Ferrous sulfate dosage and clinical uses
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Ferrous Sulfate Dosage Recommendations
Ferrous sulfate is widely used to treat and prevent iron deficiency and iron deficiency anemia in various populations, including pregnant women, children, and adults. Dosage recommendations vary depending on age, clinical condition, and severity of deficiency.
- In pregnant women, a daily dose of 60–65 mg elemental iron is commonly recommended, aligning with World Health Organization guidelines. Studies show that once-daily dosing (65 mg) is as effective as twice-daily dosing (130 mg) for preventing anemia, with fewer side effects and better compliance in the once-daily group .
- For children with iron deficiency anemia, a dose of 3 mg/kg of elemental iron once daily is effective and well-tolerated . In infants, a single daily dose of 40 mg elemental iron is as effective as splitting the same total dose into three daily administrations .
- In adults, daily supplementation with 60 mg elemental iron is safe and does not increase risks of infection or adverse effects in non-anemic, healthy individuals .
- For the treatment of iron deficiency anemia in pregnancy, higher doses such as 200 mg daily for 6–8 weeks have been shown to improve both hematological and oxidative stress parameters .
Clinical Uses of Ferrous Sulfate
Iron Deficiency Anemia in Pregnancy
Ferrous sulfate is a first-line therapy for preventing and treating iron deficiency anemia during pregnancy. It effectively increases hemoglobin and iron stores, and once-daily dosing is generally preferred due to fewer gastrointestinal side effects and improved adherence 19.
Pediatric Iron Deficiency and Anemia
Ferrous sulfate is commonly prescribed for infants and children with nutritional iron deficiency anemia. It leads to significant improvements in hemoglobin and ferritin levels, with once-daily dosing being as effective as multiple daily doses and potentially improving adherence 410. Low-dose regimens (1–3 mg/kg/day) are effective and well-tolerated in children .
Iron Deficiency in Special Populations
- In cancer patients with mild, non-chemotherapy-induced anemia, ferrous sulfate at 105 mg daily for 60 days is effective, though alternative iron formulations may have lower gastrointestinal toxicity .
- In children with restless sleep disorder (RSD) and low ferritin, oral ferrous sulfate (325 mg daily or 3 mg/kg/day) improves clinical and laboratory parameters, though intravenous iron may be more effective in some cases .
Comparison with Other Iron Formulations
Ferrous sulfate is often compared with other oral and intravenous iron preparations. While intravenous iron (such as ferric carboxymaltose) may increase hemoglobin and ferritin more rapidly and with fewer gastrointestinal side effects, oral ferrous sulfate remains effective and is generally preferred for mild to moderate cases due to ease of administration and cost 586.
Side Effects and Tolerability
Gastrointestinal side effects such as constipation, nausea, and diarrhea are the most common adverse effects of ferrous sulfate. These are generally dose-dependent, with higher doses and more frequent dosing schedules leading to increased side effects 168. Sustained-release formulations and lower daily doses can help reduce the frequency and severity of these side effects .
Safety Considerations
Ferrous sulfate is safe for most populations when used at recommended doses. In non-anemic, healthy adults, daily or weekly supplementation does not increase the risk of infections or adverse events . In children and pregnant women, it is well-tolerated, and side effects are usually mild 14710.
Conclusion
Ferrous sulfate is a well-established, effective, and generally safe treatment for iron deficiency and iron deficiency anemia across various age groups and clinical conditions. Once-daily dosing is often as effective as more frequent dosing, with fewer side effects and better adherence. Clinical use should be tailored to the patient’s age, severity of deficiency, and risk of side effects, with consideration for alternative formulations in cases of intolerance or special clinical needs.
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