Ferrous Sulfate
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Ferrous sulfate
Feosol, Fer-In-Sol, Slow Fe; mostly generic and OTC
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Summary
Classes
Common uses
Iron deficiency anemia0, Iron deficiency prevention (pregnancy, restricted diets, blood loss)0
Pharmacy
Starting dose
325 mg PO daily to TID (=65 mg elemental iron/tablet); alternate-day dosing is now favored by hepcidin physiology for better absorption with less GI burden
Preparations
325 mg tablets (65 mg elemental Fe); 220 mg/5 mL liquid (44 mg elemental Fe/5 mL); 142 mg/mL drops; OTC and Rx
US FDA Max
~200 mg elemental iron/d typical practical limit
Pharmacology
Routes
Oral
Onset
Reticulocyte response at 7-10 days; hemoglobin rise of ~1 g/dL per 3 weeks
Duration
N/A (replacement)
Half-life
N/A (incorporated into hemoglobin and tissue stores)
Bioavailability
10-20% (oral; reduced by food, calcium, antacids, PPIs, tea/coffee; enhanced by ascorbate)
Pregnancy
Routinely used; iron requirements rise substantially in pregnancy and lactation.[citation needed]
Legal status
OTC in US
Purported mechanism
Oral ferrous (Fe²⁺) iron is absorbed via DMT1 in the duodenum, transferred across enterocytes by ferroportin (regulated by hepcidin), and bound to plasma transferrin for delivery to bone marrow erythroblasts for hemoglobin synthesis.0 Replacement repletes both circulating hemoglobin iron and ferritin stores; treatment continues for 3-6 months after hemoglobin normalizes. Alternate-day dosing exploits hepcidin downregulation after a dose to improve fractional absorption while reducing constipation and nausea.