Note: Multiple concentrations of ferrous sulfate oral liquid exist; close attention must be paid to the concentration when ordering and administering ferrous sulfate; incorrect selection or substitution of one ferrous sulfate liquid for another without proper dosage volume adjustment may result in serious over- or underdosing.
Note: Doses expressed in terms of elemental iron; ferrous sulfate contains ~20% elemental iron; ferrous sulfate exsiccated (dried) contains ~30% elemental iron.
Adequate intake (AI): Note: Recommended intake from dietary sources (eg, breast milk, formula). Neonate: 0.27 mg elemental iron/day (IOM 2001).
Iron deficiency, prevention in neonates fed human milk:
GA <37 weeks:
Birth weight <2 kg: Oral: 2 to 3 mg elemental iron/kg/day divided every 12 to 24 hours; maximum daily dose: 15 mg elemental iron/day; begin at 2 to 6 weeks of age and continue until 6 to 12 months of age (AAP [Baker 2010]; CPS [Unger 2019]; Eichenwald 2017; ESPGHAN [Agostoni 2010]; ESPGHAN [Domellöf 2014]; ESPGHAN [Lapillonne 2018]; NIH 2021).
Birth weight 2 to 2.5 kg: Oral: 1 to 2 mg elemental iron/kg/day divided every 12 to 24 hours; maximum daily dose: 15 mg elemental iron/day; begin at 2 to 6 weeks of age and continue until 6 months of age (AAP [Baker 2010]; CPS [Unger 2019]; Eichenwald 2017; ESPGHAN [Domellöf 2014]; ESPGHAN [Lapillonne 2018]; NIH 2021).
Birth weight >2.5 kg: Oral: 2 mg elemental iron/kg/day divided every 12 to 24 hours; begin at 4 to 8 weeks of life; maximum daily dose: 15 mg elemental iron/day (AAP [Baker 2010]; Eichenwald 2017; NIH 2021; WHO 2001).
GA ≥37 weeks: In healthy, term infants (exclusively fed human milk or human milk provides >50% of nutrition without iron fortified food), AAP recommends iron supplementation beginning at 4 months of age and continued until sufficient iron is provided in complementary foods (see "Dosing: Pediatric") (AAP [Baker 2010]).
Iron deficiency anemia, treatment: Oral: 3 to 6 mg elemental iron/kg/day in 1 to 3 divided doses (ASPEN [Corkins 2015]; Kliegman 2020; Rao 2009).
Supplementation during epoetin use: Limited data available; dosing regimens variable: Oral: Usual dose: 6 mg elemental iron/kg/day in 2 to 3 divided doses; usual range: 3 to 8 mg elemental iron/kg/day although higher doses (up to 12 mg elemental iron/kg/day) have been used in some protocols (Eichenwald 2017; Meyer 1996; Rao 2009).
Note: Multiple concentrations of ferrous sulfate oral liquid exist; close attention must be paid to the concentration when ordering and administering ferrous sulfate; incorrect selection or substitution of one ferrous sulfate liquid for another without proper dosage volume adjustment may result in serious over- or underdosing.
Note: Doses expressed in terms of elemental iron; Ferrous sulfate contains ~20% elemental iron; ferrous sulfate exsiccated (dried) contains ~30% elemental iron.
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 ≥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 who may become pregnant): 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 (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.
(For additional information see "Ferrous sulfate: Drug information")
Note: Dosage expression: Dose is expressed in terms of elemental iron; ferrous sulfate contains ~20% elemental iron per mg of mineral salt (eg, each 325 mg tablet contains 65 mg 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: 65 mg of elemental iron (1 tablet or equivalent as liquid) once every other day or on Monday, Wednesday, and Friday. Note: Daily dosing has been shown to result in decreased absorption but may be reasonable in some individuals to improve adherence (Stoffel 2017; Stoffel 2020).
Restless legs syndrome (off-label use):
Note: Oral iron repletion is recommended for patients with serum ferritin ≤75 ng/mL and transferrin saturation <45% (Allen 2018).
