From the Guidelines
Oral iron supplements are the first-line treatment for iron deficiency anemia, with ferrous sulfate being the most commonly recommended form, as stated in the most recent study 1. The recommended dose is typically 200 mg of ferrous sulfate twice daily, as suggested by the guidelines for the management of iron deficiency anaemia 1. It is essential to take iron supplements on an empty stomach with vitamin C (like orange juice) to enhance absorption, and to continue treatment for at least 3 months to replenish iron stores, even after symptoms improve 1. Common side effects of oral iron supplements include constipation, dark stools, stomach discomfort, and nausea, which can be minimized by starting with a lower dose and gradually increasing 1. If oral iron is not tolerated or is not effective after 3 months, intravenous iron may be necessary, as recommended by the AGA clinical practice update on management of iron deficiency anemia 1. Some key points to consider when treating iron deficiency anemia include:
- Monitoring hemoglobin levels to assess the effectiveness of treatment
- Checking for underlying causes of iron deficiency, such as gastrointestinal bleeding or menstrual bleeding
- Considering alternative forms of iron, such as ferrous gluconate or ferrous fumarate, if ferrous sulfate is not tolerated
- Avoiding taking iron with calcium, dairy, coffee, tea, or antacids, as these can reduce absorption
- Being aware of the potential for anaphylactic reactions with intravenous iron, although the risk is low with newer formulations 1. Overall, the goal of treatment is to replenish iron stores, improve symptoms, and enhance quality of life, as emphasized in the european consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases 1.
From the Research
Treatment of Iron Deficiency Anemia with Oral Iron
- Oral iron supplementation is the first line of treatment for iron-deficiency anemia and pre-anemic iron deficiency 2.
- The most commonly prescribed oral iron supplements include ferrous sulfate, other ferrous salts, and ferric complexes with polysaccharides or succinylated milk proteins 2.
- Novel iron formulations, such as ferric maltol and nanoparticle encapsulated sucrosomial iron, have been developed to improve efficacy and tolerability 2.
Efficacy and Tolerability of Oral Iron Supplements
- Oral iron supplementation is usually efficacious in correcting iron-deficiency anemia and replenishing iron stores, but can cause gastrointestinal side effects that reduce compliance 2.
- Low-dose oral iron supplementation may have comparable efficacy to high-dose supplementation, with fewer side effects 3.
- Sucrosomial iron, an oral formulation consisting of ferric pyrophosphate conveyed by a phospholipid and sucrester matrix, has higher iron intestinal absorption and excellent gastrointestinal tolerance compared to oral iron salts 4.
Comparison of Oral Iron Supplements
- Lactoferrin supplementation has been shown to have better effects on serum iron, ferritin, and hemoglobin concentration compared to ferrous sulfate supplementation, with a reducing effect on fractional iron absorption and IL-6 levels 5.
- The anti-inflammation effect of lactoferrin may be the potential mechanism to explain its efficacy on iron status and erythropoiesis 5.
- The optimal formulation and dosing strategy for oral iron supplementation are still under debate, and further study is needed to advance the care of individuals affected by iron deficiency 6.