Abstract

ORAL IRON SUPPLEMENTS AND IRON ABSORPTION PATHWAYS – SCIENTIFIC RATIONALE AND CLINICAL RELEVANCE

Varsha Narayanan*

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Abstract

Iron supplements are mainstay for prevention and management of anemia. Women, pregnant or not, in particular are vulnerable, and need regular clinical monitoring and care. A knowledge of different pathways of iron absorption and their regulation, helps in understanding the scientific rationale behind formulation, dosing, and response of different iron supplements. The amount of elemental iron, the absorption of the selected iron supplement, and the hemoglobin rise needed, are the parameters that help calculate the dosing amount and frequency. Conventional iron supplements like ferrous sulphate maybe lower on cost with acceptable efficacy and therefore suitable for initiating therapy especially in low socio-economic strata, but gastrointestinal adverse effects are common, that may compromise response and compliance. Advanced formulations like liposomal iron have shown higher bioavailability and tolerability among iron supplements, maintaining at least comparable efficacy to conventional ferrous supplements, and therefore can be the treatment of choice to initiate therapy in those where cost is not a factor, or as a switch when tolerability, compliance, or rise in hemoglobin and ferritin with conventional iron supplements is not satisfactory. For heme iron, comparative clinical studies are yet to show clinical benefits over conventional ferrous supplements, however it can still serve as another option available when gastro-intestinal side effects like constipation, limit the effectiveness of conventional iron supplements.

Keywords: Iron, Ferrous salts, Ferric, Liposomal iron, Heme iron, Anemia, Hemoglobin.