IV Treatment for Iron Deficiency Anemia

If you have been diagnosed with iron deficiency with or without anemia, it may seem like an easy fix. "I'll just take some iron tabs, and everything will be fine." Although this is true for many people with iron deficiency, it can be much more complicated.

Determining Which Iron Therapy Is Right for You

When determining which iron therapy—oral or intravenous (IV)—is right for you, it is important to consider several factors, including the following.

• Age: Historically, infants and children have been treated with oral iron, except in rare circumstances, such as children who are unable to absorb oral iron due to gastrointestinal issues. In adults, IV iron is used more commonly, particularly in people with ongoing bleeding or after gastric bypass surgery, which makes it difficult to absorb iron.
• Cost: Without question, oral iron is less expensive. It is readily available over the counter and may be the only choice in resource-poor settings. It can be given at home with little monitoring. IV iron must be administered in a clinic or hospital for monitored infusion, which makes it more costly.
• Absorption: Some people are unable to absorb oral iron. Causes may include gastric bypass surgery (iron is absorbed in the stomach and requires gastric acid for absorption), celiac disease, inflammatory bowel disease, or after the Whipple procedure.
• Tolerance: Although oral iron is inexpensive, almost 70% of people taking oral iron complain of gastrointestinal side effects, including nausea, constipation, stomach pain, or vomiting. The liquid forms of oral iron, in particular, have a metallic taste and can cause staining of the teeth. Fortunately, the staining is temporary and can be minimized by brushing the teeth afterward. These side effects are common reasons why people do not take iron as recommended by their physician.
• Length of treatment: It can take months for oral iron to fully correct anemia, and even longer to completely restore the iron storage in the body. IV iron can correct iron deficiency with one to two doses.
• Cause of anemia: In people with iron deficiency anemia caused by ongoing blood loss, oral iron therapy is not likely to keep up with the need. IV iron may be a better choice in these situations.

Options for IV Iron

For many years, IV iron was reserved for severe cases of iron deficiency anemia because the IV iron products available could cause allergic or anaphylactic reactions. However, newer formulations are safer and far less likely to have these reactions. Some of the forms of currently available IV iron are reviewed below.

• Iron dextran: This is the least expensive version of IV iron. Iron deficiency can usually be corrected with only one infusion. Newer versions of iron dextran are less likely to cause allergic reactions than older formulations. Usually, a small test dose is given first, and, if that's well tolerated, the remainder of the dose is given. Sometimes medications are given prior to the IV iron in an attempt to prevent a reaction. This is the most common form of iron used in children (although any form can be used).
• Ferric gluconate: This form of IV iron can be given over multiple smaller doses. This formulation is commonly used in people receiving hemodialysis for severe kidney disease.
• Iron sucrose: Iron sucrose is also given over multiple smaller doses. If you are allergic to other medications, you may receive a small test dose first to ensure no reaction prior to receiving the remainder of the medication. This form of IV iron can be used in multiple settings, including dialysis or in pregnant women.
• Ferric carboxymaltose: This medication is given in one or two infusions depending on the severity of iron deficiency. It has been used safely in multiple settings, including in children.

A Word From Verywell

Iron deficiency is a common cause of anemia in the United States and worldwide. Although oral iron can be an easy, inexpensive treatment for many people, it may not be the best option for everyone. Discuss with your physician all of your treatment options, including risks and benefits, prior to starting new medications.