Indications for and administration of oral iron supplementation
In most patients with iron deficiency, it is reasonable and appropriate to trial oral iron supplementation. However, patients who do not tolerate or cannot absorb oral iron supplements (eg following gastrectomy) require intravenous iron supplementationKo, 2020.
Many of the iron-containing supplements available from health food stores and pharmacies do not have adequate elemental iron to be an effective treatment for iron deficiency. It is important to ensure that the patient is taking a sufficient dose of elemental iron; Examples of oral iron preparations and their elemental iron content lists iron preparations that contain adequate elemental iron. Vitamin C is often given concurrently to optimise iron absorptionKo, 2020.
For oral iron supplementation, use:
elemental iron 100 to 210 mg (child: 3 to 6 mg elemental iron/kg/day up to 210 mgThe Royal Children's Hospital Melbourne (RCH), January 2019 ) orally, daily (see Examples of oral iron preparations and their elemental iron content for preparations). iron preparations (oral) iron preparations (oral) iron preparations (oral)
An iron overdose can be fatal for a child; see Iron poisoning for detailed information.
Brand name and dose form | Elemental iron content | Iron salt and content | Other active ingredients |
Ferro-tab film-coated tablet | 65.7 mg | ferrous fumarate 200 mg | nil |
Ferro-grad F, Ferrogen Iron + Folic Acid modified-release tablet | 80 mg | ferrous sulfate 250 mg | folic acid 300 micrograms |
Fefol capsule containing delayed-release pellets | 87.4 mg | ferrous sulfate 270 mg | folic acid 300 micrograms |
Ferro-F film-coated tablet | 100 mg | ferrous fumarate 310 mg | folic acid 350 micrograms |
Maltofer film-coated tablet | 100 mg | iron polymaltose 370 mg | nil |
Ferro-grad, Ferrogen, Ferrovance modified-release tablet | 105 mg | ferrous sulfate 325 mg | nil |
Ferro-grad C, Ferro-Max C, Ferrogen Iron + Vitamin C, Ferrovance C modified-release tablet | 105 mg | ferrous sulfate 325 mg | ascorbic acid (vitamin C) 500 mg |
Ferro-liquid oral liquid | 6 mg/mL (90 mg/15 mL) | ferrous sulfate heptahydrate 30 mg/mL (450 mg/15 mL) | nil |
Maltofer syrup | 10 mg/mL (100 mg/10 mL) | iron polymaltose 37 mg/mL (370 mg/10 mL) | nil |
Adverse effects such as nausea, bloating, constipation and diarrhoea are common with oral iron supplementation, particularly during pregnancy. To reduce these adverse effects, the daily dose can be administered in divided doses or every second dayStoffel, 2017Ko, 2020.
Oral absorption of iron is reduced by food, so iron supplements should be taken at least 1 hour before eating; however, if this worsens gastrointestinal adverse effects, iron can be taken with foodKo, 2020. Oral absorption is also reduced by calcium supplements, proton pump inhibitors, H2-receptor antagonists, antacids and tea. Warn patients that oral iron supplements cause black stools.
Check patient adherence because poor adherence is a frequent cause of an inadequate responseKo, 2020.