Iron supplementation

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  • Multiple types of oral and intravenous therapy available
  • IV therapy is usually reserved for patients undergoing epoetin therapy or severely anemic Jehovah's Witness patients
    • Should be cautiously administered due to the risk of anaphylaxis with some preparations.[1]

Oral Preparations

Recommended oral daily dose for the treatment of iron deficiency in adults is in the range of 150 to 200mg/day of elemental iron

  • Ferrous Sulfate
  • Ferrous fumarate
  • Ferrous gluconate
  • Ferrous succinate

Elemental Iron Percentages

Elemental Iron Percentages

Iron Preparation % of Elemental Iron
Ferrous Fumarate 33%
Ferrous Sulfate 20%
Ferrous Gluconate 12%
Ferric pyrophosphate 30%
Ferroglycine sulfate 16%
Ferrous carbonate (anhydrous) 38%

Intravenous Preparations

Occasionally used by nephrologists and patients receiving epoitin. IV iron can increase hemoglobin concentrations by 1-2 g/dL

  • Iron dextran
  • Iron dextrin
  • Iron sodium gluconate
  • Iron hyroxysaccharate

IV iron Regimens

Low dose

  • 20–60mg every dialysis session[1]
  • Hemodialysis patients only
  • Any of iron preparations suitable
  • May be given as IV push

Medium dose

  • 100–400mg as IV infusion
  • All iron preparations (maximum dose of iron sodium gluconate is 62.5–125mg)

High dose

  • 500–1000mg
  • Must be given as IV infusion
  • Only iron dextran suitable
  • Only for patients with large iron deficit and resistance to all other treatment regemins

Intramuscular preparations

Rarely if ever used

  • Iron sorbitol citrate is only possible formulation

See Also


  1. 1.0 1.1 Macdougall IC. Strategies for iron supplementation: oral versus intravenous. Kidney Int Suppl. 1999;69:S61-S66.