Iron preparations and therapy

  • Iron Supplementation

    Aim for iron supplementation at 2 - 6mg/kg/day of elemental iron.

    2mg/kg/day is the preventative dose for iron deficiency and also effective in mild-moderate deficiency.

    The higher range doses are usually only necessary for severe deficiency, and iron studies should be monitored carefully to prevent overload.

    Higher doses should be divided (up to tds) to reduce gastric irritation.

    Ferrous sulphate mixture (Ferro-Liquid) is usually available and contains 6mg/ml elemental iron. There is a shortage of this sometimes

    Ferrous sulphate spansules contain beads (Fefol; also contains folate and sucrose). Each spansule contains 87.4mg of elemental iron. The spansule can be opened and the beads sprinkled on food to give lower doses, but the beads shouldn't be crushed or chewed.

    Ferro-Gradumet slow release tablets are suitable for older children who can swallow them whole.

    So, you can prescribe:
    • Ferro-liquid: 0.3 - 0.45 ml/kg/day (or up to 0.9ml/kg/day initially in severe deficiency - suggest splitting into BD or TDS dosing).

    Or,

    • Ferrous sulphate spansules: see table below

    Iron is better absorbed if given with an acidic substance (eg orange juice, Vitamin C etc).

    Check reticulocyte response and ferritin at 4 weeks. Continue supplements for minimum of 3 mths usually (to replenish stores).

    Monitor response as there is a risk of iron overload with excessive doses over long periods, particularly in susceptible patients.

    Quick Dose reference - for approx 2mg/kg (more can be given in severe deficiency)

    Note: doses in patients > 40kg are usually limited to one spansule / tablet per day unless inadequate response.

    These are the total daily dose. The liquid can be split into BD or TDS amounts for the larger doses to avoid gastric irritation.

    Weight

    Ferro-Liquid

    Fefol Spansules

    Ferro-Gradumet slow release tablets

    10kg

    3mls per day

    half a spansule every second day

     

     

    20kg

    6mls per day

    half a spansule daily

     

     

    30kg

    9mls per day

    whole & half spansule alternate days

     

     

    >40kg

    12mls per day

    whole spansule daily

     

    1 tablet daily