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{{Short description|Iron formulation used to prevent or treat iron deficiency anemia}}
{{See also|Ferrous sulfate}}
{{Use dmy dates|date=February 2024}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Infobox drug
| drug_name =▼
| INN =▼
| type =<!-- empty -->▼
| IUPAC_name = ▼
| image = Dr Williams' 'Pink Pills', London, England, 1850-1920 Wellcome L0058211.jpg
| alt =
| caption = Iron supplement from the late 19th and early 20th century
<!-- Clinical data -->
| synonyms = Iron pills, iron salts, ferrous salts, ferric salts▼
| pronounce =
| tradename = Feosol, Feostat, Feratab, others
| Drugs.com = {{
| {{drugs.com|monograph|iron-preparations-oral}} | {{drugs.com|monograph|iron-dextran}}
}}
| MedlinePlus =
|
| pregnancy_AU = B3
| pregnancy_AU_comment =
| pregnancy_US = <!-- A/B/C/D/X/N -->▼
| pregnancy_category=
| routes_of_administration = [[By mouth]],
|
| ATC_prefix = B03▼
| legal_AU_comment =▼
|
| ATC_supplemental =
| legal_DE = <!-- Anlage I, II, III -->▼
<!-- Legal status -->
| legal_AU = <!-- S2, S3, S4, S5, S6, S7, S8, S9 or Unscheduled -->
▲| legal_AU_comment =
| legal_BR = <!-- OTC, A1, A2, A3, B1, B2, C1, C2, C3, C4, C5, D1, D2, E, F -->
| legal_BR_comment =
| legal_CA = Rx-only
| legal_CA_comment = /{{nbsp}}OTC<ref>{{cite web | title=Ferinject Product information | website=[[Health Canada]] | date=11 March 2024 | url=https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=103479 | access-date=21 June 2024}}</ref><ref>{{cite web | title=Health product highlights 2021: Annexes of products approved in 2021 | website=[[Health Canada]] | date=3 August 2022 | url=https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/health-product-highlights-2021/appendices.html | access-date=25 March 2024}}</ref>
▲| legal_DE = <!-- Anlage I, II, III or Unscheduled -->
| legal_DE_comment =
| legal_NZ_comment =
| legal_UK_comment = <ref name="Cosmofer SmPC" /><ref name="Ferinject SmPC" />
| legal_US = OTC
| legal_US_comment = / Rx-only<ref name="Injectafer FDA label" /><ref name="Drug Approval Package: Accrufer" />
| legal_UN = <!-- N I, II, III, IV / P I, II, III, IV-->▼
|
| legal_EU_comment =
▲| legal_UN = <!-- N I, II, III, IV / P I, II, III, IV -->
| legal_UN_comment =
| legal_status = <!-- For countries not listed above -->
<!-- Pharmacokinetic data -->
| bioavailability =
| protein_bound =
| metabolism =
| metabolites =
| onset =
| elimination_half-life =
| duration_of_action =
| excretion =
<!-- Identifiers -->
| CAS_number = 1332-96-3
|
▲| ATCvet =
▲| ATC_prefix = B03
| ATC_suffix = A▼
| PubChem =
| IUPHAR_ligand =
| DrugBank =
| ChemSpiderID = None
| NIAID_ChemDB =
| PDB_ligand =
▲| synonyms = Iron pills, iron salts, ferrous salts, ferric salts
<!-- Chemical and physical data -->
▲| IUPAC_name =
| chemical_formula_ref =
| chemical_formula =
| C= | H= | Ag= | Al= | As= | Au= | B= | Bi= | Br= | Ca= | Cl= | Co= | F= | Fe= | Gd= | I=
| K= | Li= | Mg= | Mn= | N= | Na= | O= | P= | Pt= | S= | Sb= | Se= | Sr= | Tc= | Zn= | charge=
| molecular_weight =
| molecular_weight_comment =
| SMILES =
| StdInChI =
| StdInChI_comment =
| StdInChIKey =
| density =
| density_notes =
| melting_point =
| melting_high =
| melting_notes =
| boiling_point =
| boiling_notes =
| solubility =
| sol_units =
| specific_rotation =
}}
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<!-- History and culture -->
Iron pills have been used medically since at least 1681, with an easy-to-use formulation being created in 1832.<ref>{{cite book| vauthors = Upfal J |title=Australian Drug Guide|date=2006|publisher=Black Inc.|isbn=9781863951746|pages=378–379|url=https://books.google.com/books?id=7O9kiqN2q2YC&pg=PA379|language=en|url-status=live|archive-url=https://web.archive.org/web/20170918183856/https://books.google.com/books?id=7O9kiqN2q2YC&pg=PA379|archive-date=
