9.1.1 Iron deficiency anaemia

Prescribing Notes

• The oral dose of elemental iron for iron-deficiency anaemia should be 100 to 200 mg daily.
• Treatment with an iron preparation is justified only in the presence of a demonstrable iron-deficiency state. Before starting treatment, it is important to exclude any serious underlying cause of the anaemia.
• Oral iron should be continued until 3 months after the iron deficiency has been corrected. Once normal, the haemoglobin concentration and red cell indices should be monitored 3 monthly for 1 year then again after a further year.
• If side effects occur, the dose may be reduced; alternatively another iron salt may be used, but an improvement in tolerance may simply be the result of a lower content of elemental iron.
• Spatone^® is not recommended for HSC prescription. It contains 5mg of elemental iron per sachet and is therefore inadequate for the treatment or prevention of iron deficiency.
• Modified release preparations have no therapeutic advantage and should not be used.
• Combination preparations:
  • Some oral preparations contain ascorbic acid to aid absorption of iron but the therapeutic advantage of such preparations is minimal and these products are more costly.
  • There is no need to routinely prescribe a combined iron/folic acid preparation in pregnancy
  • There is no justification for the inclusion of other ingredients, such as the B group of vitamins
• Parenteral iron should be reserved for where there is intolerance or non-compliance with oral preparations. Please note this is a red list drug.
• There is insufficient evidence to support the prescribing of ascorbic acid to improve iron absorption.