Usual Adult Dose for Iron Deficiency Anemia

Initial dose: 600 mg/day ferrous sulfate (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: 1000 mg/day ferrous sulfate (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: 30 to 90 mg/day ferrous sulfate (FeSO4) (6 to 18 mg/day elemental iron) orally, in divided doses (1 to 3 times daily)

51 and over: 25 to 40 mg/day FeSO4 (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: 15 to 30 mg/kg/day ferrous sulfate (FeSO4) (3 to 6 mg/kg/day elemental iron)
5 to 12 years: 300 mg FeSO4 (60 mg/day elemental)
12-18 years male: Two 300 mg FeSO4 (60 mg elemental) tablets orally daily
12-18 years female: 300 to 600 mg/day FeSO4 (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: 10 mg/kg/day ferrous sulfate (FeSO4) (2 mg/kg/day elemental iron)
0 to 6 months: 1 to 1.35 mg/day FeSO4 (0.2 to 0.27 mg/day elemental)
7 to 12 months: 35 to 55 mg/day FeSO4 (7 to 11 mg/day elemental)
1 to 3 years: 20 to 45 mg/day FeSO4 (4 to 9 mg/day elemental)
4 to 8 years: 20 to 50 mg/day FeSO4 (4 to 10 mg/day elemental)
9 to 13 years: 30 to 40 mg/day FeSO4 (6 to 8 mg/day elemental)
14 to 18 years: 40 to 75 mg/day FeSO4 (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: 115 to 135 mg/day ferrous sulfate (FeSO4) (23 to 27 mg/day elemental iron)
14 to 18 years: Lactation: 35 to 50 mg/day FeSO4 (7 to 10 mg/day elemental)
19 to 50 years: Pregnancy: 110 to 135 mg/day FeSO4 (22 to 27 mg/day elemental)
19 to 50 years: Lactation: 32.5 to 45 mg/day FeSO4 (6.5 to 9 mg/day elemental)
Maximum dose: 225 mg FeSO4 (45 mg/day elemental)

Treatment of anemia:
Pregnancy: 300 to 600 mg FeSO4 (60 to 120 mg/day elemental)

Precautions

US BOXED WARNING:

• 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.

Frequently asked questions

• What is the typical dose of ferrous sulfate?