==Medical uses==
Iron supplements are used to treat or prevent [[Iron deficiency (medicine)|iron deficiency]] and [[iron-deficiency anemia]];<ref name="
Iron deficiency anemia is classically a microcytic, hypochromic anemia. Generally, in the UK oral preparations are trialled before using parenteral delivery,<ref name="pmid21561874">{{cite journal | vauthors = Goddard AF, James MW, McIntyre AS, Scott BB | collaboration = British Society of Gastroenterology | title = Guidelines for the management of iron deficiency anaemia | journal = Gut | volume = 60 | issue = 10 | pages = 1309–16 | date = October 2011 | pmid = 21561874 | doi = 10.1136/gut.2010.228874 | s2cid = 52804934 | url = http://www.bsg.org.uk/pdf_word_docs/iron_def.pdf | archive-url = https://web.archive.org/web/20120422205151/http://www.bsg.org.uk/pdf_word_docs/iron_def.pdf | archive-date = 22 April 2012 }}</ref> unless there is the requirement for a rapid response, previous intolerance to oral iron or likely failure to respond. Intravenous iron may decrease the need for [[blood transfusions]] however it increases the risk of infections when compared to oral iron.<ref>{{cite journal | vauthors = Litton E, Xiao J, Ho KM | title = Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials | journal = BMJ | volume = 347 | pages = f4822 | date = August 2013 | pmid = 23950195 | pmc = 3805480 | doi = 10.1136/bmj.f4822 }}</ref> A 2015 [[Cochrane Collaboration]] review found that daily oral supplementation of iron during pregnancy reduces the risk of maternal anemia and that effects on infant and on other maternal outcomes are not clear.<ref>{{cite journal | vauthors = Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T | title = Daily oral iron supplementation during pregnancy | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 7 | pages = CD004736 | date = July 2015 | pmid = 26198451 | pmc = 4233117 | doi = 10.1002/14651858.CD004736.pub5 }}</ref> Another review found tentative evidence that intermittent iron supplements by mouth for mothers and babies is similar to daily supplementation with fewer side effects.<ref name="Cochrane Review on Intermittent Iron Supplementation in Pregnancy">{{cite journal | vauthors = Peña-Rosas JP, De-Regil LM, Gomez Malave H, Flores-Urrutia MC, Dowswell T | title = Intermittent oral iron supplementation during pregnancy | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 10 | pages = CD009997 | date = October 2015 | pmid = 26482110 | pmc = 7092533 | doi = 10.1002/14651858.CD009997.pub2 }}</ref> Supplements by mouth should be taken on an empty stomach, optionally with a small amount of food to reduce discomfort.<ref>{{Cite encyclopedia|url=https://medlineplus.gov/ency/article/007478.htm|title=Taking iron supplements | encyclopedia = MedlinePlus Medical Encyclopedia| publisher = U.S. National Library of Medicine |language=en|access-date=
===Athletes===
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===Frequent blood donors===
{{main|Blood donation}}
Frequent blood donors may be advised to take iron supplements. [[Canadian Blood Services]] recommends discussing "taking iron supplements with your doctor or pharmacist" as "the amount of iron in most multivitamins may not meet your needs and iron supplements may be necessary".<ref>{{cite web |title=What you need to know about iron |url=https://www.blood.ca/en/blood/am-i-eligible/abcs-eligibility/iron |website=Canadian Blood Services |access-date=30 May 2022}}</ref> The [[American Red Cross]] recommends "taking a multivitamin with 18 mg of iron or an iron supplement with 18-38 mg of elemental iron for 60 days after each blood donation, for 120 days after each power red donation or after frequent platelet donations".