Oral Iron 💊
Ward guide to oral iron in Ireland. Galfer (ferrous fumarate) dosing from the HPRA SmPC, elemental iron comparison, tolerability tips, and when to switch to IV iron.
💡 Ward approach
- Confirm iron deficiency before treating: microcytic anaemia or iron studies (low ferritin ± low transferrin saturation). Seek the cause (bleeding, malabsorption, diet, menstrual loss) rather than replacing iron alone.
- Galfer is the usual Irish oral iron brand: ferrous fumarate 305 mg capsules (= 100 mg elemental iron per capsule).
- Licensed adult / ≥12 y Galfer capsule doses (HPRA SmPC): prophylaxis 1 capsule once daily; treatment 1 capsule twice daily.
- Many wards start once daily (one capsule OD) for better GI tolerability, then increase if needed. Confirm local formulary and pharmacy advice.
- Continue oral iron for about 3 months after Hb normalises to replenish stores, then stop and recheck as advised by the treating team / GP.
- Take on an empty stomach if tolerated (absorption falls with food, tea, coffee, dairy, antacids, and calcium). Separate from levothyroxine, bisphosphonates, and many antibiotics (e.g. tetracyclines, quinolones) by ≥2 hours.
💊 Common preparations (elemental iron)
- Galfer capsules: ferrous fumarate 305 mg = 100 mg elemental iron per capsule.
- Galfer oral suspension 140 mg/5 ml: ferrous fumarate = 45 mg elemental iron per 5 ml. Adult / ≥12 y (SmPC): prevention 10 ml once daily; treatment 10 ml twice daily. Under 12 y: weight-based dosing under medical supervision (see SmPC).
- Ferrous sulfate 200 mg tablets ≈ 65 mg elemental iron per tablet (common generic). Do not assume the same tablet count as Galfer.
- Ferrous gluconate 300 mg ≈ 35 mg elemental iron per tablet (lower elemental content; more tablets needed for an equivalent dose).
- Modified-release oral iron (e.g. some “slow” ferrous sulfate brands) is generally avoided: little advantage and may bypass the main absorption site. Use standard-release salts.
- Always prescribe by salt strength and state elemental iron if there is any doubt; check the product on the chart against the SmPC.
⚠️ Cautions
- GI side effects are common: constipation, nausea, epigastric discomfort, black stools. Warn patients that dark stools are expected.
- If not tolerated: try once-daily or alternate-day dosing, take with a small amount of food (accepting lower absorption), switch salt, or use liquid Galfer. If still intolerant or urgent correction needed → consider IV iron.
- Active infection / inflammation can blunt response; treat the underlying process and reassess iron studies.
- Do not give oral iron if iron overload is possible (e.g. haemochromatosis) or if the patient is receiving IV iron in the same period without a clear plan.
- Liquid iron can stain teeth: dilute and use a straw where practical.
- Children: use age/weight-appropriate product and dose from the SmPC; Galfer capsules are not recommended under 12 years.
🚨 When to escalate / switch to IV
- Failure of oral therapy (poor adherence, malabsorption, ongoing losses, or inadequate Hb rise after a reasonable trial) → senior review; consider IV iron per local protocol (e.g. Ferinject).
- Need for rapid rise (e.g. pre-op optimisation, severe symptomatic IDA without immediate transfusion) → discuss IV iron.
- Significant bleeding, haemodynamic instability, or Hb meeting transfusion thresholds → manage as anaemia / bleed pathway first; iron replacement is adjunctive.
- Unexplained iron deficiency (especially men and post-menopausal women) → investigate for GI blood loss; involve gastroenterology as appropriate.
Educational reference only. Medical disclaimer