Iron Deficiency Anemia Treatments

IRON DEFICIENCY ANEMIA TREATMENTS

Iron deficiency accounts for approximately one-half of anemia cases. Causes of iron deficiency anemia (IDA) can include inadequate iron intake, decreased iron absorption, increased iron demand, and increased iron loss. Treatment can be initiated with oral iron therapy to replenish iron stores. For patients unable to tolerate or absorb oral preparations, parenteral therapy may be used.

Generic Brand Strength Form Elemental iron Dose
ORAL1

carbonyl iron

Feosol Natural Release

OTC

45mg

caplets

45mg

Adults: 1 caplet once daily.
Children: <12yrs: Consult physician.

carbonyl iron + ferrous gluconate

Ferralet 90

Rx

90mg

tabs

90mg

Adults: Take 2hrs after meals. 1 tab once daily.
Children: Not established.

ferric citrate

Auryxia

Rx

1g

tabs

210mg

Adults: IDA due to CKD: 1 tab three times daily; titrate as needed; max 12 tabs/day.
Children: Not established.

ferric maltol

Accrufer

Rx

30mg

caps

30mg

Adults: Take 1hr before or 2hrs after a meal. 1 cap twice daily for ≥12wks.
Children: Not established.

ferrous asparto glycinate (Sumalate)

Feriva 21/7

Rx

75mg

tabs

75mg

Adults: 1 tab once daily for 28 days; repeat as needed.
Children: Not established.

ferrous asparto glycinate (Sumalate) + ferrous bisglycinate chelate (Ferrochel) + ferrous fumarate

Feriva FA

Rx

110mg

gel caps

110mg

Adults: 1 cap once daily.
Children: <12yrs: Not recommended.

ferrous fumarate

Ferretts

OTC

325mg

tabs

106mg

Adults: 1 tab once daily.
Children: Not recommended.

Ferro-Sequels

OTC

160mg

timed-rel caplets

50mg

Adults: 1 caplet once daily or as needed.
Children: Not recommended.

ferrous gluconate

OTC

324mg

tabs

38mg

Adults: 1 tab 3–4 times daily.
Children: Not recommended.

Fergon

OTC

240mg

tabs

27mg

Adults: 1 tab once daily.
Children: Not recommended.

ferrous sulfate

OTC

325mg

tabs

65mg

Adults: May mix elixir with water or fruit juice. 1 tab or 5mL once daily.
Children: <12yrs: Consult physician.

220mg/5mL

elixir

44mg/5mL

Feosol Original

OTC

325mg

tabs

65mg

Fer-In-Sol

OTC

75mg/mL

drops

15mg/mL

Adults: Not recommended.
Children: ≥4yrs: Not recommended. May give directly into the mouth or mix with formula, fruit juice, cereal or other foods. <4yrs: 1mL once daily.

Slow Fe

OTC

142mg

sust-rel tabs

45mg

Adults: 1 tab once daily.
Children: Not recommended.

INJECTABLE2

ferric carboxymaltose

Injectafer

Rx

750mg/15mL

soln for IV push or infusion

50mg/mL

Adults and Children: Give by slow IV push (undiluted) at rate of approx. 100mg (2mL)/min; or by IV infusion (diluted) over 15mins. When giving via IV infusion, dilute to concentration not less than 2mg/mL of iron. ≥1yr (<50kg): 15mg/kg/dose in 2 doses separated by ≥7 days per course; (≥50kg): 750mg/dose in 2 doses separated by ≥7 days (total cumulative dose per course: 1500mg). For adults (≥50kg): alternatively can give 15mg/kg (up to max 1000mg) as a single-dose. May repeat treatment if IDA reoccurs.

ferric derisomaltose

Monoferric

Rx

100mg/mL

soln for IV infusion

100mg/mL

Adults: Infuse over ≥20mins. <50kg: 20mg/kg (of actual body wt.) once as a single dose. ≥50kg: 1000mg once as a single dose. Both: repeat if IDA reoccurs.
Children: Not established.

ferumoxytol

Feraheme

Rx

510mg/17mL

soln for IV infusion

30mg/mL

Adults: Infuse over ≥15mins. Initially 510mg, followed by a second 510mg 3–8 days later. May repeat treatment if condition persists or reoccurs.
Children: <18yrs: Not established.

iron dextran3

Infed

Rx

100mg/2mL

soln for IV or IM inj

50mg/mL

Adults and Children: <4mos: Not recommended. Give 0.5mL test dose first; if no anaphylactic-type reactions, may give full therapeutic dose. ≥4mos: IDA: determine total dose based on hemoglobin and body weight (see full labeling). Iron replacement for blood loss: Replacement iron (mg) = blood loss (mL) x hematocrit. See full labeling.

iron sucrose

Venofer

Rx

20mg/mL

soln for IV push or infusion

20mg/mL

Adults: Give by slow IV push (undiluted) or infusion (diluted). Usual total cumulative dose: 1000mg. HDD: 100mg slow IV push over 2–5mins or infuse 100mg over ≥15mins per consecutive session. NDD: 200mg slow IV push over 2–5mins or infuse 200mg over ≥15mins on 5 different occasions within a 14-day period. PDD: two infusions of 300mg over 1.5hrs 14 days apart, then one 400mg infusion over 2.5hrs 14 days later.
Children: <2yrs or for iron replacement: Not established. ≥2yrs: Iron maintenance: give undiluted by slow IV push over 5mins or diluted at a concentration of 1–2mg/mL over 5–60mins. HDD: 0.5mg/kg (max 100mg/dose) every 2wks for 12wks. NDD or PDD: 0.5mg/kg (max 100mg/dose) every 4wks for 12wks. May repeat treatment if needed.

sodium ferric gluconate complex in sucrose

Ferrlecit

Rx

62.5mg/5mL

soln for IV push or infusion

12.5mg/mL

Adults: Give by IV infusion (diluted) or slow IV push (undiluted). 125mg infused over 1hr or by slow IV push (up to 12.5mg/min). Minimum cumulative dose: 1g given over 8 sequential dialysis sessions; usual max: 125mg/dose.
Children: <6yrs: Not recommended. Give by IV infusion (diluted) over 1hr. ≥6yrs: 1.5mg/kg per dose at 8 sequential dialysis sessions; max: 125mg/dose.

NOTES

Key: CBC=complete blood count; CKD = chronic kidney disease; HDD=hemodialysis dependent; IDA=iron deficiency anemia; NDD=non-dialysis dependent; PDD=peritoneal dialysis dependent; RBC=red blood cell

 1 Initiate oral iron therapy after IDA diagnosis. If hematocrit and RBC indices improved after a month, continue oral iron for 2–6mos until hematocrit/ferritin normalize or iron stores repleted.

 2 Administer intravenous (IV) iron therapy if initial oral iron therapy is not tolerated. If oral therapy was initiated with no improvement in hematocrit and RBC indices, consider IV iron. Indications for IV iron include intolerable GI effects, worsening symptoms of inflammatory bowel disease, unresolved bleeding, renal failure–induced anemia treated with erythropoietin, and insufficient absorption (eg, celiac disease, gastrectomy, gastrojejunostomy, bariatric surgery, or other small bowel surgeries).

 3 Higher incidence of life-threatening anaphylaxis

Not an inclusive list of medications and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.

REFERENCE

Ko CW, Siddique SM, Patel A, et al. AGA Clinical Practice Guidelines on the Gastrointestinal Evaluation of Iron Deficiency Anemia. Gastroenterology. 2020 Sep;159(3):1085-1094. doi: 10.1053/j.gastro.2020.06.046.

(Rev. 4/2022)