<ref>{{cite web |title=Frequent Blood Donors and the Importance of Iron |url=https://www.redcrossblood.org/donate-blood/blood-donation-process/before-during-after/iron-blood-donation/iron-informationforfrequentdonors.html |website=American Red Cross Blood Services |access-date=30 May 2022}}</ref> A 2014 [[Cochrane Review]] found that blood donors were less likely to be deferred for low hemoglobin levels if they were taking oral iron supplements, although 29% of those who took them experienced side effects in contrast to the 17% that took a placebo. It is unknown what the long-term effects of iron supplementation for blood donors may be.<ref>{{cite journal | vauthors = Smith GA, Fisher SA, Doree C, Di Angelantonio E, Roberts DJ | title = Oral or parenteral iron supplementation to reduce deferral, iron deficiency and/or anaemia in blood donors | journal = The Cochrane Database of Systematic Reviews | issue = 7 | pages = CD009532 | date = July 2014 | pmid = 24990381 | doi = 10.1002/14651858.CD009532.pub2 | s2cid = 205200473 | pmc = 11019466 }}</ref>
==Side effects==
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Treatments with [[iron(II) sulfate]] have higher incidence of adverse events than [[Iron polymaltose|iron(III)-hydroxide polymaltose complex]] (IPC)<ref name="pmid17691594">{{cite journal | vauthors = Geisser P | title = Safety and efficacy of iron(III)-hydroxide polymaltose complex / a review of over 25 years experience | journal = Arzneimittel-Forschung | volume = 57 | issue = 6A | pages = 439–452 | year = 2007 | pmid = 17691594 | doi = 10.1055/s-0031-1296693 | s2cid = 70657238 }}</ref><ref name="pmid17691593">{{cite journal | vauthors = Toblli JE, Brignoli R | title = Iron(III)-hydroxide polymaltose complex in iron deficiency anemia / review and meta-analysis | journal = Arzneimittel-Forschung | volume = 57 | issue = 6A | pages = 431–438 | year = 2007 | pmid = 17691593 | doi = 10.1055/s-0031-1296692 | s2cid = 2635923 }}</ref><ref name="pmid17435611">{{cite journal | vauthors = Saha L, Pandhi P, Gopalan S, Malhotra S, Saha PK | title = Comparison of efficacy, tolerability, and cost of iron polymaltose complex with ferrous sulphate in the treatment of iron deficiency anemia in pregnant women | journal = MedGenMed | volume = 9 | issue = 1 | pages = 1 | date = January 2007 | pmid = 17435611 | pmc = 1924983 }}</ref> or iron bis-glycinate chelate.<ref name="pmid11688081">{{cite journal | vauthors = Szarfarc SC, de Cassana LM, Fujimori E, Guerra-Shinohara EM, de Oliveira IM | title = Relative effectiveness of iron bis-glycinate chelate (Ferrochel) and ferrous sulfate in the control of iron deficiency in pregnant women | journal = Archivos Latinoamericanos de Nutricion | volume = 51 | issue = 1 Suppl 1 | pages = 42–47 | date = March 2001 | pmid = 11688081 }}</ref><ref name="pmid11688084">{{cite journal | vauthors = Ashmead SD | title = The chemistry of ferrous bis-glycinate chelate | journal = Archivos Latinoamericanos de Nutricion | volume = 51 | issue = 1 Suppl 1 | pages = 7–12 | date = March 2001 | pmid = 11688084 }}</ref>
Iron overdose has been one of the leading causes of death caused by toxicological agents in children younger than
Iron poisoning may result in mortality or short-term and long-term morbidity.<ref>{{cite web | url = http://www.tripdatabase.com/doc/813847-Toxicity-Iron-Overview#content | title = Toxicity, Iron (Overview) | archive-url = https://web.archive.org/web/20160308211454/https://www.tripdatabase.com/doc/813847-Toxicity-Iron-Overview | archive-date = 8 March 2016 | work = Tripdatabase.com| access-date = 21 December 2012 }}</ref>
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==Contraindications==
Contraindications often depend on the substance in question. Documented [[hypersensitivity]] to any ingredients and anemias without proper work-up (i.e., documentation of iron deficiency) is true of all preparations. Some can be used in iron deficiency, others require iron deficiency anaemia to be present. Some are also contraindicated in [[rheumatoid arthritis]].<ref name="Cosmofer SmPC">{{cite web | url =