Oral: 130 mg elemental iron (650 mg ferrous sulfate) once daily or in 2 divided doses (AAN [Winkelman 2016]; Allen 2018). Note: Some experts recommend 65 mg elemental iron (325 mg ferrous sulfate) once daily or every other day to improve absorption and tolerability (Auerbach 2021; Silber 2021).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Elixir, Oral:
FeroSul: 220 (44 Fe) MG/5ML (473 mL [DSC]) [contains alcohol, usp, fd&c yellow #6 (sunset yellow), propylene glycol, saccharin sodium, sodium benzoate; lemon flavor]
Iron Supplement: 220 (44 Fe) MG/5ML (473 mL) [contains fd&c yellow #6 (sunset yellow), sodium benzoate]
Generic: 220 (44 Fe) MG/5ML (473 mL)
Liquid, Oral:
Generic: 220 (44 Fe) MG/5ML (473 mL [DSC])
Solution, Oral:
BProtected Pedia Iron: 75 (15 Fe) MG/ML (50 mL) [alcohol free, gluten free; contains sodium metabisulfite; citrus flavor]
Fe-Vite Iron: 75 (15 Fe) MG/ML (50 mL) [alcohol free, gluten free, no artificial color(s); contains sodium benzoate]
Fer-In-Sol: 75 (15 Fe) MG/ML (50 mL) [contains alcohol, usp, sodium bisulfite]
Iron Supplement Childrens: 75 (15 Fe) MG/ML (50 mL) [alcohol free, dye free, gluten free, lactose free; contains sodium bisulfite]
Generic: 300 mg/6.8 mL (6.8 mL); 75 (15 Fe) MG/ML (50 mL)
Syrup, Oral:
Generic: 300 (60 Fe) MG/5ML (5 mL)
Tablet, Oral:
FeroSul: 325 (65 Fe) MG [contains fd&c blue #1 aluminum lake, fd&c red #40 aluminum lake, fd&c yellow #5 aluminum lake]
FeroSul: 325 (65 Fe) MG [contains fd&c blue #2 aluminum lake, fd&c red #40 aluminum lake]
FeroSul: 325 (65 Fe) MG [DSC] [contains fd&c red #40 aluminum lake, fd&c yellow #6 aluminum lake]
Generic: 325 (65 Fe) MG
Tablet, Oral [preservative free]:
FerrouSul: 325 (65 Fe) MG [gluten free, sodium free; contains brilliant blue fcf (fd&c blue #1), fd&c blue #2 (indigotine), fd&c red #40, fd&c yellow #6 (sunset yellow)]
Generic: 325 (65 Fe) MG
Tablet Delayed Release, Oral:
Generic: 324 mg, 324 (65 Fe) MG, 325 (65 Fe) MG
Tablet Extended Release, Oral:
Slow Fe: 142 (45 Fe) MG [contains fd&c blue #1 aluminum lake, fd&c red #40 aluminum lake, fd&c yellow #6 aluminum lake]
Tablet Extended Release, Oral [preservative free]:
Slow Iron: 160 (50 Fe) MG [gluten free]
Generic: 140 (45 Fe) MG [DSC]
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Liquid, Oral:
Generic: 150 (30 Fe) MG/5ML (10 mL, 250 mL, 500 mL)
Ferrous sulfate contains ~20% elemental iron (ie, 325 mg ferrous sulfate is equivalent to 65 mg elemental iron); ferrous sulfate exsiccated (dried) contains ~30% elemental iron.
Oral: Do not chew or crush extended-release preparations; administer with water or juice on an empty stomach prior to breakfast and/or between meals for maximum absorption (Kliegman 2020; Reeves 1985); may administer with food if GI upset occurs; do not administer with milk or milk products (Powers 2017).
Oral: Do not chew or crush ER preparations; administer with water or juice on an empty stomach.
Bariatric surgery: Tablet, extended or delayed release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. Switch to IR tablet, chewable, or oral solution. Of note, many specialty bariatric multivitamins contain the recommended amount of daily iron for bariatric surgery patients.
Iron is a leading cause of fatal poisoning in children. Store out of children's reach and in child-resistant containers.
Prevention and treatment of iron deficiency anemias (OTC: FDA approved in all ages); has also been used as supplemental therapy for patients receiving epoetin alfa.
Feosol may be confused with Fer-In-Sol
Fer-In-Sol may be confused with Feosol
Slow FE may be confused with Slow-K
Multiple concentrations of liquid iron preparations exist. Fer-In-Sol drops (manufactured by Mead Johnson) and a limited number of generic products are available at a concentration of 15 mg/mL. However, a suspension product, MyKidz Iron 10 drops, is available at a concentration of 15 mg/1.5 mL. Check concentration closely prior to dispensing. Prescriptions written in milliliters (mL) should be clarified.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Gastrointestinal: Darkening of stools (≤80%; Tolkien 2015), abdominal pain (≤70%; Tolkien 2015), heartburn (1% to 68%; Tolkien 2015), nausea (≤63%; Tolkien 2015), constipation (≤39%; Tolkien 2015), flatulence (≤36%; Tolkien 2015), vomiting (≤34%; Tolkien 2015), diarrhea (≤23%; Tolkien 2015)
<1%, postmarketing, and/or case reports: Abdominal discomfort (Tolkien 2015)
Hypersensitivity to iron salts or any component of the formulation; hemochromatosis, hemolytic anemia
Disease-related concerns:
• Gastrointestinal disease: Avoid in patients with peptic ulcer, enteritis, or ulcerative colitis.
Special populations:
• Blood transfusion recipients: Avoid in patients receiving frequent blood transfusions.
• Elderly: Anemia in the elderly is often caused by “anemia of chronic disease” or associated with inflammation rather than blood loss. Iron stores are usually normal or increased, with a serum ferritin >50 ng/mL and a decreased total iron binding capacity. Hence, the “anemia of chronic disease” is not secondary to iron deficiency but the inability of the reticuloendothelial system to reclaim available iron stores.
• 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.
• Premature infants: Avoid use in premature infants until the vitamin E stores, deficient at birth, are replenished.
