Ferrous

Ferrous sulfate stands as a cornerstone in the clinical management and prevention of iron deficiency, a condition affecting millions globally. This essential mineral supplement is specifically formulated to replenish depleted iron stores, thereby supporting critical physiological processes such as oxygen transport, cognitive function, and energy metabolism. Its high elemental iron content and proven bioavailability make it a first-line therapeutic agent recommended by healthcare professionals for addressing hematological deficiencies and associated symptoms. Proper utilization under medical guidance ensures efficacy while minimizing potential adverse effects, making it a vital component of patient care protocols.

Features

• Pharmaceutical-grade ferrous sulfate, USP
• High elemental iron content per dosage unit (typically 65 mg elemental iron per 325 mg ferrous sulfate)
• Standardized immediate-release tablet formulation for predictable absorption
• Often available in enteric-coated or extended-release variants to improve gastric tolerance
• Precisely calibrated dosage strengths for tailored therapeutic regimens
• Manufactured under strict cGMP (current Good Manufacturing Practices) compliance

Benefits

• Effectively restores hemoglobin levels to within normal physiological range, correcting iron deficiency anemia.
• Significantly reduces symptoms associated with anemia, including fatigue, weakness, and shortness of breath.
• Supports normal cognitive development and function by ensuring adequate oxygen supply to neural tissues.
• Enhances overall energy metabolism and physical performance capacity.
• Contributes to a healthy immune system response by supporting necessary enzymatic functions.
• Provides a cost-effective and widely accessible treatment option for iron supplementation.

Common use

Ferrous sulfate is primarily indicated for the treatment of iron deficiency anemia, confirmed by laboratory findings of low hemoglobin, low serum ferritin, and low mean corpuscular volume (MCV). It is also extensively used for the prophylaxis (prevention) of iron deficiency in high-risk populations. These populations include pregnant individuals, women with menorrhagia (heavy menstrual bleeding), pediatric patients experiencing rapid growth phases, individuals with chronic malabsorptive conditions (e.g., Celiac disease, inflammatory bowel disease), and patients with chronic kidney disease, particularly those on erythropoiesis-stimulating agents. It may also be used perioperatively to optimize hemoglobin levels before elective surgery.

Dosage and direction

Dosage is highly individualized based on the severity of the deficiency, the patient’s age, weight, and hemoglobin response. Treatment is typically divided into a therapeutic phase to correct anemia and a maintenance phase to replenish iron stores.

• Adults for Treatment: The typical therapeutic dose for adults is 325 mg (65 mg elemental iron) orally two to three times daily. Doses may be adjusted based on tolerance and laboratory response.
• Adults for Prophylaxis: 325 mg (65 mg elemental iron) orally once daily is often sufficient.
• Pediatric Dosing: Dosing is based on mg elemental iron per kg body weight per day, as calculated by a pediatrician. Common ranges are 3-6 mg/kg/day divided into 1-3 doses.
• Administration: Tablets should be taken on an empty stomach, at least 1 hour before or 2 hours after meals, to maximize absorption. If gastric irritation occurs, it may be taken with a small amount of food, though this will reduce absorption. To enhance iron absorption, co-administration with a source of Vitamin C (e.g., a glass of orange juice or a 250 mg ascorbic acid tablet) is recommended. Tablets should be swallowed whole and not crushed, chewed, or split (unless specifically designed for it), and followed with a full glass of water.

Precautions

• This medication can cause gastrointestinal irritation, including constipation, nausea, and heartburn. Starting with a lower dose and gradually increasing it can help mitigate these effects.
• Iron supplements will darken stools to a greenish-black or black color. This is a harmless and expected effect and should not be mistaken for melena (blood in stool).
• Liquid preparations can stain teeth. Administering the liquid dose with a dropper towards the back of the mouth or brushing teeth shortly after administration can prevent staining.
• Patients should be advised to keep this product out of reach of children, as iron overdose is a leading cause of fatal poisoning in children under 6.
• Long-term use without medical supervision for non-deficient individuals can lead to iron overload (hemosiderosis), which can damage organs.