===Hemochromatosis===
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Iron can be supplemented [[oral route|by mouth]] using various forms, such as [[iron(II) sulfate]]. This is the most common and well studied soluble iron [[salt]] sold under brand names such as Feratab, Fer-Iron, and Slow-FE. It is in complex with [[gluconate]], [[dextran]], [[carbonyl iron]], and other salts. [[Ascorbic acid]], vitamin C, increases the absorption of non-heme sources of iron.<ref>{{cite journal | vauthors = Lynch SR, Cook JD | title = Interaction of vitamin C and iron | journal = Annals of the New York Academy of Sciences | volume = 355 | issue = 1 | pages = 32–44 | year = 1980 | pmid = 6940487 | doi = 10.1111/j.1749-6632.1980.tb21325.x | s2cid = 35848195 | citeseerx = 10.1.1.530.1906 | bibcode = 1980NYASA.355...32L }}</ref>
Heme iron polypeptide (HIP) (e.g. Proferrin ES and Proferrin Forte) can be used when regular iron supplements such as ferrous sulfate or ferrous fumarate are not tolerated or absorbed. A clinical study demonstrated that HIP increased serum iron levels 23 times greater than ferrous fumarate on a milligram-per-milligram basis.<ref>{{cite journal | vauthors = Seligman PA, Moore GM, Schleicher RB |title=Clinical studies of hip: An oral heme-iron product |journal=Nutrition Research |volume=20 |issue=9 |year=2000 |pages=1279–86 |doi=10.1016/s0271-5317(00)00215-3 |s2cid=84515114 }}</ref>
Another alternative is
Since iron stores in the body are generally depleted, and there is a limit to what the body can process (about 2–6 mg/kg of body mass per day; i.e. for a 100 kg/220 lb man this is equal to a maximum dose of 200–600 mg/per day) without [[iron poisoning]], this is a chronic therapy which may take 3–6 months.<ref>{{cite web | url = http://www.webmd.com/a-to-z-guides/iron-poisoning | title = Iron Poisoning | archive-url = https://web.archive.org/web/20120412155245/http://www.webmd.com/a-to-z-guides/iron-poisoning | archive-date = 12 April 2012 | work = Webmd.com | date = 27 September 2012 | access-date = 21 December 2012 }}</ref>
Due to the frequent intolerance of oral iron and the slow improvement, parenteral iron is recommended in many indications.<ref>{{cite book |author=National Clinical Guideline Centre |title=Anaemia Management in Chronic Kidney Disease |location=London |publisher=Royal College of Physicians |year=2015 |series=NICE Guideline, No. 8 |url=https://www.ncbi.nlm.nih.gov/books/NBK299242/ |pmid=26065064 |url-status=live |archive-url=https://web.archive.org/web/20170918183856/https://www.ncbi.nlm.nih.gov/books/NBK299242/ |archive-date=
===By injection===
Iron therapy (intravenously or intramuscular) is given when therapy by mouth has failed (not tolerated), oral absorption is seriously compromised (by illnesses, or when the person cannot swallow), benefit from oral therapy cannot be expected, or fast improvement is required (for example, prior to elective surgery).<ref name="pmid9070014">{{cite journal | vauthors = Kumpf VJ | title = Parenteral iron supplementation | journal = Nutrition in Clinical Practice | volume = 11 | issue = 4 | pages = 139–146 | date = August 1996 | pmid = 9070014 | doi = 10.1177/0115426596011004139 }}</ref> [[Parenteral|Parenteral therapy]] is more expensive than oral iron preparations and is not suitable during the first trimester of [[pregnancy]].<ref
There are cases where parenteral iron is preferable over oral iron. These are cases where oral iron is not tolerated, where the [[haemoglobin]] needs to be increased quickly (e.g. post partum, post operatively, post transfusion), where there is an underlying inflammatory condition (e.g. inflammatory bowel disease) or renal patients, the benefits of parenteral iron far outweigh the risks.
