6 best iron supplements

*Overview of the best according to the editors of Healthy Food Near Me. About selection criteria. This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.

Iron preparations are usually always sold without a prescription, because for some reason it is believed that they are not capable of harm if they are prescribed just like that, for prevention. Therefore, many doctors can meet the abuse of indications for the appointment of iron “right and left.” However, any prescription of drugs just for the sake of it, including conventional multivitamin complexes, can do more harm than good. Iron-containing preparations must be prescribed or indeed if there is anemia or anemia, or an increased consumption of iron is planned, for example, during pregnancy.

But even if the patient is diagnosed with anemia, then sometimes you need to start not at all with iron preparations, but with a search for the cause. And if the cause of the anemia that has arisen is not identified, then this treatment is worthless. Let’s imagine that the patient has chronic blood loss through the intestines, because there are bleeding polyps, a tumor, or parasites. Yes, there are special parasites, hookworms, which literally just suck blood, they feed exclusively on human blood. Therefore, an attempt to prescribe iron-containing preparations to such a patient with chronic and permanent blood loss would be a gross mistake. He needs to be given anthelmintics, and then, after the parasites are destroyed, even a proper and balanced diet, the diet can lead to the restoration of iron levels. What quantitative indicators can indicate a normal iron metabolism in humans? Here they are.

Indicators of normal iron metabolism

The most important indicator of red blood and iron levels, although indirect, but simple and important, is the concentration of hemoglobin. If it is lower than 130 grams per liter for men, 120 grams per liter for women, or 110 grams per liter for pregnant women, then the condition is anemia. In the same case, if the hemoglobin index is less than 90 g / l, then the person should “automatically” go on sick leave, since he cannot work, especially hard work, physically, with such a concentration of hemoglobin.

1. Other direct indicators of iron metabolism are:

2. ferritin plasma,

3. transferrin,

4. percent saturation of transferrin with iron;

5. free serum iron concentration.

We deliberately do not provide norms for men and women in order to save the reader from the temptation to replace doctor’s appointments with various types of self-diagnosis. What are the symptoms and signs of iron deficiency anemia that can alarm a person and make him go for tests?

Symptoms of iron deficiency anemia (IDA, sideropenic syndrome)

Symptoms of iron deficiency anemia can manifest themselves to varying degrees much earlier than a person is going to take tests. Most often, the skin and its appendages are affected, that is, nails and hair, the gastrointestinal tract, as well as the cardiovascular and nervous systems. In descending order of frequency of symptoms of long-term, slowly developing anemia, the signs are as follows:

1. increased dryness of the skin,

2. excessive striation, layering and fragility of nails, changes in their structure and shape;

3. hair begins to grow more slowly, and the ends of the hair split;

4. there is mild fatigue and weakness, which increases with the progression of anemia;

5. shortness of breath during physical exertion, and with progression and pallor;

6. if there is separately cyanosis of the nasolabial triangle, that is, its cyanosis, cyanosis of the earlobes or the tip of the nose, then this may not indicate anemia, but some kind of cardiovascular pathology, for example, heart disease with a decrease in capillary oxygenation with oxygen;

7. an earthy shade of the face, along with pallor, may indicate the presence of malignant neoplasms;

8. anemic patients sometimes complain of a special, painful sensation of smells, hyperosmia, taste perversion. It is sometimes common to eat chalk, tooth powder or paste, raw grits, and so on;

9. fainting and dizziness, especially with a rapid transition from a horizontal to a vertical position of the body, can also be a formidable sign of progressive anemia.

Usually, any anemia in its development goes through several stages before it becomes clinically and laboratory noticeable. The main stage from which the anemic process begins is the prelatent or latent phase. There is no clinically significant iron deficiency yet; reserves that should be in the body are spent to cover it. Then ferritin and transferrin begin to decrease, the concentration of free iron in the blood serum begins to change, and only then, as a rough laboratory symptom of anemia, the hemoglobin concentration also decreases, since it is in the hemoglobin molecule that there is a special structure – heme containing iron.

