Note: Dosage expression: Dose is expressed in terms of elemental iron; the strength of each capsule or concentration of liquid represents the amount of elemental iron (eg, a 150 mg capsule contains 150 mg of elemental iron). Formulation: Enteric-coated and slow/sustained-release preparations are generally not preferred due to poor absorption (Hershko 2014; Liu 2012). Route of administration: IV iron replacement is preferred over oral replacement in several clinical situations (eg, poor GI absorption, lack of response to or poor tolerability of oral iron, chronic kidney disease, active inflammatory bowel disease, cancer, chronic or extensive blood loss) (Auerbach 2021).
Iron deficiency or iron deficiency anemia: Oral: 50 to 200 mg of elemental iron (1 tablet or equivalent as liquid) once every other day or on Monday, Wednesday, and Friday (Liu 2012; Stoffel 2017; Stoffel 2020; Stoltzfus 1998; WHO 2001). Note: Daily dosing has been shown to result in decreased absorption but may be reasonable in some individuals to improve adherence (Auerbach 2021; Stoffel 2017; Stoffel 2020).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosing adjustments provided in the manufacturer’s labeling.
There are no dosing adjustments provided in the manufacturer’s labeling.
(For additional information see "Polysaccharide-iron complex: Pediatric drug information")
Note: Multiple concentrations of polysaccharide iron complex oral liquid exist; close attention must be paid to the concentration when ordering and administering polysaccharide iron complex; incorrect selection or substitution of one polysaccharide iron complex liquid for another without proper dosage volume adjustment may result in serious over- or underdosing.
Note: Dosages are expressed in terms of elemental iron.
Dietary supplementation: Note: Refer to product-specific labeling for approved pediatric ages.
Infants and Children <12 years: Oral liquid: Oral: 15 mg elemental iron daily.
Children ≥12 years and Adolescents: Oral: 50 mg elemental iron daily.
Iron deficiency anemia, prevention:
AAP recommendations:
Infants ≥4 months (exclusively fed human milk or human milk provides >50% of nutrition without iron fortified food): Oral: 1 mg elemental iron/kg/day; supplementation should be continued until sufficient iron is provided in complementary foods (AAP [Baker 2010]).
WHO recommendations:
Areas where anemia prevalence is ≥40%:
Infants ≥6 months and Children <2 years: Oral: 10 to 12.5 mg elemental iron daily for 3 consecutive months in a year (WHO 2016b).
Children 2 to <5 years: Oral: 30 mg elemental iron daily for 3 consecutive months in a year (WHO 2016b).
Children ≥5 to 12 years: Oral: 30 to 60 mg elemental iron daily for 3 consecutive months in a year (WHO 2016b).
Adolescent menstruating patients (nonpregnant patients of reproductive potential): Oral: 30 to 60 mg elemental iron daily for 3 consecutive months in a year (WHO 2016a).
Areas where anemia prevalence 20% to <40%: Weekly intermittent dosing:
Children 2 to <5 years: Oral: 25 mg elemental iron once weekly for 3 consecutive months, then alternating 3 months off supplementation, 3 months on supplementation (WHO 2011).
Children 5 to 12 years: Oral: 45 mg elemental iron once weekly for 3 consecutive months, then alternating 3 months off supplementation, 3 months on supplementation (WHO 2011).
Iron deficiency anemia, treatment: Infants, Children, and Adolescents: Oral: Initial: 3 mg elemental iron/kg/day as a single daily dose (Kazal 2002; Oski 1993; Powers 2017; Reeves 1985) up to 60 to 120 mg elemental iron once daily (AAP [Kleinman 2019]); higher doses may be needed in select patients; dosage range: 3 to 6 mg elemental iron/kg/day in 1 to 3 divided doses; usual maximum daily dose: 150 to 200 mg elemental iron/day (ASPEN [Corkins 2015]; Kliegman 2020; Zlotkin 2001); once-daily administration may be preferred for ease of administration and adherence (Zlotkin 2001). Studies in iron-depleted adults suggest that iron absorption may be improved by less frequent dosing (alternate-day dosing, or once daily versus multiple daily doses) (Moretti 2015; Stoffel 2017).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosing adjustments provided in the manufacturer's labeling.
