Iron replacement
Step 2: Get up and go!
In this step, you can start replacing the iron you've lost. While we encourage eating
foods that are rich in iron, it can be hard to eat your way out of iron deficiency.
There are two treatments that can supplement your iron intake: oral iron (pills) and intravenous (IV) iron.
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Absorbing iron through your gut is what your body is used to doing, so iron pills are the safest option. Iron pills are also available over the counter, so you don’t need a doctor’s prescription.
How to take iron pills:
This is easy to remember and will help reduce side effects. Almost all iron pills should be taken this way.
Take one pill, once a day...
Iron pills should be taken with water, two hours after your last meal. Bed time works well for most people.
Take on an empty stomach...
If you need to take it with food, have it with citrus...
Citrus contains vitamin C, which helps your gut absorb iron. Some examples of citrus foods are orange, lemon, grapefruit, tangerine, apple, and tomato. You can either eat the fruit, or drink it as juice.
Types of iron pills:
Ferrous Fumarate...
(Brand names: Palafer ®, common dose: 300 mg daily, elemental iron in each pill: 100 mg, price for one month: $8)
Ferrous Sulfate...
(Brand names: Fer-in-Sol ®, Feosol ®, common dose: 300 mg daily, elemental iron in each pill: 60 mg, price for one month: $6)
Ferrous Gluconate...
(Brand names: Fergon ®, common dose: 300 mg daily, elemental iron in each pill: 35 mg, price for one month: $3)
Polysaccharide-Iron Complex...
(Brand names: Feramax ®, Triferrex ®, Polyride Fe ®, common dose: 150 mg daily, elemental iron in each pill: 150 mg, price for one month: $22)
(Brand names: Proferrin-ES ®, OptiFer ® Alpha, common dose: 33 mg daily, elemental iron in each pill: 11 mg, price for one month: $80)
Heme Iron Polypeptide...
Managing potential side effects of iron pills
Dark stools...
This is normal. It is expected for all patients who take iron pills.
Upset stomach, bloating, diarrhea, nausea, and/or constipation...
These side effects occur in about 30% of people who take iron pills. They are usually mild and can be easily tolerated or improved.
If that doesn't work, try taking your iron pill every other day.
If you're still feeling ill, try taking a different iron pill...
Just because you didn’t tolerate one, doesn’t mean you won’t tolerate another!
Intravenous iron
Sometimes iron pills are not enough to raise your red blood cell levels. When your red blood cell levels stay low (aka anemia), either because of ongoing bleeding, or because the iron pills are poorly tolerated, your doctor may consider giving you intravenous (IV) iron.
Our usual threshold for considering this is when your hemoglobin level (which is a marker of red blood cell levels) is under 100 g/L.
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How intravenous iron works
Intravenous (IV) iron is a procedure that transfers iron directly into your blood. An IV bag slowly drips iron down a tube and into a vein in your body. This procedure usually takes place in a hospital or clinic where they can give IV medications. The treatment may take up to several hours.
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The benefit of IV iron is that you don’t have to rely on your gut to absorb iron from food or iron pills. You also won’t receive the gastrointestinal side effects associated with iron pills. However, IV iron comes with its own potential side effects.
Potential side effects of intravenous iron
Mild:
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Low grade fever
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Ache/pain in bones
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Passing dark urine
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Skin problems, including rash
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Nausea and stomach cramps
Severe (less common):
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Bloating or swelling of the face, arms, hands, lower legs, or feet
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Chest pain, trouble breathing
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Low blood pressure
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Dizziness or fainting
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Anaphylaxis (life threatening allergic reaction) – this rarely happens
After you receive IV iron, your health team will watch you for 30 minutes. They will make sure you do not have a reaction or a drop in your blood pressure. If you have any serious side effects when you get home, please go to the emergency department or call 911. After, let your doctor know what happened.
Types of IV iron:
Iron sucrose...
(Brand name: Venofer ®, DIN: 02243716, time for one dose: 2 to 3 hours)
Sodium Ferric Gluconate...
(Brand name: Ferrlecit ®, DIN: 02243333, time for one dose: 1 hour)
Iron Isomaltoside 1000...
(Brand name: Monoferric ®, DIN: 02477777, time for one dose: 30 minutes)