9.1.1.1 Oral iron

ChoiceDrugDosage
1st choicesFerrous fumarate 305mg capsules(100mg iron)Dose:
Prophylactic, 1 capsule daily;
Therapeutic, 1 capsule twice daily
Or
Ferrous sulphate
200mg tablets (65mg iron)
Dose:
Prophylactic, 1 tablet daily;
Therapeutic, 1 tablet 2-3 times daily

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.