Ferrous Sulfate

Dose & administration

Prevention of iron deficiency:

• Preterm infants: 2-4 mg/kg/day of elemental iron in divided oral doses; initiate no later than 1 month of age and continued through at least 1 year of age, depending on nutritional context and other iron intake. Maximum of 15 mg/day.
• Term infants: 1 mg/kg/day of elemental iron orally; may not need to initiate until 4 months of age.
• Low birth weight infants (<2500 g): 2-3 mg/kg/day of elemental iron in divided oral doses during the first 6 months of life.

Treatment of iron deficiency: 4-6 mg/kg/day of elemental iron in divided oral doses until serum markers of iron deficiency have normalized.

Supplement during epoetin administration: 6 mg/kg/day of elemental iron in divided oral doses.

Indications
Prevention of iron deficiency.
Treatment of iron deficiency.

Contraindications and special considerations (incl incompatibilities)

Oral products are available in many formulations- verify concentration and dose before use.

Consider monitoring iron storage via serum ferritin levels, especially in infants who have received many blood transfusions. If the ferritin level is >350 microgram/L, halt iron supplementation until the level has decreased to <350 microgram/L.

Hypersensitivity to iron or any component of the formulation.

Hemolytic anemia.

Adverse effects
Common side effects include nausea, vomiting, constipation, upset stomach, and black stools. Iron toxicity may include an increase in free radical formation, thus increasing oxidative stress.  

Pharmacological aspects
Iron is an essential part of the heme groups forming hemoglobin, the oxygen-binding metalloprotein of red blood cells.

Onset of action for oral administration is about 5-10 days.

Effects on hemoglobin may be seen in 2-4 weeks.

Enteral absorption is about 30%.

Iron is not actively excreted in the stool or urine, so virtually all absorbed iron remains in the body.

References

• Baker RD, Greer FR, and Committee on Nutrition American Academy of Pediatrics, "Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infants and Young Children (0-3 Years of Age)," Pediatrics, 2010, 126(5):1040-50. PMID 20923825.
• Berglund S, Domellof M, “Meeting iron needs for infants and children,” Curr Opin Clin Nutr Metab Care, 2014, 17(3):267-72. PMID: 24535217.
• Meyer MP, Haworth C, Meyer JH, et al, "A Comparison of Oral and Intravenous Iron Supplementation in Preterm Infants Receiving Recombinant Erythropoietin," J Pediatr, 1996, 129(2):258-63. PMID 8765624.
• Rao R and Georgieff MK, "Iron Therapy for Preterm Infants," Clin Perinatol, 2009, 36(1):27-42. PMID 19161863.
• United Nations Children's Fund, United Nations University, World Health Organization. Iron deficiency anaemia assessment, prevention, and control. A guide for programme managers, 2001. Available from: http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf?ua=1

Document version history
Created 2017-01-14 / Maegan Wells