There are no dosing adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule, Oral:
EZFE 200: 200 mg [non-toxic; contains brilliant blue fcf (fd&c blue #1), fd&c red #40, fd&c yellow #10 (quinoline yellow)]
Ferrex 150: 150 mg [contains fd&c blue #1 aluminum lake, fd&c red #40 aluminum lake, fd&c yellow #5 aluminum lake]
Ferric x-150: 150 mg [contains brilliant blue fcf (fd&c blue #1), fd&c red #40, tartrazine (fd&c yellow #5)]
IFerex 150: 150 mg [contains brilliant blue fcf (fd&c blue #1), fd&c red #40, fd&c yellow #10 (quinoline yellow)]
Myferon 150: 150 mg [DSC]
NovaFerrum 50: 50 mg [DSC]
Nu-Iron: 150 mg [contains brilliant blue fcf (fd&c blue #1), fd&c red #40]
Poly-Iron 150: 150 mg [contains fd&c blue #1 aluminum lake, fd&c red #40 aluminum lake, fd&c yellow #5 aluminum lake]
Generic: 150 mg
Liquid, Oral:
NovaFerrum: Polysaccharide-iron complex 125 mg and cholecalciferol 100 units per 5 mL (180 mL) [contains sodium benzoate]
NovaFerrum Pediatric Drops: 15 mg/mL (120 mL) [alcohol free, dye free, gluten free, lactose free, sodium free, sugar free; contains sodium benzoate; raspberry-grape flavor]
May be product dependent
Oral: Shake liquid well prior to administration.
Oral: Administer with water or juice prior to breakfast and/or between meals for maximum absorption (Kliegman 2020; Oski 1993); may administer with food if GI upset occurs; do not administer with milk or milk products (Powers 2017). Shake liquid well prior to administration.
Iron deficiency or iron-deficiency anemia: Management (prevention and treatment) of iron-deficiency anemia.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Gastrointestinal: Constipation, darkening of stools, epigastric pain, gastrointestinal irritation, nausea, stomach cramps, vomiting
1% to 10%:
Gastrointestinal: Dental discoloration, diarrhea, heartburn
Genitourinary: Urine discoloration
<1%, postmarketing, and/or case reports: Local irritation
Known hypersensitivity to polysaccharide-iron complex or any component of the formulations; hemochromatosis; hemosiderosis
Documentation of allergenic cross-reactivity for other iron-containing products is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.
Concerns related to adverse effects:
• Stool discoloration: Oral iron preparations commonly cause dark or black stools; patients should be informed of the effect.
Special populations:
• Pediatric: Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6 years of age. Keep this product out of the reach of children. In case of accidental overdose call the poison control center immediately.
Dosage form specific issues:
• Oral iron formulations: Immediate-release oral iron products are preferred for treatment of iron deficiency anemia; enteric-coated and slow-/sustained-release preparations are not desired due to poor absorption (Hershko 2014; Liu 2012).
• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity ("gasping syndrome") in neonates; the "gasping syndrome" consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions and intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggest that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer's labeling.
• Excipient: Some formulations may contain tartrazine, which is associated with allergic-type reactions. Although rare, hypersensitivity is more frequently seen in individuals with aspirin allergy.
Other warnings/precautions:
• Appropriate use: Investigate type of anemia and potential underlying causes (eg, recurrent blood loss) prior to initiating iron supplementation.
Consider all iron sources when evaluating the dose of iron, including combination products, infant formulas, and liquid nutritional supplements.
None known.
