Ferrous sulfate dosage
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Ferrous Sulfate Dosage: Insights from Recent Research
Single vs. Multiple Daily Doses of Ferrous Sulfate for Anemia Treatment
Single-Dose Efficacy in Infants
A study conducted in rural Ghana compared the efficacy of single versus three-times-daily ferrous sulfate drops in treating anemia in infants. Both regimens provided the same total iron dose of 40 mg elemental iron daily. The results showed that 61% of infants in the single-dose group and 56% in the three-times-daily group successfully treated their anemia, with minimal side effects in both groups. This suggests that a single daily dose is as effective as multiple doses and may improve adherence to treatment 1.
Alternate-Day Dosing in Women
Research on iron-depleted women indicated that providing iron supplements on alternate days, rather than consecutive days, optimizes iron absorption. The study found that alternate-day dosing resulted in higher cumulative fractional and total iron absorption compared to consecutive-day dosing. Additionally, once-daily dosing was more effective than twice-daily split dosing, as the latter increased serum hepcidin levels, which can inhibit iron absorption 3.
Comparison of Ferrous Sulfate with Other Iron Supplements
Ferrous Bisglycinate Chelate vs. Ferrous Sulfate in Cancer Patients
In cancer patients with mild iron deficiency anemia, ferrous bisglycinate chelate was found to have similar efficacy to ferrous sulfate but with potentially lower gastrointestinal toxicity. Both supplements significantly increased hemoglobin and ferritin levels over two months, but adverse events were less frequent with ferrous bisglycinate chelate 2.
Ferrous Bisglycinate in Pregnancy
A study comparing ferrous bisglycinate (25 mg/day) to ferrous sulfate (50 mg/day) in pregnant women found that both supplements were equally effective in preventing iron deficiency and anemia. However, ferrous bisglycinate was associated with fewer gastrointestinal complaints, suggesting it may be a more tolerable option for pregnant women 6.
Dosage Frequency in Pregnant Women
Once vs. Twice Daily Dosing
A clinical trial in Nigeria compared the effectiveness of once-daily (65 mg) versus twice-daily (130 mg) ferrous sulfate supplementation in pregnant women. The study concluded that once-daily dosing was as effective as twice-daily dosing in preventing anemia, with fewer side effects, which could lead to better compliance 5.
Ferrous Sulfate and Gastrointestinal Side Effects
Meta-Analysis Findings
A systematic review and meta-analysis of 43 trials involving 6,831 adults confirmed that ferrous sulfate significantly increases the risk of gastrointestinal side effects compared to placebo and intravenous iron. The odds of experiencing gastrointestinal issues were notably higher with ferrous sulfate, highlighting the need for careful consideration of side effects when prescribing this supplement 10.
Conclusion
Recent research underscores the effectiveness of various dosing regimens of ferrous sulfate in treating iron deficiency anemia. Single daily doses and alternate-day dosing have shown promising results in improving adherence and optimizing iron absorption. Comparisons with other iron supplements like ferrous bisglycinate chelate suggest similar efficacy but with potentially fewer side effects. For pregnant women, once-daily dosing appears to be as effective as twice-daily dosing, with better tolerability. However, the increased risk of gastrointestinal side effects with ferrous sulfate remains a significant concern, necessitating careful patient management and consideration of alternative iron supplements.
Sources and full results
Most relevant research papers on this topic
Randomized, controlled trial of single versus 3-times-daily ferrous sulfate drops for treatment of anemia.
A single-dose daily regimen of ferrous sulfate drops for anemia treatment in infants resulted in similar success rates and minimal side effects, potentially improving adherence to treatment.
RCT
Large Human Trial
Highly CitedTreatment of mild non-chemotherapy-induced iron deficiency anemia in cancer patients: comparison between oral ferrous bisglycinate chelate and ferrous sulfate.
Ferrous bisglycinate chelate has similar efficacy and likely lower gastrointestinal toxicity than ferrous sulphate for treating mild non-chemotherapy-induced iron deficiency anemia in cancer patients.
RCTIron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials.
Oral iron supplements given alternate days and as single morning doses have better iron absorption than those given daily or split doses in iron-depleted women.
RCTHighly CitedTreatment and prevention of anemia with ferrous sulfate plus folic acid in children attending daycare centers in Goiânia, Goiás State, Brazil: a randomized controlled trial.
Ferrous sulfate and folic acid effectively treat anemia and improve hemoglobin levels in non-anemic children.
RCTDaily versus twice daily dose of ferrous sulphate supplementation in pregnant women: A randomized clinical trial
Once daily (65 mg elemental iron) ferrous sulphate is as effective as twice daily (130 mg elemental iron) dose regimen in preventing anaemia in pregnancy, with fewer side effects and better compliance in a developing economy like Nigeria.
RCTFerrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial
Ferrous bisglycinate 25 mg iron/day is as effective as ferrous sulfate 50 mg iron/day in preventing iron deficiency and anemia in pregnant women, with a higher likelihood of gastrointestinal complaints in the bisglycinate group.
RCTRandomized, Placebo-Controlled Trial of Ferrous Sulfate to Treat Insomnia in Children With Autism Spectrum Disorders.
Ferrous sulfate supplementation improved iron status but did not significantly improve sleep onset latency or wake time after sleep onset in children with autism spectrum disorders.
RCTEffect of Ferric Citrate versus Ferrous Sulfate on Iron and Phosphate Parameters in Patients with Iron Deficiency and CKD: A Randomized Trial.
Ferric citrate treatment for 12 weeks resulted in a greater increase in TSAT and ferritin concentrations compared to ferrous sulfate in individuals with moderate to severe CKD and iron deficiency.
RCTFerrous sulfate does not affect mycophenolic acid pharmacokinetics in kidney transplant patients.
Ferrous sulfate oral therapy for iron deficiency in long-term kidney graft recipients does not reduce intestinal absorption of mycophenolate mofetil, resulting in no reduced exposure to this immunosuppressive agent.
RCTFerrous Sulfate Supplementation Causes Significant Gastrointestinal Side-Effects in Adults: A Systematic Review and Meta-Analysis
Ferrous sulfate supplementation significantly increases the risk of gastrointestinal side-effects in adults, but the relationship with dose remains unclear.
Meta-Analysis
Rigorous JournalHighly Cited