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Iron Supplementation
Aka: Iron Supplementation, Iron Replacement, Ferrous Sulfate, Iron Sulfate, Ferrous Gluconate, Feosol, Fer-In-Sol, Ferrous Fumarate, Hemocyte, Ferric Compounds
- See also
- Dietary Iron
- Iron
- Hemochromatosis
- Iron Deficiency Anemia
- Acute Iron Toxicity
- Indications
- Iron Deficiency Anemia
- Precautions
- Iron supplements in overdosage may be lethal in children (FDA black box warning)
- See Iron Ingestion
- Ferrous Sulfate and Ferrous Fumarate are preferred preparations
- Delivers highest elemental iron amounts
- Ferrous Gluconate supplies only 50% of the elemntal iron
- Formulations with risk of lower iron absorption
- Extended release or enteric coated iron formulations
- Formulations with no evidence of benefit
- Polysaccharide-iron complex (e.g. Ferrex 150)
- Carbonyl iron (ICAR)
- Heme Iron Polypeptide (Proferrin ES)
- Avoid every other day dosing
- When same dose is taken every other day instead of daily, does not decrease gastrointestinal side effects
- Although absorption may increase with every day dosing, the total time for replacement is still twice as long
- Compliance decreases with every other day dosing
- References
- (2017) Presc Lett 24(3)
- (2020) Presc Lett 27(9): 52-3
- Preparations
- Ferrous Fumarate (33% elemental iron)
- Elemental Iron: 106 mg per 325 mg tablet (or 29.5 mg per 90 mg tablet)
- Ferrous Sulfate (FeSO4, 20% elemental iron)
- Elemental Iron: 15 mg per 75 mg/0.6 ml Dropper
- Elemental Iron: 60 mg per 300 mg/5 ml Syrup
- Elemental Iron: 44 mg per 220 mg/5 ml Elixir/Liquid
- Elemental Iron: 65 mg per 325 mg Tablet (or 60 mg per 300 mg tablet)
- Ferrous Gluconate (Fergon, 12% elemental iron)
- May be better tolerated that other forms, but supplies only 50% of the iron in other formulations
- Elemental Iron: 36 mg per 325 mg tablet (or 27 mg per 240 mg tablet)
- Elemental Iron: 30 mg per 300 mg/5 ml syrup
- Parenteral Iron
- See Parenteral Iron
- Iron sucrose (Venofer)
- Iron Dextran (Imferon)
- Sodium Ferric Gluconate (Ferrlecit)
- Ferumoxytol (Feraheme)
- Ferric Carboxymaltose (Injectafer)
- Dosing
- General Anemia management (adults)
- Ferrous Sulfate 325 mg orally daily (65 to 100 mg elemental iron daily)
- Postpartum Iron Deficiency Anemia
- Hemoglobin 7-9
- Ferrous Sulfate 325 mg PO tid
- Hemoglobin 9-10
- Ferrous Sulfate 325mg PO bid
- Hemoglobin >10
- Ferrous Sulfate 325mg PO qd
- Pediatric Anemia
- Severe Pediatric Anemia
- Ferrous Sulfate 4-6 mg/kg/day PO tid
- Mild Pediatric Anemia or Prophylaxis
- Ferrous Sulfate 1-2 mg/kg/day PO qd-bid
- Overall daily dietary requirements (or supplementation) in non-anemic children
- Preterm Infants (born <37 weeks) age <12 months
- Exclusively Breast fed: 2 mg/kg/day
- Iron-fortified formula: 1 mg/kg/day
- Term infants age <12 months
- Exclusively Breast fed: 1 mg/kg/day
- Iron-fortified formula: No additional needed
- Children age 1 to 3 years
- Requirement: 7 mg/day elemental iron total via diet or supplementation
- Children age 4 to 8 years
- Requirement: 10 mg/day elemental iron total via diet or supplementation
-
Drug Interactions
- Food and drugs reducing iron absorption
- Antacids (raise pH, low acidity)
- Tums, Maalox, or Mylanta
- Histamine H2 Receptor Blockers (e.g. Ranitidine)
- Proton Pump Inhibitors (e.g. Prilosec)
- Inhibitors of iron absorption
- Polyphenol (in vegetables)
- Tannins (in tea)
- Phytate (in bran, cereal)
- Calcium (dairy products)
- Drugs increasing iron absorption
- Vitamin C (Ascorbic Acid) 200 mg or orange juice 8 ounces increases iron absorption by 10% (minimal)
- Drugs with decreased absorption when taken with iron
- Levodopa
- Methyldopa
- Penicillamine
- Quinolones
- Tetracyclines
- Adverse Effects
- Gastrointestinal distress
- Ferrous iron causes mucosal irritation
- Start with once daily dosing and titrate to two to three times daily if needed
- Tolerance is directly related to iron concentration
- Start with normal concentration elemental iron
- Decrease to lower concentrations as needed
- Lower elemental iron concentration better tolerated
- Ferrous Gluconate
- More expensive iron preparations
- Consider 15 mg elemental iron liquid dissolved in orange juice
- Enteric coated Iron has decreased absorption
- Liquid formulations may be better tolerated
- Black stools
- Hemochromatosis
- Prolonged, excessive Iron Supplementation
- References
- Little (1999) Am Fam Physician 59(6):1598-604 [PubMed]