Low-certainty evidence suggests that IBD-related anemia treatment with [[Intravenous iron infusion|Intravenous (IV) iron infusion]] may be more effective than [[Oral iron|oral iron therapy]], with fewer people needing to stop treatment early due to adverse effects.<ref name=":0">{{cite journal | vauthors = Gordon M, Sinopoulou V, Iheozor-Ejiofor Z, Iqbal T, Allen P, Hoque S, Engineer J, Akobeng AK
In many cases, use of intravenous iron such as ferric carboxymaltose has lower risks of adverse events than a blood transfusion and as long as the person is stable is a better alternative.<ref>{{cite journal | vauthors = Moore RA, Gaskell H, Rose P, Allan J | title = Meta-analysis of efficacy and safety of intravenous ferric carboxymaltose (Ferinject) from clinical trial reports and published trial data | journal = BMC Blood Disorders | volume = 11 | pages = 4 | date = September 2011 | pmid = 21942989 | pmc = 3206450 | doi = 10.1186/1471-2326-11-4 }}</ref> Ultimately this always remains a clinical decision based on local guidelines, although National Guidelines are increasingly stipulating IV iron in certain groups of patients.<ref>{{cite journal | vauthors = Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P | display-authors = 6 | title = 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC | journal = European Heart Journal | volume = 37 | issue = 27 | pages = 2129–2200 | date = July 2016 | pmid = 27206819 | doi = 10.1093/eurheartj/ehw128 | author22 = ESC Scientific Document Group | doi-access = free }}</ref><ref>{{cite journal | vauthors = Dignass AU, Gasche C, Bettenworth D, Birgegård G, Danese S, Gisbert JP, Gomollon F, Iqbal T, Katsanos K, Koutroubakis I, Magro F, Savoye G, Stein J, Vavricka S | display-authors = 6 | title = European consensus on the diagnosis and management of iron deficiency and anaemia in inflammatory bowel diseases | journal = Journal of Crohn's & Colitis | volume = 9 | issue = 3 | pages = 211–222 | date = March 2015 | pmid = 25518052 | doi = 10.1093/ecco-jcc/jju009 | doi-access = free }}</ref>▼
A Cochrane review of controlled trials comparing [[Intravenous iron infusion|intravenous (IV) iron therapy]] with oral iron supplements in people with [[chronic kidney disease]], found low-certainty evidence that people receiving IV-iron treatment were 1.71 times as likely to reach their target [[hemoglobin]] levels.<ref name=":1">{{cite journal | vauthors = O'Lone EL, Hodson EM, Nistor I, Bolignano D, Webster AC, Craig JC | title = Parenteral versus oral iron therapy for adults and children with chronic kidney disease | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 2 | pages = CD007857 | date = February 2019 | pmid = 30790278 | pmc = 6384096 | doi = 10.1002/14651858.CD007857.pub3 | collaboration = Cochrane Kidney and Transplant Group }}</ref> Overall, hemoglobin was 0.71g/dl higher than those treated with oral iron supplements. Iron stores in the liver, estimated by serum [[ferritin]], were also 224.84 µg/L higher in those receiving IV-iron.<ref name=":1" /> However, there was also low-certainty evidence that allergic reactions were more likely following IV-iron therapy. It was unclear whether type of iron therapy administration affects the risk of death from any cause, including cardiovascular, nor whether it may alter the number of people who may require a blood transfusion or dialysis.<ref name=":1" />▼
