Usual Adult Dose for Iron Deficiency Anemia

Initial dose: 360 mg/day ferrous fumarate (120 mg/day elemental iron) for 3 months

• Give in divided doses (1 to 3 times daily)

Usual Adult Dose for Anemia Associated with Chronic Renal Failure

Initial dose: 600 mg/day ferrous fumarate (200 mg/day elemental iron) orally in divided doses (1 to 3 times daily)

Comments:

• If goals are not met with oral iron after 1 to 3 months, consider IV iron supplementation.
• Smaller daily doses may be better tolerated.

Usual Adult Dose for Vitamin/Mineral Supplementation

Initial dose: 1 tablet orally once a day

or

Initial dose: 18 to 54 mg/day ferrous fumarate (6 to 18 mg/day elemental iron) orally, in divided doses (1 to 3 times daily)

51 and over: 15 to 24 mg/day ferrous fumarate (5 to 8 mg/day elemental) orally, in divided doses (1 to 3 times daily)

Usual Pediatric Dose for Iron Deficiency Anemia

0 to 5 years: 9 to 18 mg/kg/day ferrous fumarate (3 to 6 mg/kg/day elemental iron)
5 to 12 years: 180 mg ferrous fumarate (60 mg/day elemental)
12-18 years male: 360 mg ferrous fumarate (120 mg elemental) orally daily
12-18 years female: 180 to 360 mg/day ferrous fumarate (60 to 120 mg/day elemental)

• Give in divided doses (1 to 3 times daily)

Usual Pediatric Dose for Vitamin/Mineral Supplementation

Preterm infant (less than 37 weeks gestation), 0 to 12 months: 6 mg/kg/day ferrous fumarate (2 mg/kg/day elemental iron)
0 to 6 months: 0.6 to 0.81 mg/day ferrous fumarate (0.2 to 0.27 mg/day elemental)
7 to 12 months: 21 to 33 mg/day ferrous fumarate (7 to 11 mg/day elemental)
1 to 3 years: 12 to 27 mg/day ferrous fumarate (4 to 9 mg/day elemental)
4 to 8 years: 12 to 30 mg/day ferrous fumarate (4 to 10 mg/day elemental)
9 to 13 years: 18 to 24 mg/day ferrous fumarate (6 to 8 mg/day elemental)
14 to 18 years: 24 to 45 mg/day ferrous fumarate (8 to 15 mg/day elemental)

• Give in divided doses (1 to 3 times daily)

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

No adjustment recommended

Dose Adjustments

Vitamin supplementation/Prevention of anemia:
14 to 18 years: Pregnancy: 69 to 81 mg/day ferrous fumarate (23 to 27 mg/day elemental iron)
14 to 18 years: Lactation: 21 to 30 mg/day ferrous fumarate (7 to 10 mg/day elemental)
19 to 50 years: Pregnancy: 66 to 81 mg/day ferrous fumarate (22 to 27 mg/day elemental)
19 to 50 years: Lactation: 19.5 to 27 mg/day ferrous fumarate (6.5 to 9 mg/day elemental)
Maximum dose: 135 mg ferrous fumarate (45 mg/day elemental)

Treatment of anemia:
Pregnancy: 180 to 360 mg ferrous fumarate (60 to 120 mg/day elemental)

Precautions

US BOXED WARNING(S):

• Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6.
• Keep out of reach of children.
• In case of accidental overdose, call a doctor or poison center immediately.

Dialysis

Iron supplementation is routinely provided to peritoneal dialysis and hemodialysis patients for prevention or treatment of anemia associated with chronic renal failure.

Other Comments

Administration advice:

• Coffee, tea, milk, cereal, dietary fiber, and phosphate containing carbonated drinks decrease iron absorption.
• Supplements containing calcium, zinc, manganese, or copper decrease iron absorption.
• Antacids, H2 blockers, and proton pump inhibitors decrease iron absorption; do not use within 1 to 2 hours of iron administration.
• Vitamin C and acidic foods increase iron absorption.
• Delayed release and enteric coated formulations are better tolerated, but are not as well absorbed.

• Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6.
• Keep out of reach of children.
• In case of accidental overdose, call a doctor or poison center immediately.