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Ferrous sulfate

Class
Iron replacement
Subclass
Iron salts
Substance name
Ferrous sulfate, ferrous sulphate, iron(II) sulfate, FeSO4
Common formulations
Tablet, Enteric-coated tablet, Solution, Elixir
Dosage and administration
Adults patients
Treatment
Iron deficiency
•
220 mg PO daily (oral elixir)
Iron deficiency anemia
•
300 mg PO q6-12h (oral solution)
Taken preferably between meals.
Alternative
•
324 mg PO BID-TID (tablet)
Taken preferably after meals.
Alternative
•
220 mg PO daily (oral elixir)
Iron deficiency anemia, after bariatric surgery • Off-label
•
600 mg PO daily
Iron deficiency in patients with restless legs syndrome • Transferrin saturation < 20% • Off-label
•
325 mg PO BID
Administered in combination with with vitamin C orally 200 mg BID.
Prevention
Prevention of iron deficiency
•
324 mg PO daily (tablet)
Taken preferably after a meal.
Alternative
•
300 mg PO daily (oral solution)
Indications for use
Labeled indications
Adults
•
Treatment of iron deficiency anemia
•
Treatment of iron deficiency
•
Prevention of iron deficiency
Off-label indications
Adults
•
Treatment of iron deficiency anemia, after bariatric surgery
•
Treatment of iron deficiency in patients with restless legs syndrome (transferrin saturation < 20%)
Safety risks
Contraindications
Hypersensitivity to ferrous sulfate or its components or to other iron products
Hemochromatosis or hemosiderosis
Concomitant use of other iron-containing products
Warnings and precautions
Decreased serum tetracycline levels, decreased iron absorption
•
Use caution in patients taking oral tetracycline antibiotics. Advise taking ferrous sulfate at least 2 hours after taking oral tetracycline antibiotics, as oral iron products interfere with tetracycline absorption.
Gastrointestinal adverse events
•
Maintain a high level of suspicion, as iron-containing products may cause gasrointestinal discomfort, nausea, constipation, or diarrhea. Advise take ferrous sulfate with or immediately after meals to minimize gastrointestinal effects.
Specific populations
Renal impairment
eGFR 0-90 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
Renal replacement therapy
Any modality
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters
•
Generally acceptable for use. Maternal anemia increases the risk of low birth weight, premature delivery, and impaired cognitive and behavioral development. The ACOG recommends screening all pregnant women for anemia with a CBC in the first trimester and again at 24-28 weeks of gestation.
•
The ACOG recommends low-dose iron supplementation starting in the first trimester to reduce the prevalence of maternal anemia at delivery. Oral iron preparations are the preferred first-line treatment for iron deficiency in pregancy.
Breastfeeding
Acceptable for use during breastfeeding.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Abdominal pain, constipation, dark stools, diarrhea, flatulence, nausea, vomiting
Interactions
Drug(s)
Check Interactions
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