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Iron supplement (Oral route, parenteral route)

Brand Names:

  • Beef,Iron & Wine
  • Bifera
  • Elite Iron
  • Femiron
  • Feosol
  • Fergon
  • Ferrex 150
  • Hemocyte
  • Fer-In-Sol
  • Palafer
  • Pms-Ferrous Sulfate

Dosage Forms:

  • Tablet, Chewable
  • Tablet
  • Liquid
  • Capsule
  • Solution
  • Tablet, Enteric Coated
  • Tablet, Extended Release
  • Suspension
  • Capsule, Liquid Filled
  • Syrup
  • Capsule, Extended Release
  • Elixir

Uses of This Medicine:

Iron is a mineral that the body needs to produce red blood cells. When the body does not get enough iron, it cannot produce the number of normal red blood cells needed to keep you in good health. This condition is called iron deficiency (iron shortage) or iron deficiency anemia.

Although many people in the U.S. get enough iron from their diet, some must take additional amounts to meet their needs. For example, iron is sometimes lost with slow or small amounts of bleeding in the body that you would not be aware of and which can only be detected by your doctor. Your doctor can determine if you have an iron deficiency, what is causing the deficiency, and if an iron supplement is necessary.

Lack of iron may lead to unusual tiredness, shortness of breath, a decrease in physical performance, and learning problems in children and adults, and may increase your chance of getting an infection.

Some conditions may increase your need for iron. These include:

  • Bleeding problems
  • Burns
  • Hemodialysis
  • Intestinal diseases
  • Stomach problems
  • Stomach removal
  • Use of medicines to increase your red blood cell count

In addition, infants, especially those receiving breast milk or low-iron formulas, may need additional iron.

Increased need for iron supplements should be determined by your health care professional.

Injectable iron is administered only by or under the supervision of your health care professional. Other forms of iron are available without a prescription; however, your health care professional may have special instructions on the proper use and dose for your condition.

For good health, it is important that you eat a balanced and varied diet. Follow carefully any diet program your health care professional may recommend. For your specific dietary vitamin and/or mineral needs, ask your health care professional for a list of appropriate foods. If you think that you are not getting enough vitamins and/or minerals in your diet, you may choose to take a dietary supplement.

Iron is found in the diet in two forms—heme iron, which is well absorbed, and nonheme iron, which is poorly absorbed. The best dietary source of absorbable (heme) iron is lean red meat. Chicken, turkey, and fish are also sources of iron, but they contain less than red meat. Cereals, beans, and some vegetables contain poorly absorbed (nonheme) iron. Foods rich in vitamin C (e.g., citrus fruits and fresh vegetables), eaten with small amounts of heme iron-containing foods, such as meat, may increase the amount of nonheme iron absorbed from cereals, beans, and other vegetables. Some foods (e.g., milk, eggs, spinach, fiber-containing, coffee, tea) may decrease the amount of nonheme iron absorbed from foods. Additional iron may be added to food from cooking in iron pots.

The daily amount of iron needed is defined in several different ways.

  • Recommended Dietary Allowances (RDAs) are the amount of vitamins and minerals needed to provide for adequate nutrition in most healthy persons. RDAs for a given nutrient may vary depending on a person's age, sex, and physical condition (e.g., pregnancy).
  • Daily Values (DVs) are used on food and dietary supplement labels to indicate the percent of the recommended daily amount of each nutrient that a serving provides. DV replaces the previous designation of United States Recommended Daily Allowances (USRDAs).
  • Recommended Nutrient Intakes (RNIs) are used to determine the amounts of vitamins, minerals, and protein needed to provide adequate nutrition and lessen the risk of chronic disease.

Normal daily recommended intakes in milligrams (mg) for iron are generally defined as follows (Note that the RDA and RNI are expressed as an actual amount of iron, which is referred to as “elemental”' iron. The product form [e.g., ferrous fumarate, ferrous gluconate, ferrous sulfate] has a different strength):

PersonsU.S.
(mg)
Canada
(mg)
Infants birth to 3 years of age6–100.3–6
Children 4 to 6 years of age108
Children 7 to 10 years of age108–10
Adolescent and adult males108–10
Adolescent and adult females10–158–13
Pregnant females3017–22
Breast-feeding females158–13

Before Using This Medicine:

If you are taking a dietary supplement without a prescription, carefully read and follow any precautions on the label. For these supplements, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Problems in children have not been reported with intake of normal daily recommended amounts. Iron supplements, when prescribed by your health care professional, are not expected to cause different side effects in children than they do in adults. However, it is important to follow the directions carefully, since iron overdose in children is especially dangerous.