Anemia risk groups

Some of the reasons for the development of anemia syndrome, such as bleeding, diseases of the stomach and intestines, helminthic invasions, we have already indirectly mentioned. It should be especially remembered that children and pregnant women, who have an increased need for iron, form a risk group. Pregnant women need an excess of iron due to its high consumption for building the baby’s blood, children are actively growing, and women themselves, not even pregnant, are also at risk, and it is at reproductive age. After all, even normal menstrual bleeding is nothing more than a “planned loss of iron.”

As soon as a newborn is born, the mother spends about 300 mg of iron during her pregnancy on the construction of his body and on the synthesis of his blood, spending her own reserves. And then, after birth, the baby’s only source of iron will be mother’s milk. Therefore, the lactation period, which begins immediately after pregnancy, is a continuation of the increased load on the woman’s body, and increased iron consumption. If a child is fed on artificial mixtures, then they must necessarily contain a known amount of easily digestible iron.

The active period of building the child’s skeleton, lengthening the body requires an increase in its mass, and hence the volume of circulating blood. And some mild signs of anemia, both laboratory and clinical, can occur in half of all children, but they are especially pronounced in girls. Indeed, in girls during the period of active growth, the first menstruation, or menarche, begins, and then the loss of iron with menstruation becomes planned.

Basic principles for the treatment of anemic syndrome without drugs

Naturally, the intensity of treatment of anemic syndrome, as we have already understood, depends on the causes. If it is bleeding and the decay of the tumor tissue, then an emergency operation is needed, if it is helminthiasis, then this is the appointment of anthelmintic drugs, but let’s leave difficult situations for specialists. Consider a classic example of increased iron consumption in a pregnant woman, which must first be compensated by nutritional correction.

And in the event that there are clinical, or even more so laboratory signs of the presence of anemia, then one cannot do without drugs, but a diet can compensate for a low level of iron deficiency, if it is simply about the depletion of reserve reserves. On average, every day we get about 20 mg of elemental iron with food, and it is absorbed somewhere 10 times less: 2 mg. And if you modify the diet, then you can improve not only the intake of iron with food, but also its absorption, but not more than 30%.

1. Non-drug principles for the treatment of iron deficiency through diet therapy and rational nutrition are as follows:

2. it is necessary to increase the intake of beef and fish liver, eggs and meat, natural products. Boiled, dietary meat is preferable, rather than refined sausages;

3. you should not rely on fresh apples as the legendary “source of iron”: no more than 5% of iron is absorbed from them,

4. the presence in the diet of folic acid, vitamin C, or ascorbic acid, as well as copper increases the absorption of iron. It is on this that the action of complex iron-containing preparations, for example, Totems, is based, which will be discussed later.

5. various tannins, such as tea tannin, oxalates, (oxalic acid), phosphates and calcium reduce the availability of iron to the intestines, and reduce its absorption. Therefore, regular consumption of strong tea can contribute to iron deficiency;

6. if dairy products are consumed, then they must be consumed separately from meat, since milk contains calcium.

What valency of iron should be preferred? Both ferrous and trivalent iron enter our body. But our body itself is well versed with these varieties of iron atoms, and in the body processes of oxidation and reduction take place with them. As a result, the valency of the iron atoms changes. So, in order for the gland to bind to ferritin, it must have a valence of 3 plus, and hemoglobin contains ferrous iron.

Pharmacotherapy of anemic syndrome

Treatment should continue under test control, and on average, oral iron supplementation with medication lasts about 3-5 months under medical supervision. In this case, of course, it is necessary to initially make sure that the loss of iron during treatment does not exceed the norm, otherwise the treatment will be useless.

In addition, it is necessary to strictly observe the principles of treatment of iron deficiency anemia. If iron deficiency anemia is diagnosed, and laboratory parameters testify to this, then this means that one diet is not enough. Even with the highest saturation with iron, it is unlikely that more than 3 mg can be absorbed into the body. Of modern preparations, 10 or even 20 times more iron can be absorbed than with the most balanced and rich diet.

