Iron Supplementation

Aka: Iron Supplementation, Ferrous Sulfate, Iron Sulfate, Ferrous Gluconate, Feosol, Fer-In-Sol, Ferrous Fumarate, Hemocyte

1. See also
   1. Dietary Iron
   2. Iron
2. Indications
   1. Iron Deficiency Anemia
3. Precautions
   1. Iron supplements in overdosage may be lethal in children (FDA black box warning)
4. Preparations
   1. Ferrous Sulfate (FeSO4)
      1. Elemental Iron: 15 mg per 0.6 ml dropper
      2. Elemental Iron: 18 mg per 5 ml Syrup
      3. Elemental Iron: 65 mg per 325 mg tablet
   2. Ferrous Gluconate (Fergon)
      1. Elemental Iron: 36 mg per 325 mg tablet
      2. Elemental Iron: 30 mg per 300 mg/5 ml syrup
   3. Iron Dextran (Imferon)
      1. See Parenteral iron
5. Dosing
   1. General Anemia management
      1. Ferrous Sulfate 325 mg PO tid
   2. Postpartum Iron Deficiency Anemia
      1. Hemoglobin 7-9
         1. Ferrous Sulfate 325 mg PO tid
      2. Hemoglobin 9-10
         1. Ferrous Sulfate 325mg PO bid
      3. Hemoglobin >10
         1. Ferrous Sulfate 325mg PO qd
   3. Pediatric Anemia
      1. Severe Pediatric Anemia
         1. Ferrous Sulfate 4-6 mg/kg/day PO tid
      2. Mild Pediatric Anemia or Prophylaxis
         1. Ferrous Sulfate 1-2 mg/kg/day PO qd-bid
6. Drug Interactions
   1. Food and drugs reducing iron absorption
      1. Antacids (raise pH, low acidity)
         1. Tums, Maalox, or Mylanta
         2. Histamine H2 Receptor Blockers (e.g. Ranitidine)
         3. Proton Pump Inhibitors (e.g. Prilosec)
      2. Inhibitors of iron absorption
         1. Polyphenol (in vegetables)
         2. Tannins (in tea)
         3. Phytate (in bran, cereal)
         4. Calcium (dairy products)
   2. Drugs increasing iron absorption
      1. Vitamin C (Ascorbic acid)
   3. Drugs with decreased absorption when taken with iron
      1. Levodopa
      2. Methyldopa
      3. Penicillamine
      4. Quinolones
      5. Tetracyclines
7. Adverse Effects
   1. Gastrointestinal distress
      1. Ferrous iron causes mucosal irritation
      2. Start with once daily dosing and titrate to tid
      3. Tolerance is directly related to iron concentration
         1. Start with normal concentration elemental iron
            1. Decrease to lower concentrations as needed
         2. Lower elemental iron concentration better tolerated
            1. Ferrous Gluconate
            2. More expensive iron preparations
      4. Enteric coated Iron has decreased absorption
   2. Black stools
   3. Hemochromatosis
      1. Prolonged, excessive Iron Supplementation
8. References
   1. Little (1999) Am Fam Physician 59(6):1598-604