Studies on sodium ferric gluconate have shown that this supplement is safe to use in children ages 6 to 15 years. The safety of sodium ferric gluconate has not been determined in patients who are younger than 6 years of age.

Older adults—

Problems in older adults have not been reported with intake of normal daily recommended amounts. Elderly people sometimes do not absorb iron as easily as younger adults and may need a larger dose. If you think you need to take an iron supplement, check with your health care professional first. Only your health care professional can decide if you need an iron supplement and how much you should take.

Pregnancy—

It is especially important that you are receiving enough vitamins and minerals when you become pregnant and that you continue to receive the right amount of vitamins and minerals throughout your pregnancy. Healthy fetal growth and development depend on a steady supply of nutrients from mother to fetus. During the first 3 months of pregnancy, a proper diet usually provides enough iron. However, during the last 6 months, in order to meet the increased needs of the developing baby, an iron supplement may be recommended by your health care professional.

However, taking large amounts of a dietary supplement in pregnancy may be harmful to the mother and/or fetus and should be avoided.

Breast-feeding—

It is especially important that you receive the right amounts of vitamins and minerals so that your baby will also get the vitamins and minerals needed to grow properly. Iron normally is present in breast milk in small amounts. When prescribed by a health care professional, iron preparations are not known to cause problems during breast-feeding. However, nursing mothers are advised to check with their health care professional before taking iron supplements or any other medication. Taking large amounts of a dietary supplement while breast-feeding may be harmful to the mother and/or infant and should be avoided.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these dietary supplements, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using dietary supplements in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Altretamine
  • Amygdalin
  • Dabrafenib
  • Deferoxamine
  • Digoxin
  • Eltrombopag
  • Elvitegravir
  • Ketoconazole
  • Ledipasvir
  • Pazopanib
  • Phenytoin
  • Rilpivirine
  • Vismodegib

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of dietary supplements in this class. Make sure you tell your doctor if you have any other medical problems, especially:

  • Alcohol abuse (or history of) or
  • Blood transfusions (with high red blood cell iron content) or
  • Kidney infection or
  • Liver disease or
  • Porphyria cutaneous tarda—Higher blood levels of the iron supplement may occur, which may increase the chance of side effects.
  • Arthritis (rheumatoid) or
  • Asthma or allergies or
  • Heart disease—The injected form of iron may make these conditions worse.
  • Colitis or other intestinal problems or
  • Iron overload conditions (e.g., hemochromatosis, hemosiderosis, hemoglobinopathies) or
  • Stomach ulcer—Iron supplements may make these conditions worse.
  • Other anemias—Iron supplements may increase iron to toxic levels in anemias not associated with iron deficiency.

Proper Use of This Medicine:

After you start using this dietary supplement, continue to return to your health care professional to see if you are benefiting from the iron. Some blood tests may be necessary for this.

Iron is best absorbed when taken on an empty stomach, with water or fruit juice (adults: full glass or 8 ounces; children: ½ glass or 4 ounces), about 1 hour before or 2 hours after meals. However, to lessen the possibility of stomach upset, iron may be taken with food or immediately after meals.

For safe and effective use of iron supplements:

  • Follow your health care professional's instructions if this dietary supplement was prescribed.
  • Follow the manufacturer's package directions if you are treating yourself. If you think you still need iron after taking it for 1 or 2 months, check with your health care professional.

Liquid forms of iron supplement tend to stain the teeth. To prevent, reduce, or remove these stains:

  • Mix each dose in water, fruit juice, or tomato juice. You may use a drinking tube or straw to help keep the iron supplement from getting on the teeth.
  • When doses of liquid iron supplement are to be given by dropper, the dose may be placed well back on the tongue and followed with water or juice.
  • Iron stains on teeth can usually be removed by brushing with baking soda (sodium bicarbonate) or medicinal peroxide (hydrogen peroxide 3%).

