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.
ferrous gluconate	—	OTC	324mg	tabs	38mg	Adults: 1 tab 3–4 times daily. Children: Not recommended.
ferrous gluconate	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.
	—	OTC	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. 3/2024)

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