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Difference between oral iron preparations
The amount of elemental iron they contain and hence tolerability (more iron per dose likely means more adverse effects). The key to tolerability is starting low and slow.
For many patients, starting with one ferrous fumarate daily (usually at bedtime) is just fine and you can work up from there as needed. If a patient is not tolerating that, I would roll back to ferrous gluconate at bedtime and slowly increase your dose (BID then TID). Your target total daily dose is usually 100-200 mg.
Here’s a table for quick reference…
| Preparation | Dose | Preparation |
|---|---|---|
| Ferrous Fumarate (Palafer®, generics) |
100 mg elemental Fe in one 300 mg ferrous fumarate tab | Available over-the-counter (OTC) but covered by ODB with a prescription |
| Ferrous sulfate (Fer-in-sol®, Slow- Fe®, generics |
60 mg elemental Fe in one 300 mg ferrous sulfate tab Note: Slow-Fe is an extended release prep of dried ferrous sulfate containing 50 mg elemental Fe per tab |
Available OTC, not covered by ODB |
| Ferrous Gluconate, generics |
35 mg elemental Fe in one 300 mg ferrous gluconate tab | Available OTC, covered by ODB with a prescription |
| Polysaccharide-iron complex (Niferex®) |
150 mg elemental Fe in one 150 mg polysaccharide iron complex |
Available OTC, not covered, ~$100 for 100 tabs |