Synopsis
Choose oral or intravenous iron for the confirmed indication, prescribe a formulation-specific regimen, manage intolerance and interactions, and verify response, replenishment and infusion safety.
- Confirm iron deficiency or a guideline-supported functional iron indication before treatment. Low haemoglobin alone does not justify iron when haemolysis, B12 deficiency, renal disease or marrow pathology may dominate.
- For most stable adults, BSG prefers one tablet daily of ferrous sulfate, fumarate or gluconate; if intolerance occurs, every-other-day dosing is a supported alternative before abandoning oral therapy.
- The iron salt and elemental iron content are not interchangeable. Prescribe the exact product and tablet strength and check the BNF rather than writing 'iron tablets'.
Key red flags
Flushing, urticaria, wheeze, airway swelling, hypotension or collapse during infusion requires immediate cessation, ABCDE assessment and the anaphylaxis pathway.
Investigation priorities
Confirm indication, severity and inflammatory modification before treatment.
Management branches
Confirmed iron deficiency is stable and oral absorption is expected to be adequate.
- Preferred treatment is one daily tablet of ferrous sulfate, fumarate or gluconate with the exact product documented, plus counselling on adverse effects, food and medicine interactions and child-safe storage.
- If intolerance occurs, the supported alternative is one tablet every other day, another salt or a carefully agreed food schedule rather than unstructured dose escalation.
Key medicines
Ferrous sulfateOne 200 mg tablet by mouth once daily is a common adult BSG starting regimen; reduce to every other day if gastrointestinal intolerance limits adherence.
Ferrous fumarateOne 210 mg tablet by mouth once daily is a BSG-listed alternative, with every-other-day administration if needed for tolerance.