Iron deficiency anemia occurs when iron levels in the body are so low that they are insufficient to produce enough hemoglobin, useful for transporting oxygen to the tissues. Iron deficiency anemia can be favored by several elements: iron-deficient diet, bleeding, pregnancy, inability to absorb iron (typical consequence of celiac disease, steatorrhea, chronic diarrhea and gastric surgery), abundant menstruation.
The therapy aimed at treating iron deficiency anemia is called “martial” and is essentially based on the administration of ferrous salts, generally orally; in some cases, especially in patients who present malabsorption in the context of iron deficiency anemia, it is preferable to take iron salts parenterally (intramuscularly or intravenously).
If the patient is malnourished, too thin or overweight, iron deficiency anemia could depend on an unregulated diet: in this case, the first therapeutic measure is represented by the correction of eating habits. If the patient suffering from iron deficiency anemia takes in too many liquids during the day, it is advisable to reduce their intake.
Below are the classes of drugs most used in therapy against iron deficiency anemia, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the patient’s state of health and his response to the treatment:
Iron supplements: typical side effects caused by the administration of iron supplements are digestive alterations and associated disorders, such as abdominal cramps, diarrhea and heartburn. In order to avoid these unpleasant inconveniences, it is recommended to start administration with a low dosage, which will be gradually increased during therapy. Furthermore, even if administration on an empty stomach would be more effective for the absorption of the product, the supplement is generally taken together with the meal or immediately after its end, given the gastro-intestinal effects it can cause.
- Ferrous sulphate (e.g. Ferrograd): anti-anemic par excellence, ferrous sulphate is widely used in martial therapy (iron deficiency anemia). Typically, the drug is available in the form of controlled-release tablets with 595 mg of active ingredient. It is recommended to take 1 tablet per day, with water. The drug requires a medical prescription. To improve absorption, it is recommended to take the drug with vitamin C (e.g. with a glass of orange juice).
- Iron dextran (e.g. Ferro ATI 100 solution for injection): indicatively, take 25-100 mg of active ingredient intramuscularly or intravenously. Consult your doctor.
- Iron fumarate (e.g. Organic Iron): start therapy for iron deficiency anemia with 325 mg of the drug orally, once a day. Continue with maintenance therapy by taking 325 mg of active ingredient, three times a day. The dosage for the treatment of iron deficiency anemia associated with kidney disease remains the same; it is recommended to subject the patient to regular checks.
- Ferrous gluconate (e.g. Sidervim, Cromatonferro, Bioferal, Losferron): available in effervescent tablets and effervescent granules. The dosage of this drug for the treatment of iron deficiency anemia follows that of ferrous fumarate.
- Carbonyl iron (e.g. Icar): the dose for adults suffering from iron deficiency anemia is 50 mg of active ingredient, to be taken orally, three times a day.
- Iron sucrose (e.g. Ferrum Hausmann Oral, Venofer): available in vials for oral use, it is recommended to take the drug in case of iron deficiency anemia at a dose of 2-3 vials (each containing 40 mg of iron), after meals. The dose should be reduced to 1-2 vials per day for the treatment of iron deficiency anemia in children. Alternatively, it is also possible to take the drug by slow intravenous injection (5 ml of solution contains 100 mg of active ingredient), lasting 2-5 minutes. Consult your doctor.
There are also multivitamin supplements, formulated with more vitamins and minerals: for example Multicentrum, Supradyn, Be-Total Plus.
Hematopoietic growth factors (HGF): they are useful when iron deficiency anemia depends on renal failure or neoplasms. Drugs (e.g. formulated with erythropoietin: Eprex, Epoxitin), stimulate the synthesis of red blood cells, rebalance iron levels in the blood.
Blood transfusions: in particularly serious cases, in which iron deficiency anemia cannot be treated with the drugs just listed, it is possible to proceed with a blood transfusion.
Secondary therapies for the prevention of anemia and to treat secondary symptoms
If neither iron supplementation nor correcting eating habits are sufficient to cure iron deficiency anemia, the patient must undergo more in-depth checks in order to identify the real cause that triggers iron deficiency in the blood. Depending on the etiological element, the doctor may prescribe antibiotics, oral contraceptives or recommend surgery:
1) Antibiotics: anemia could also be related to a peptic ulcer; therefore, treating this disease could also balance iron levels in the blood.
- Metronidazole (e.g. Metronid, Deflamon): take one 250 mg tablet every 6 hours.
- Amoxicillin (e.g. Augmentin, Klavux) belongs to the penicillins: it is a bactericide capable of inhibiting the synthesis of the bacterial cell wall (Helicobacter pylori), responsible for peptic ulcers. Take one tablet orally (1 gram) 2-3 times a day for 14 days.
2) Oral contraceptives: in the case of particularly heavy menstruation, the risk of iron deficiency anemia increases considerably, given the large amount of blood lost due to hypermenorrhea. Oral contraceptives, by regulating menstrual flow, could represent a possible therapeutic option.
- Ethinylestradiol/Levonorgestrel (e.g. Loette, Microgynon, Miranova, Egogyn): these drugs are available in packs of 21-28 tablets: each tablet consists of 0.02 mg of ethinylestradiol and 0.1 mg of levonorgestrel. The pharmacological treatment involves taking one tablet a day, for 21 days, possibly at approximately the same time every day, followed by a free interval of one week.
- Desogestrel/Ethinylestradiol (e.g. Gracial, Novynette, Lucill, Dueva, Securgin): these are coated tablets with 20 mcg of ethnilestradiol and 150 mcg of desogestrel. The dosage of these drugs reflects that described above: the correct method of taking these active ingredients generally guarantees a significant reduction in menstrual flow. It should not be forgotten, however, that in some patients the worsening of the prodromes can sometimes be observed: in this case, do not hesitate to contact your doctor. In any case, in the first three months of taking the pill, a change in symptoms, in a positive or negative sense, is very frequent.
3) Lastly, the causes responsible for iron deficiency anemia also include bleeding polyps, fibroids or uterine tumors: in this case, iron deficiency must be considered as a secondary symptom, useful for the diagnosis of the disease below. There surgical removal of the bleeding polyp or abnormal mass, in all probability cancels out the iron deficiency anemia.