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Conclusions
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The bioavailability and side effect profile of ferrous iron salts are similar, but their elemental iron content and cost varies; thus, choice should generally be based on the amount of iron and cost.
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Compared to ferric Fe3+ salts, ferrous Fe2+ salts are generally better absorbed.
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Absorption of oral iron, particularly when taken with meals, will be higher if given with ascorbic acid at a molar ratio of ≥2:1 to iron; that is, about 6 mg of ascorbic acid for each 1 mg of iron.
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Although WHO has recommended intermittent iron supplementation (WHO, 2011), proposing as the rationale a mucosal block in enterocytes lasting for 5–6 days, our data clearly indicate that 48 h, not 5 or 6 days, is sufficient time for iron absorption to return to baseline.
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Given as ferrous sulfate, oral iron doses ≥60 mg in non-anemic women with iron deficiency and ≥100 mg in women with IDA trigger an increase in circulating hepcidin that persists 24 h after the dose, but subsides by 48 h. It appears oral iron doses ≤40 mg do not trigger an acute increase in circulating hepcidin in iron-deficient subjects. This suggests the optimal dosing schedule to maximize fractional iron absorption in women with iron deficiency and mild IDA is to give oral doses ≤40 mg daily and give doses ≥60 mg on alternate days.
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There is a circadian increase in circulating hepcidin over the day and this is augmented by a morning iron dose; therefore, iron doses should not be given in the afternoon or evening after a morning dose.
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If rate of Hb response is important, twice the target daily iron dose can be given on alternate days. However, because fractional iron absorption decreases sharply with increasing iron doses, and unabsorbed luminal iron likely has adverse effects on the gut, lower doses may be better tolerated and improve compliance.
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Oral iron supplementation in iron-deficient women: How much and how often?
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