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Anaemia - iron deficiency - Management
Iron supplements

  • The aim of treatment is to restore haemoglobin levels and red cell indices to normal and to replenish iron stores [British Society of Gastroenterology, 2005].
  • Dose-related adverse effects from taking an iron supplement are commonly experienced. It may be good practice to recommend ferrous sulphate 200 mg (65 mg elemental iron content) twice a day until the clinical response is assessed after 2–4 weeks, and thereafter:
    • If well tolerated increase to three times a day.
    • If poorly tolerated reduce to once a day.
  • Alternatively if ferrous sulphate is not tolerated then the person may prefer to try taking a different iron preparation such as ferrous fumarate, or ferrous gluconate [BNF 54, 2007].
    • Ferrous gluconate 300 mg tablets may be better tolerated than ferrous sulphate as there is less elemental iron content per tablet than ferrous sulphate.
    • Ferrous fumarate tablets contain more elemental iron per tablet than ferrous sulphate and is therefore likely to be no better tolerated.
  • For more information on prescribing iron supplements see Prescribing information.
  • After eating food, iron absorption may be [Heath and Fairweather-Tait, 2002; Killip et al, 2007]:
    • Increased if a person has a high intake of fish, or red or white meat.
    • Reduced if a person has a high intake of phytate (e.g. from wholegrain cereals), polyphenols (e.g. from tea and coffee), calcium (e.g. from dairy products), or medication that raises the gastric pH (e.g. antacids, proton pump inhibitors).

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