Iron supplementation
Background
- 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