▲In many cases, use of intravenous iron such as ferric carboxymaltose has lower risks of adverse events than a blood transfusion and as long as the person is stable is a better alternative.<ref>{{cite journal | vauthors = Moore RA, Gaskell H, Rose P, Allan J | title = Meta-analysis of efficacy and safety of intravenous ferric carboxymaltose (Ferinject) from clinical trial reports and published trial data | journal = BMC Blood Disorders | volume = 11 | pages = 4 | date = September 2011 | pmid = 21942989 | pmc = 3206450 | doi = 10.1186/1471-2326-11-4 | doi-access = free }}</ref> Ultimately this always remains a clinical decision based on local guidelines, although National Guidelines are increasingly stipulating IV iron in certain groups of patients.<ref>{{cite journal | vauthors = Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P
Soluble iron salts have a significant risk of adverse effects and can cause toxicity due to damage to cellular macromolecules. Delivering iron parenterally has utilised various different molecules to limit this. This has included [[dextrans]], [[sucrose]], carboxymaltose and more recently Isomaltoside 1000.{{citation needed|date=July 2015}}▼
▲A Cochrane review of controlled trials comparing [[Intravenous iron infusion|intravenous (IV) iron therapy]] with oral iron supplements in people with [[chronic kidney disease]], found low-certainty evidence that people receiving IV-iron treatment were 1.71 times as likely to reach their target [[hemoglobin]] levels.<ref name=":1">{{cite journal | vauthors = O'Lone EL, Hodson EM, Nistor I, Bolignano D, Webster AC, Craig JC | title = Parenteral versus oral iron therapy for adults and children with chronic kidney disease | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 2 | pages = CD007857 | date = February 2019 | pmid = 30790278 | pmc = 6384096 | doi = 10.1002/14651858.CD007857.pub3 | collaboration = Cochrane Kidney and Transplant Group }}</ref> Overall, hemoglobin was 0.71g/dl higher than those treated with oral iron supplements. Iron stores in the liver, estimated by serum [[ferritin]], were also 224.84
One formulation of parenteral iron is ''iron dextran'' which covers the old high molecular weight (trade name ''DexFerrum'') and the much safer low molecular iron dextrans (tradenames including Cosmofer and Infed).<ref>{{cite journal | vauthors = Chertow GM, Mason PD, Vaage-Nilsen O, Ahlmén J | title = On the relative safety of parenteral iron formulations | journal = Nephrology, Dialysis, Transplantation | volume = 19 | issue = 6 | pages = 1571–1575 | date = June 2004 | pmid = 15150356 | doi = 10.1093/ndt/gfh185 | doi-access = }}</ref>▼
▲Soluble iron salts have a significant risk of adverse effects and can cause toxicity due to damage to cellular macromolecules. Delivering iron parenterally has utilised various different molecules to limit this. This has included [[dextrans]], [[sucrose]], carboxymaltose, and
''Iron [[sucrose]]'' has an occurrence of allergic reactions of less than 1 in 1000.<ref name=fass-venofer>{{cite web | url = http://www.fass.se/LIF/produktfakta/artikel_produkt.jsp?NplID=20000211000213&DocTypeID=7 | title = Venofer | archive-url = https://web.archive.org/web/20111001011331/http://www.fass.se/LIF/produktfakta/artikel_produkt.jsp?NplID=20000211000213&DocTypeID=7 | archive-date = 1 October 2011 | work = [[FASS (drug formulary)]] | language = Swedish | quote = Allergiska reaktioner (inträffar hos färre än 1 av 1 000 patienter)" and "Vanliga (inträffar hos färre än 1 av 10 patienter): Tillfälliga smakförändringar (speciellt metallsmak). }}</ref> A common side effect is taste changes, especially a [[metallic taste]], occurring in between 1 in 10 and 1 in 100 treated patients.