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.

                                               
    Iron deficiency anemia diagnosed  
                     
               
 

• Treat underlying cause

• Initiate oral iron therapy

 
Not tolerated
Start intravenous
iron therapy1
 
           
                   
               
 

Improved hematocrit and RBC indices?2

                       
                             
        Yes             No  
                 
   

Continue oral iron for 3mos after hematocrit/ferritin normalize, then discontinue

                             
                                           
                 
   

Normal values after
periodic CBC?

                             
                                           
  Yes                 No      
                               
 

No further monitoring unless symptomatic

   

• Reevaluate for underlying cause

• Consider intravenous iron

• Transfuse if symptomatic3

               
 
IRON THERAPY
Generic Brand Strength Form Elemental iron Dose
ORAL

carbonyl iron

Feosol

OTC

45mg

caplets

45mg

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

carbonyl iron + ferrous gluconate

Ferralet 904,5,8

Rx

90mg

tabs

90mg

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

ferrous asparto glycinate (Sumalate)

Feriva 21/74,13

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 FA4,10,14

Rx

110mg

gel caps

110mg

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

ferrous fumarate

Ferretts6

OTC

325mg

tabs

106mg

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

Ferro-Sequels5

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

OTC

325mg

tabs

65mg

Fer-In-Sol6,9

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.

polysaccharide iron complex + heme iron polypeptide (as Proferrin)

Bifera6

OTC

22mg + 6mg

caplets

28mg

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

INJECTABLE

ferric carboxymaltose

Injectafer

Rx

750mg/15mL

soln for IV push or infusion

50mg/mL

Adults: Give by slow IV push (undiluted) at rate of approx. 100mg/min; or by IV infusion (diluted) over ≥15mins. Give in 2 doses separated by ≥7 days. <50kg: 15mg/kg/dose. ≥50kg: 750mg/dose. Total cumulative dose per course: max 1500mg. May repeat treatment if condition reoccurs.
Children: Not established.

ferumoxytol

Feraheme11

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 dextran7

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. Max daily doses: <5kg: 0.5mL (25mg), <10kg: 1mL (50mg), ≥10kg: 2mL (100mg).

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

Ferrlecit12

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; HDD=hemodialysis dependent; IDA=iron deficiency anemia; NDD=non-dialysis dependent; PDD=peritoneal dialysis dependent; RBC=red blood cell

 1 Indications for intravenous 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).

 2 Perform monthly CBC

 3 Tranfuse with 2 units packed RBCs, then perform clinical assessment to guide further treatment. Transfusion is recommended in pregnant women with hemoglobin <6g/dL.

 4 Contains Vit.C, Vit.B12, folic acid

 5 Contains docusate sodium

 6 Gluten-free

 7 Higher incidence of life-threatening anaphylaxis

 8 Contains tartrazine

 9 Contains sulfites, alcohol

10 Contains biotin

11 Contains mannitol

12 Contains benzyl alcohol

13 Contains zinc, succinic acid, inert tabs

14 Contains copper

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

Short MW, Domagalski JE. Iron Deficiency Anemia: Evaluation and Management. Am Fam Physician. 2013;87(2):98-104.

(Created 7/2019)