Ferrous sulfate dosing
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Ferrous Sulfate Dosing: Insights from Recent Research
Single vs. Multiple Daily Doses of Ferrous Sulfate
Single-Dose Efficacy in Infants
A study conducted in rural Ghana compared the efficacy of single versus three-times-daily dosing of ferrous sulfate drops in treating anemia in infants. The results showed that a single daily dose was as effective as the three-times-daily regimen in increasing hemoglobin levels and serum ferritin, with minimal side effects in both groups. This suggests that a single-dose regimen could improve adherence without compromising efficacy 1.
Daily vs. Twice-Daily Dosing in Pregnant Women
Research comparing once-daily and twice-daily doses of ferrous sulfate in pregnant women found that both regimens were equally effective in preventing anemia. However, the twice-daily regimen was associated with more side effects, indicating that a once-daily dose may be preferable for better compliance and fewer adverse effects 7.
Alternate-Day Dosing for Better Absorption
Iron Absorption in Women
A study on iron-depleted women revealed that alternate-day dosing of ferrous sulfate resulted in better iron absorption compared to consecutive-day dosing. This was attributed to lower serum hepcidin levels, which enhance iron absorption. The study also found that single morning doses were as effective as twice-daily split doses, but with fewer increases in serum hepcidin, suggesting that alternate-day, single-dose regimens might optimize iron absorption 4.
Comparative Efficacy and Side Effects
Ferrous Sulfate vs. Ferrous Bisglycinate Chelate in Cancer Patients
In cancer patients with mild iron deficiency anemia, ferrous bisglycinate chelate was found to be as effective as ferrous sulfate in increasing hemoglobin and ferritin levels. However, ferrous bisglycinate chelate had a lower incidence of gastrointestinal side effects, making it a potentially better option for patients who experience significant GI discomfort with ferrous sulfate 2.
Ferrous Sulfate vs. Iron Polymaltose Complex in Children
A study comparing ferrous sulfate and iron polymaltose complex in children with iron deficiency anemia found that ferrous sulfate led to higher hemoglobin levels and fewer residual complaints. This suggests that ferrous sulfate may offer a better clinical response and fewer adverse effects in pediatric populations 10.
Safety and Tolerability
Gastrointestinal Side Effects
A systematic review and meta-analysis confirmed that ferrous sulfate is associated with a significant increase in gastrointestinal side effects compared to placebo and intravenous iron. This highlights the need for careful consideration of dosing regimens to minimize adverse effects while maintaining efficacy 8.
Safety in Non-Anemic Adults
A study on non-anemic, healthy adults found that ferrous sulfate supplementation, whether given daily or weekly, did not increase the risk of malarial infectivity, bacterial proliferation, or other adverse effects. This indicates that ferrous sulfate is generally safe for use in non-anemic populations 3.
Conclusion
Recent research provides valuable insights into the dosing of ferrous sulfate for treating iron deficiency anemia. Single daily doses and alternate-day regimens appear to be effective and may improve adherence and absorption while minimizing side effects. Comparative studies suggest that while ferrous sulfate is effective, alternatives like ferrous bisglycinate chelate may offer better tolerability for some patients. Overall, these findings can guide clinicians in optimizing iron supplementation strategies to enhance patient outcomes.
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.
RCTFerrous Sulfate-Iron (60 mg/d) Does Not Increase Risks to Malarial Infectivity, Pathogenic Bacterial Proliferation or Other Adverse Effects in Non-Anemic Healthy Adults
Ferrous sulfate-iron supplementation (60 mg/d) is well-tolerated and does not increase risks of malarial infection or bacterial proliferation in non-anemic, healthy adults.
RCT
Very Rigorous JournalIron 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 Cited[Effectiveness of ferrous sulfate supplementation in the prevention of anemia in children: a systematic literature review and meta-analysis].
Daily ferrous sulfate supplementation is more effective than weekly doses in improving hemoglobin levels in children under five, but does not decrease anemia prevalence.
Meta-AnalysisFerrous 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.
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 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 CitedComparative Effects between Oral Lactoferrin and Ferrous Sulfate Supplementation on Iron-Deficiency Anemia: A Comprehensive Review and Meta-Analysis of Clinical Trials
Lactoferrin supplementation is a superior option for improving serum iron parameters and hemoglobin levels compared to ferrous sulfate, with its anti-inflammation effect potentially explaining its efficacy.
Meta-AnalysisVery Rigorous JournalFerrous sulfate versus iron polymaltose complex for treatment of iron deficiency anemia in children.
Ferrous sulfate has a better clinical response and less significant adverse effects compared to iron polymaltose complex for treating iron deficiency anemia in children.
RCT