Ferrous sulfate elemental iron
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Efficacy and Safety of Ferrous Sulfate for Iron Supplementation
Introduction to Ferrous Sulfate and Elemental Iron
Ferrous sulfate is a commonly used iron supplement, particularly effective in treating iron deficiency anemia (IDA). It is often compared with other forms of iron supplements, such as ferrous bisglycinate, iron polymaltose complex, and ferrous glycinate chelate, to evaluate its efficacy and safety.
Ferrous Sulfate in Iron Fortification
Wheat-Based Snacks Fortified with Ferrous Sulfate
A study conducted on Thai women with low iron stores compared the efficacy of wheat-based snacks fortified with ferrous sulfate, electrolytic iron, and hydrogen-reduced iron. The results showed that all three forms of iron significantly improved iron status, with ferrous sulfate being the most effective. The relative efficacy of electrolytic and hydrogen-reduced iron compared to ferrous sulfate was 77% and 49%, respectively.
Dosage and Administration of Ferrous Sulfate
Single vs. Multiple Daily Doses
In a randomized controlled trial in rural Ghana, infants with IDA were treated with either a single daily dose or three daily doses of ferrous sulfate drops. Both regimens, providing the same total iron dose, resulted in similar rates of successful anemia treatment, suggesting that a single daily dose could improve adherence without compromising efficacy.
Low-Dose Ferrous Sulfate in Children
A clinical trial comparing low-dose ferrous sulfate with iron polysaccharide complex in young children with nutritional IDA found that ferrous sulfate led to a greater increase in hemoglobin concentration over 12 weeks. The study concluded that once-daily, low-dose ferrous sulfate should be considered for treating children with IDA.
Comparison with Other Iron Supplements
Ferrous Bisglycinate vs. Ferrous Sulfate in Pregnancy
A study comparing ferrous bisglycinate and ferrous sulfate in pregnant women found that both were effective in preventing ID and IDA. However, ferrous bisglycinate caused fewer gastrointestinal complaints, suggesting it may be a more tolerable option for some women.
Ferrous Sulfate vs. Iron Polymaltose Complex in Children
In a study of children with IDA, those treated with ferrous sulfate showed higher hemoglobin levels and fewer residual complaints compared to those treated with iron polymaltose complex. This indicates that ferrous sulfate may offer a better clinical response with fewer adverse effects.
Ferrous Sulfate vs. Ferrous Glycinate Chelate in Gastrectomized Patients
A study on gastrectomized patients with IDA compared ferrous sulfate with ferrous glycinate chelate. Ferrous sulfate resulted in better hematologic parameters and higher ferritin levels, suggesting it is more effective in this patient population.
Safety and Side Effects
Toxicity and Adverse Effects
While ferrous sulfate is generally effective, it can cause side effects. A case report highlighted severe toxicity in a child who accidentally ingested a high dose of ferrous sulfate, leading to symptoms such as emesis, somnolence, hypotension, and metabolic acidosis. This underscores the importance of proper dosing and monitoring.
Gastrointestinal Effects
Ferrous sulfate can cause gastrointestinal side effects, which may be mitigated by combining it with vitamin C. A study on pregnant rats showed that ferrous sulfate plus vitamin C significantly increased blood hemoglobin levels while minimizing blood glucose fluctuations, suggesting a potential benefit of this combination.
Conclusion
Ferrous sulfate is a highly effective iron supplement for treating and preventing IDA across various populations, including children, pregnant women, and gastrectomized patients. While it is generally well-tolerated, attention to dosing and potential side effects is crucial to ensure safety and efficacy. Alternative iron supplements like ferrous bisglycinate and iron polymaltose complex may offer benefits in terms of tolerability, but ferrous sulfate remains a robust option for many patients.
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