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).
• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer's labeling.
• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Zar 2007).
Other warnings/precautions:
• Duration of therapy: Administration of iron for >6 months should be avoided except in patients with continuous bleeding or menorrhagia.
Consider all iron sources when evaluating the dose of iron, including combination products, infant formulas, and liquid nutritional supplements. Some liquid preparations may temporarily stain the teeth.
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
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
Cereals, dietary fiber, tea, coffee, eggs, and milk may decrease absorption.
May be administered with food to prevent irritation; however, not with cereals, dietary fiber, tea, coffee, eggs, or milk.
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 (IOM 2001):
0 to 6 months: Adequate intake: 0.27 mg elemental iron/day.
7 to 12 months: RDA: 11 mg elemental iron/day.
1 to 3 years: RDA: 7 mg elemental iron/day.
4 to 8 years: RDA: 10 mg elemental iron/day.
9 to 13 years: RDA: 8 mg elemental iron/day.
14 to 18 years: RDA:
Males: 11 mg elemental iron/day.
Females: 15 mg elemental iron/day.
Pregnant females: 27 mg elemental iron/day.
Lactating females: 10 mg elemental iron/day.
19 to 50 years: RDA:
Males: 8 mg elemental iron/day.
Females: 18 mg elemental iron/day.
Pregnant females: 27 mg elemental iron/day.
Lactating females: 9 mg elemental iron/day.
≥50 years: RDA: 8 mg elemental iron/day.
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 2019]; IOM 2001).
In general, treatment of iron deficiency or IDA in pregnancy is the same as in non-pregnant females (USPSTF [Siu 2015]). Ferrous salts are preferred for oral management of IDA in pregnancy (BSH [Pavord 2019]). Continued 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 2019]; 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; Peña-Rosas 2015; Reveiz 2011; 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 2019]). Ferrous sulfate has been evaluated in multiple studies as an iron supplement or for the treatment of IDA in pregnancy (Peña-Rosas 2015; Reveiz 2011). Enteric-coated and slow/sustained-release preparations may be less effective and use should be avoided (ACOG 95 2008; BSH [Pavord 2019]).
Hemoglobin and hematocrit; consider additional tests such as RBC count, RBC indices, serum ferritin, transferrin saturation, total iron-binding capacity, serum iron concentration, and erythrocyte protoporphyrin concentration (CDC 1998).
Serum iron (AAP [Kleinman 2019]):
≤6 weeks: 100 to 250 mcg/dL.
7 weeks to 11 months: 40 to 100 mcg/dL.
1 to 10 years: 50 to 120 mcg/dL.
≥11 years:
Female: 30 to 160 mcg/dL.
Male: 50 to 170 mcg/dL.
Total iron binding capacity (AAP [Kleinman 2019]):
≤2 months: 59 to 175 mcg/dL.
3 months to 17 years: 250 to 400 mcg/dL.
≥18 years: 240 to 450 mcg/dL.
Replaces iron, found in hemoglobin, myoglobin, and other enzymes; allows the transportation of oxygen via hemoglobin
Onset of action: Hematologic response: Oral: ~3 to 10 days
Peak effect: Reticulocytosis: 5 to 10 days; hemoglobin increases within 2 to 4 weeks
Absorption: Iron is absorbed in the duodenum and upper jejunum; in persons with normal serum 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 the intestinal mucosa, and menses
When treating iron deficiency anemias, treat for 3 to 4 months after hemoglobin/hematocrit return to normal in order to replenish total body stores.
Iron Salt |
Elemental Iron Content (% of salt form) |
Approximate Equivalent Doses (mg of iron salt) |
---|---|---|
Ferrous fumarate |
33 |
197 |
Ferrous gluconate |
11.6 |
560 |
Ferrous sulfate |
20 |
324 |
Ferrous sulfate, exsiccated |
30 |
217 |
Elixir (Ferrous Sulfate Oral)
220 (44 Fe) mg/5 mL (per mL): $0.01 - $0.04
Liquid (Ferrous Sulfate Oral)
220 (44 Fe) mg/5 mL (per mL): $0.01
Solution (BProtected Pedia Iron Oral)
75 (15 Fe) mg/mL (per mL): $0.17
Solution (Fer-In-Sol Oral)
75 (15 Fe) mg/mL (per mL): $0.21
Solution (Ferrous Sulfate Oral)
75 (15 Fe) mg/mL (per mL): $0.12 - $0.18
Syrup (Ferrous Sulfate Oral)
300 (60 Fe) mg/5 mL (per mL): $0.74 - $0.81
Tablet, controlled release (Slow Fe Oral)
142 (45 Fe) mg (per each): $0.23
Tablet, EC (Ferrous Sulfate Oral)
324 (65 Fe) mg (per each): $0.06 - $0.11
325 (65 Fe) mg (per each): $0.05 - $0.82
Tablets (FeroSul Oral)
325 (65 Fe) mg (per each): $0.02
Tablets (Ferrous Sulfate Oral)
325 (65 Fe) mg (per each): $0.01 - $0.15
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