<ref name=fass-venofer/> It has a maximum dose of 200 mg on each occasion according to the SPC, but it has been given in doses of 500 mg. Doses can be given up to 3 times a week.<ref>{{cite web |url=https://www.medicines.org.uk/emc/medicine/24168 |title=Venofer (iron sucrose) - Summary of Product Characteristics (SmPC) | work = eMC |access-date=2017-03-07 |url-status=live |archive-url=https://web.archive.org/web/20170308044906/https://www.medicines.org.uk/emc/medicine/24168 |archive-date=2017-03-08 }}</ref>▼
▲One formulation of parenteral iron is
▲
''Iron Isomaltoside 1000'' (Trade name ''Monofer'') is a newer formulation of parenteral iron that has a matrix structure that results in very low levels of free iron and labile iron. It can be given at high doses – 20 mg/kg in a single visit – no upper dose limit. This formulation has the benefit of giving a full iron correction in a single visit.<ref>{{cite journal | vauthors = Jahn MR, Andreasen HB, Fütterer S, Nawroth T, Schünemann V, Kolb U, Hofmeister W, Muñoz M, Bock K, Meldal M, Langguth P | display-authors = 6 | title = A comparative study of the physicochemical properties of iron isomaltoside 1000 (Monofer), a new intravenous iron preparation and its clinical implications | journal = European Journal of Pharmaceutics and Biopharmaceutics | volume = 78 | issue = 3 | pages = 480–491 | date = August 2011 | pmid = 21439379 | doi = 10.1016/j.ejpb.2011.03.016 }}</ref><ref name="CançadoMuñoz2011">{{cite journal | vauthors = Cançado RD, Muñoz M | title = Intravenous iron therapy: how far have we come? | journal = Revista Brasileira de Hematologia e Hemoterapia | volume = 33 | issue = 6 | pages = 461–469 | year = 2011 | pmid = 23049364 | pmc = 3459360 | doi = 10.5581/1516-8484.20110123 }}</ref>▼
Iron carboxymaltose is marketed as Ferinject,<ref name="Ferinject SmPC" /> Injectafer,<ref name="Injectafer FDA label" /><ref>{{cite web | title=Drug Approval Package: Injectafer (ferric carboxymaltose) Injection NDA #203565 | website=U.S. [[Food and Drug Administration]] (FDA) | date=4 September 2013 | url=https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203565Orig1s000TOC.cfm | access-date=8 February 2024}}</ref> and Iroprem in various countries.<ref name="CançadoMuñoz2011"/> The most common side effects are [[headaches]] which occur in 3.3%, and hypophosphatemia, which occurs in more than 35%.<ref name="Ferinject SmPC" /><ref name="Injectafer FDA label">{{cite web | title=Injectafer- ferric carboxymaltose injection injection, solution; Injectafer- ferric carboxymaltose injection, solution | website=DailyMed | date=1 May 2023 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=517b4a19-45b3-4286-9f6a-ced4e10447de | access-date=8 February 2024}}</ref>
[[Ferric maltol]], marketed as ''Accrufer'' and ''Ferracru,'' is available in oral and IV preparations. When used as a treatment for IBD-related anemia, very low certainty evidence suggests a marked benefit with oral ferric maltol compared with placebo. However it was unclear whether the IV preparation was more effective than oral ferric maltol.<ref name=":0" />▼
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▲[[Ferric maltol]], marketed as
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