ferrous sulfate: clinical use

Prescribing considerations

• Confirm iron deficiency and investigate its underlying cause.
• Consider vitamin B12 or folate deficiency, poor absorption and continuing blood loss.
• Review gastrointestinal tolerance, adherence, swallowing ability and important interactions.
• Avoid concurrent oral and parenteral iron with the selected coated-tablet product.

Contraindications and cautions

• Hypersensitivity to the active substance or formulation ingredients
• Iron-overload states such as haemochromatosis or haemosiderosis
• Active peptic ulcer
• Repeated blood transfusions
• Haemolytic anaemia
• For Ironorm Drops, regional enteritis and ulcerative colitis; the selected tablet information instead advises caution in inflammatory bowel disease

Monitoring

• Use full blood count and appropriate iron studies to document deficiency and assess response.
• If response is inadequate, reassess adherence, diagnosis, absorption and ongoing blood loss.
• Watch for constipation or faecal impaction, particularly in older people, and oral or oesophageal injury in people with swallowing difficulties.

Clinical pharmacology

Ferrous sulfate provides Fe(II), absorbed mainly in the small intestine. It binds to transferrin and is incorporated into haemoglobin and storage pools including ferritin.

Formulation and product differences

• The coated tablet must be swallowed whole and is not recommended for children in its product information; it contains glucose and sucrose.
• Ironorm is an oral-drop solution supplied with a calibrated oral syringe.
• Ironorm contains sorbitol and sodium metabisulfite; metabisulfite may cause allergic reactions or bronchospasm in susceptible people.
• The liquid may cause reversible dental staining; rinsing the mouth afterwards may help.

Tablet

Route: Oral

Strengths: 200 mg