the full course, with further reassessment at 6 months to ensure sustained correction 1

Managing Non-Response and Side Effects

• If hemoglobin fails to increase after 4 weeks despite confirmed adherence and absence of acute illness, obtain MCV, RDW, and serum ferritin to exclude alternative diagnoses 1, 3
• Common gastrointestinal side effects (nausea, vomiting, diarrhea) should not necessarily prompt discontinuation 1
• If GI symptoms are intolerable, consider dividing the daily dose into smaller, more frequent administrations or switching to alternate-day dosing, which may improve tolerability while maintaining efficacy 3

Critical Safety Considerations

• Systemic iron toxicity with hepatocellular damage has been reported with excessive iron administration in pediatric patients, emphasizing the importance of strict weight-based dosing 1, 4
• Ferrous sulfate remains the most cost-effective and evidence-based first-line treatment for iron-deficiency anemia in children, with superior efficacy compared to iron polysaccharide complex 5
• Always provide concurrent dietary counseling to address underlying inadequate iron intake that precipitated the deficiency 1

Formulation Appropriateness

• Liquid iron preparations are more appropriate for pediatric patients than solid dose forms, making your syrup formulation suitable for a 13-year-old 3
• Ferrous sulfate liquid formulations typically provide known amounts of elemental iron and are well-studied in pediatric populations 1, 5