Alpha-Lipoic Acid: Iron Preparations may decrease the absorption of Alpha-Lipoic Acid. Alpha-Lipoic Acid may decrease the absorption of Iron Preparations. Management: Separate administration of alpha-lipoic acid from that of any iron-containing compounds by several hours. If alpha-lipoic acid is given 30 minutes before breakfast, then administer oral iron-containing products at lunch or dinner. Risk D: Consider therapy modification
Antacids: May decrease the absorption of Iron Preparations. Management: No action is likely necessary for the majority of patients who only use antacids intermittently or occasionally. Consider separating doses of oral iron and antacids in patients who require chronic use of both agents and monitor for reduced iron efficacy. Risk D: Consider therapy modification
Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Risk X: Avoid combination
Bictegravir: Iron Preparations may decrease the serum concentration of Bictegravir. Management: Bictegravir, emtricitabine, and tenofovir alafenamide can be administered with iron preparations under fed conditions, but coadministration with or 2 hours after an iron preparation is not recommended under fasting conditions. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Risk D: Consider therapy modification
Cabotegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Cabotegravir. Management: Administer polyvalent cation containing products at least 2 hours before or 4 hours after oral cabotegravir. Risk D: Consider therapy modification
Cefdinir: Iron Preparations may decrease the serum concentration of Cefdinir. Red-appearing, non-bloody stools may also develop due to the formation of an insoluble iron-cefdinir complex. Management: Avoid concurrent cefdinir and oral iron when possible. Separate doses by at least 2 hours if combined. Iron-containing infant formulas do not appear alter cefdinir pharmacokinetics, but red-appearing, non-bloody stools may develop when combined. Risk D: Consider therapy modification
Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Risk D: Consider therapy modification
Dimercaprol: May enhance the nephrotoxic effect of Iron Preparations. Risk X: Avoid combination
Dolutegravir: Iron Preparations may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral iron. Administer dolutegravir/rilpivirine at least 4 hours before or 6 hours after oral iron. Alternatively, dolutegravir and oral iron can be taken together with food. Risk D: Consider therapy modification
Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Risk D: Consider therapy modification
Elvitegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Elvitegravir. Management: Administer elvitegravir 2 hours before or 6 hours after the administration of polyvalent cation containing products. Risk D: Consider therapy modification
Entacapone: Iron Preparations may decrease the serum concentration of Entacapone. Management: Consider separating doses of the agents by 2 or more hours to minimize the effects of this interaction. Monitor for decreased therapeutic effects of levodopa during concomitant therapy, particularly if doses cannot be separated. Risk D: Consider therapy modification
Ferric Hydroxide Polymaltose Complex: May decrease the serum concentration of Iron Preparations. Specifically, the absorption of oral iron salts may be reduced. Management: Do not administer intravenous (IV) ferric hydroxide polymaltose complex with other oral iron preparations. Therapy with oral iron preparations should begin 1 week after the last dose of IV ferric hydroxide polymaltose complex. Risk D: Consider therapy modification
Levodopa: Iron Preparations may decrease the serum concentration of Levodopa. Only applies to oral iron preparations. Management: Consider separating doses of the agents by 2 or more hours to minimize the effects of this interaction. Monitor for decreased therapeutic effects of levodopa during concomitant therapy, particularly if doses cannot be separated. Risk D: Consider therapy modification
Levothyroxine: Iron Preparations may decrease the serum concentration of Levothyroxine. Management: Separate oral administration of iron preparations and levothyroxine by at least 4 hours. Separation of doses is not required with parenterally administered iron preparations or levothyroxine. Risk D: Consider therapy modification
Methyldopa: Iron Preparations may decrease the serum concentration of Methyldopa. Management: Consider separating doses of methyldopa and orally administered iron preparation by 2 or more hours. Monitor for decreased efficacy of methyldopa if an oral iron preparation is initiated/dose increase, or increased efficacy if discontinued/dose decreased. Risk D: Consider therapy modification
PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Risk D: Consider therapy modification
Phosphate Supplements: Iron Preparations may decrease the absorption of Phosphate Supplements. Management: Administer oral phosphate supplements as far apart from the administration of an oral iron preparation as possible to minimize the significance of this interaction. Risk D: Consider therapy modification
Quinolones: Iron Preparations may decrease the serum concentration of Quinolones. Management: Give oral quinolones at least several hours before (4 h for moxi- and sparfloxacin, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome-, 3 h for gemi-, and 2 h for enox-, levo-, nor-, oflox-, peflox, or nalidixic acid) oral iron. Risk D: Consider therapy modification
Raltegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Raltegravir. Management: Administer raltegravir 2 hours before or 6 hours after administration of the polyvalent cations. Dose separation may not adequately minimize the significance of this interaction. Risk D: Consider therapy modification
Tetracyclines: May decrease the absorption of Iron Preparations. Iron Preparations may decrease the serum concentration of Tetracyclines. Management: Avoid this combination if possible. Administer oral iron preparations at least 2 hours before, or 4 hours after, the dose of the oral tetracycline derivative. Monitor for decreased therapeutic effect of oral tetracycline derivatives. Risk D: Consider therapy modification
Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant administration of trientine and oral products that contain polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. If other oral polyvalent cations are needed, separate administration by 1 hour. Risk D: Consider therapy modification
Maternal iron requirements increase during pregnancy. Adequate iron concentrations to the fetus can be maintained regardless of maternal iron status, except in severe cases of anemia (IOM 2001). Untreated iron deficiency and iron deficiency anemia (IDA) in a pregnant female may be associated with adverse events, including low birth weight, preterm birth, or increased perinatal mortality (ACOG 95 2008; BSH [Pavord 2020]; IOM 2001).