Contraindications

Ferrous sulfate is absolutely contraindicated in patients with the following conditions:

• Known hypersensitivity to ferrous sulfate or any component of the formulation.
• Hemochromatosis, hemosiderosis, and other iron overload syndromes.
• Hemolytic anemias (e.g., sickle cell anemia, thalassemia major) unless concurrent iron deficiency is confirmed, as iron overload can occur.
• Patients receiving repeated blood transfusions.
• Peptic ulcer disease, regional enteritis, or ulcerative colitis may be relative contraindications due to potential for exacerbating the conditions.

Possible side effect

While many side effects are dose-related and manageable, patients should be monitored.

• Very Common (>10%): Gastrointestinal disturbances: constipation, dark stools, nausea, epigastric pain, heartburn.
• Common (1-10%): Diarrhea, vomiting, abdominal cramping.
• Uncommon (<1%): Tooth staining (with liquid forms), transient taste perversion.
• Rare: Allergic reactions, including urticaria, rash, and pruritus. Severe hypersensitivity reactions are very rare.

Drug interaction

Ferrous sulfate can interact with numerous medications, often by forming insoluble complexes that reduce the absorption of both agents. A gap of 2-4 hours between doses is typically recommended.

• Antacids, H2-receptor antagonists (e.g., ranitidine), Proton-Pump Inhibitors (e.g., omeprazole): Decreased gastric acid reduces iron absorption.
• Tetracycline & Quinolone Antibiotics (e.g., ciprofloxacin, doxycycline): Iron binds to these antibiotics, drastically reducing their bioavailability and effectiveness.
• Levothyroxine: Iron can significantly decrease its absorption, compromising thyroid hormone replacement therapy.
• Bisphosphonates (e.g., alendronate): Absorption of both drugs is impaired.
• Penicillamine and Methyldopa: Effectiveness may be reduced.
• Chloramphenicol: May delay the hematological response to iron therapy.

Missed dose

If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed. The patient should not double the dose to make up for the missed one, as this increases the risk of side effects.

Overdose

Iron overdose is a medical emergency, particularly in young children, and can be fatal. Symptoms of overdose can manifest in stages:

• Stage 1 (0-6 hours): Severe vomiting (often bloody), diarrhea, abdominal pain, lethargy, hypotension, and metabolic acidosis.
• Stage 2 (6-24 hours): An apparent recovery period may occur.
• Stage 3 (12-48 hours): Potential for severe recurrence with metabolic acidosis, hypoglycemia, fever, bleeding diathesis, jaundice, liver failure, shock, coma, and death.
• Treatment: Immediate medical attention is critical. Treatment may include gastric lavage, whole bowel irrigation, and chelation therapy with deferoxamine. Serum iron levels and total iron-binding capacity (TIBC) are crucial for diagnosis and guiding treatment.

Storage

• Store at controlled room temperature (20°-25°C or 68°-77°F), away from light, moisture, and heat.
• Keep the bottle tightly closed.
• Do not store in the bathroom.
• Keep all medications out of sight and reach of children. Consider using a locked cabinet.
• Do not keep outdated medicine or medicine no longer needed. Dispose of it properly.

Disclaimer

This information is for educational and informational purposes only and does not constitute medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided is believed to be accurate at the time of publication but may not be exhaustive or fully updated.

Reviews

• “As a hematologist, ferrous sulfate remains my go-to first-line therapy for confirmed iron deficiency. Its efficacy is well-documented, predictable, and cost-effective for patients. Managing GI side effects is usually achievable with dose timing adjustments.” – Dr. E. Lawson, MD
• “Prescribed this during my second trimester when labs showed anemia. The fatigue and dizziness improved noticeably within a few weeks. The constipation was a challenge, but increasing water and fiber intake helped manage it effectively.” – Patient, verified purchase.
• “From a pharmacy perspective, patient education is key with this OTC medication. We always counsel on the expected stool darkening, the importance of keeping it away from children, and how to space it from other common medications like thyroid pills.” – Pharmacist R. Singh, RPh
• “After a period of significant blood loss, my ferritin levels were critically low. A 3-month course of ferrous sulfate brought my levels and energy back to normal. Follow-up blood tests confirmed the treatment was successful.” – Patient, verified purchase.