Dosing—

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage forms (capsules, tablets, oral solution):
    • To prevent deficiency, the amount taken by mouth is based on normal daily recommended intakes:
      • Adult and teenage males—10 milligrams (mg) per day.
      • Adult and teenage females—10 to 15 mg per day.
      • Pregnant females—30 mg per day.
      • Breast-feeding females—15 mg per day.
      • Children 7 to 10 years of age—10 mg per day.
      • Children 4 to 6 years of age—10 mg per day.
      • Children birth to 3 years of age—6 to 10 mg per day.
      • Adult and teenage males—8 to 10 mg per day.
      • Adult and teenage females—8 to 13 mg per day.
      • Pregnant females—17 to 22 mg per day.
      • Breast-feeding females—8 to 13 mg per day.
      • Children 7 to 10 years of age—8 to 10 mg per day.
      • Children 4 to 6 years of age—8 mg per day.
      • Children birth to 3 years of age—0.3 to 6 mg per day.
    • To treat deficiency:
      • Adults, teenagers, and children— The dose will be determined by your doctor, based on your condition.
  • For injection dosage forms:
    • Adults, teenagers, and children— The dose will be determined by your doctor, based on your condition.

Missed dose—

If you miss a dose of this medicine, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using This Medicine:

When iron is combined with certain foods it may lose much of its value. If you are taking iron, the following foods should be avoided, or only taken in very small amounts, for at least 1 hour before or 2 hours after you take iron:

  • Cheese and yogurt
  • Eggs
  • Milk
  • Spinach
  • Tea or coffee
  • Whole-grain breads and cereals and bran

Do not take iron supplements and antacids or calcium supplements at the same time. It is best to space doses of these 2 products 1 to 2 hours apart, to get the full benefit from each medicine or dietary supplement.

If you are taking iron supplements without a prescription:

  • Do not take iron supplements by mouth if you are receiving iron injections. To do so may result in iron poisoning.
  • Do not regularly take large amounts of iron for longer than 6 months without checking with your health care professional. People differ in their need for iron, and those with certain medical conditions can gradually become poisoned by taking too much iron over a period of time. Also, unabsorbed iron can mask the presence of blood in the stool, which may delay discovery of a serious condition.

If you have been taking a long-acting or coated iron tablet and your stools have not become black, check with your health care professional. The tablets may not be breaking down properly in your stomach, and you may not be receiving enough iron.

It is important to keep iron preparations out of the reach of children. Keep a 1-ounce bottle of syrup of ipecac available at home to be taken in case of an iron overdose emergency when a doctor, poison control center, or emergency room orders its use.

If you think you or anyone else has taken an overdose of iron medicine:

  • Call your doctor, a poison control center, or the nearest hospital emergency room at once. Always keep these phone numbers readily available.
  • Follow any instructions given to you. If syrup of ipecac has been ordered and given, do not delay going to the emergency room while waiting for the ipecac syrup to empty the stomach, since it may require 20 to 30 minutes to show results
  • Go to the emergency room without delay
  • Take the container of iron with you.

Early signs of iron overdose may not appear for up to 60 minutes or more. Do not delay going to the emergency room while waiting for signs to appear.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

More common
(with injection only)
Backache , groin, side, or muscle pain
chest pain
chills
dizziness
fainting
fast heartbeat
fever with increased sweating
flushing
headache
metallic taste
nausea or vomiting
numbness, pain, or tingling of hands or feet
pain or redness at injection site
redness of skin
skin rash or hives
swelling of mouth or throat
troubled breathing
More common
(when taken by mouth only)
Abdominal or stomach pain
cramping (continuing) or soreness
Less common or rare
(with injection only)
Double vision
general unwell feeling
weakness without feeling dizzy or faint
Less common or rare
(when taken by mouth only)
Chest or throat pain, especially when swallowing
stools with signs of blood (red or black color)
Early symptoms of iron overdose
Diarrhea (may contain blood)
fever
nausea
stomach pain or cramping (sharp)
vomiting, severe (may contain blood)

Symptoms of iron overdose may not occur for up to 60 minutes or more after the overdose was taken. By this time you should have had emergency room treatment. Do not delay going to emergency room while waiting for signs to appear.

Late symptoms of iron overdose
Bluish-colored lips, fingernails, and palms of hands
convulsions (seizures)
pale, clammy skin
shallow and rapid breathing
unusual tiredness or weakness
weak and fast heartbeat

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Constipation
diarrhea
leg cramps
nausea
vomiting
Less common
Darkened urine
heartburn
stained teeth

Stools commonly become dark green or black when iron preparations are taken by mouth. This is caused by unabsorbed iron and is harmless. However, in rare cases, black stools of a sticky consistency may occur along with other side effects such as red streaks in the stool, cramping, soreness, or sharp pains in the stomach or abdominal area. Check with your health care professional immediately if these side effects appear.

If you have been receiving injections of iron, you may notice a brown discoloration of your skin. This color usually fades within several weeks or months.

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 11/4/2014

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