question and answer
Iron supplements: how to curb the constipation
June 2005
ELSPETH MACEWAN, MD, asks, "Can you suggest strategies for treating a patient with iron deficiency anemia, when compliance with supplements is chronically compromised by constipation?"
There are several strategies for treating iron deficiency anemia in such cases.

Often, a gradual increase in dosage will result in fewer side effects. Start iron therapy with one tablet daily. After a week, increase it to two tablets daily for another week and then raise the dose to three a day. If the patient can tolerate one tablet a day but not two, ask him or her to take only one. Unless the individual is loosing large amounts of blood daily or has malabsorption of iron, 300 mg of ferrous sulfate or gluconate should gradually increase the hemoglobin.

Secondly, even though the absorption of iron is better when taken on an empty stomach, the side effects are less if taken with a meal or right after eating.

If constipation is the only contraindication for the iron therapy, you can prescribe a mild laxative or stool softener to see if this would reduce it to a level tolerable to the patient.

You should also check why the patient needs iron supplementation and see if this requirement can be reduced. For example, if the cause is heavy menstrual blood loss, you could try hormone therapy or refer the patient to a gynecologist to verify if there are ways of cutting down the iron loss.

If the patient can't tolerate taking enough iron by mouth to raise the hemoglobin level, you can try parenteral iron therapy. Iron preparations for intramuscular and intravenous administration are available, but not recommended unless strictly necessary. Parenteral iron therapy is associated with a small risk of anaphylaxis and should be given under close observation when a physician is available to manage any reaction. MS
(see our gastroenterologist's response to this question in the gastroenterology category)
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