In general, treatment of iron deficiency or IDA in pregnancy is the same as in nonpregnant females (USPSTF [Siu 2015]). Ferrous salts are preferred for oral management of IDA in pregnancy (BSH [Pavord 2020]). Iron supplementation is recommended for 3 months once hemoglobin is within the normal range, and for at least 6 months postpartum to replenish maternal iron stores (BSH [Pavord 2020]; FIGO 2019). The majority of studies note iron therapy improves maternal hematologic parameters; however, information related to clinical outcomes in the mother and neonate is limited (FIGO 2019; USPSTF [Siu 2015]). Oral preparations are generally sufficient; however, parenteral iron therapy may be used in females who cannot tolerate or will not take oral iron, in cases of severe iron deficiency, or when malabsorption is present (ACOG 95 2008; BSH [Pavord 2020]). Enteric-coated and slow/sustained-release preparations may be less effective and use should be avoided (ACOG 95 2008; BSH [Pavord 2019]).
Iron is present in breast milk (IOM 2001). It is not known if maternal use of polysaccharide iron complex significantly changes breast milk concentrations.
Maternal iron requirements are increased in breastfeeding women (IOM 2001). Breast milk levels of iron are maintained in females with mild to moderate iron deficiency anemia (IDA), but concentrations decrease if IDA is severe (El-Farrash 2012; Kumar 2008). All postpartum women at risk of gestational anemia (regardless of breastfeeding status) may be given oral iron with or without folic acid for 6 to 12 weeks postpartum to reduce the risk of anemia (WHO 2016c).
Dietary sources of iron include beans, cereal (enriched), clams, beef, lentils, liver, oysters, shrimp, and turkey. Foods that enhance dietary absorption of iron include broccoli, grapefruit, orange juice, peppers and strawberries. Foods that decrease dietary absorption of iron include coffee, dairy products, soy products, spinach, and tea.
Dietary reference intake (elemental iron) (IOM 2001):
0 to 6 months: Adequate intake: 0.27 mg elemental iron daily.
7 to 12 months: Recommended dietary allowance (RDA): 11 mg elemental iron daily.
1 to 3 years: RDA: 7 mg elemental iron daily.
4 to 8 years: RDA: 10 mg elemental iron daily.
9 to 13 years: RDA: 8 mg elemental iron daily.
14 to 18 years: RDA:
Males: 11 mg elemental iron daily.
Females: 15 mg elemental iron daily.
Pregnancy: 27 mg elemental iron daily.
Lactation: 10 mg elemental iron daily.
19 to 50 years: RDA:
Males: 8 mg elemental iron daily.
Females: 18 mg elemental iron daily.
Pregnancy: 27 mg elemental iron daily.
Lactation: 9 mg elemental iron daily.
≥50 years: RDA: 8 mg elemental iron daily.
Onset of action: Hematologic response: Red blood cells form within 3 to 10 days; similar onset as parenteral iron salts; Maximum effect: Peak reticulocytosis occurs in 5 to 10 days, and hemoglobin values increase within 2 to 4 weeks
Absorption: Oral: Iron is absorbed in the duodenum and upper jejunum; in persons with normal iron stores 10% of an oral dose is absorbed; this is increased to 20% to 30% in persons with inadequate iron stores; food and achlorhydria will decrease absorption
Protein binding: To transferrin
Excretion: Urine, sweat, sloughing of intestinal mucosa, and by menses
Capsules (EZFE 200 Oral)
434.8 (200 Fe) mg (per each): $0.36
Capsules (Ferrex 150 Oral)
150 mg (per each): $0.15
Capsules (IFerex 150 Oral)
150 mg (per each): $0.34
Capsules (Nu-Iron Oral)
150 mg (per each): $0.51
Capsules (Poly-Iron 150 Oral)
150 mg (per each): $0.14
Capsules (Polysaccharide Iron Complex Oral)
150 mg (per each): $0.28
Liquid (Hematex Oral)
100 mg/5 mL (per mL): $0.08
Liquid (NovaFerrum Oral)
125 mg/5 mL (per mL): $0.14
Liquid (NovaFerrum Pediatric Drops Oral)
15 mg/mL (per mL): $0.19
Tablets (Hematex Iron Complex Oral)
150 mg (per each): $0.30
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.