In most cases, oral medications are sufficient for anemia, and blood transfusion, that is, hemotransfusion of red blood cells, will be needed when hemoglobin drops to 50 or 40 g per liter. Of course, this is a very severe anemia and should not be brought to patients. Therefore, one should try to prescribe iron as early as possible, and for a fairly long time, in order not only to eliminate the symptoms of anemia, both laboratory and clinical, but also to create in the body a supply of iron that was wasted in the initial, latent stages. And this means that after the normalization of the hemoglobin level and the receipt of quite favorable tests, it is not necessary to stop treatment. It usually takes another two or three months, when the iron supply is created in the body, and already half the doses of the drugs that managed to cure the anemia are prescribed. In the event that the growth of iron stores in the body will occur slowly, then it is necessary to take additional drugs, for example, multivitamins.

Various iron-containing drugs also, in turn, contain either ferrous or ferric iron. You can therefore take both drugs containing ferrous and ferric iron. It is generally believed that when it comes to organic iron compounds, they are absorbed better, and iron compounds with maltose, ferrous gluconate, are still not as coarse as inorganic compounds of this metal, such as ferrous sulfate. But that is why organic iron compounds are a little more expensive.

All the drugs listed below are over-the-counter, they can be purchased at a pharmacy in the free market. All of them are included in national and international clinical guidelines for the treatment of anemia and sideropenic syndrome, and all are oral, that is, they are administered by mouth. That is, drugs containing iron for intravenous use, such as Venofer and Kosmofer, we will not consider here. They are used in specialized settings, such as dialysis patients.

For medicinal products, the INN, that is, the international non-proprietary name, will be named first, and then the commercial name. The price is valid for the end of March 2020 for pharmacies of all forms of ownership in the Russian Federation. Almost all iron preparations are imported, and they have very few, if any, domestic analogues.

Rating of popular iron-containing drugs for the treatment and prevention of anemia

Iron hydroxide polymaltose (Ferrum Lek, Maltofer)

Rating: 4.9

Ferrum Lek is a trivalent iron preparation in the form of hydroxide bound to the organic residue of the polymerized sugar maltose. In a pharmacy, you can buy chewable tablets for sale, at an average price of 275 rubles per package of 30 tablets, or you can buy them in the form of a syrup. The drug is produced by Lek from Slovenia. This medicine is only manufactured in Slovenia and is marketed by Sandoz, Switzerland. And this is a guarantee of quality. In addition to chewable tablets, you can also purchase 100 milliliters of syrup along with a measuring spoon, but it is more convenient for adults to take tablets.

In terms of iron, 1 tablet contains 100 mg of the drug. As a result, the resulting molecular complex of iron with maltose is very large, and its passive diffusion is rather slow, 40 times less than that of ferrous iron. Therefore, this iron is absorbed only actively in the intestine. Then in the liver it binds to ferritin, and then transported to the red bone marrow and included in the composition of hemoglobin. This drug is indicated in the treatment of any iron deficiency anemia, in the prevention of iron deficiency in pregnancy, and in the treatment of latent deficiency. Adults need to take the drug 1 tablet 3 times a day for prevention, and pregnant women 2-3 tablets daily. Children over 12 years old can be given 1 to 3 tablets per day. In case of latent iron deficiency, it is necessary to treat with this remedy for about 2 months.

Advantages and disadvantages

It is necessary to remember about possible contraindications. This is high blood iron, a disorder of iron utilization, such as lead intoxication, or anemia of another etiology, such as hemolytic or megaloblastic anemia. There may also be side effects, for example, a feeling of heaviness and pressure in the epigastric region, nausea and upset stools. Almost always, while taking the medicine, the feces turn dark in color when the non-absorbed iron is excreted, but this is not scary. This drug has a convenient syrup form that can be prescribed to babies, has a low cost. All side effects are mild and pass quickly. Ferrum Lek has been well and long tested by doctors, it is a familiar remedy with proven effectiveness.

Ferrous fumarate (Ferretab comp)

Rating: 4.8

This medicine is already ferrous fumarate, that is, a salt of organic fumaric acid. Ferretab Komp is produced by the Austrian company Lannacher. One package of 30 tablets will cost from 340 to 470 rubles. In terms of active iron, each tablet contains more than the previous preparation – 163 mg. Ferretab contains ferrous iron, unlike the previous medication. It is necessary to take it both for the treatment of anemia and for the prevention of iron deficiency.

The preventive direction is one capsule on an empty stomach with plenty of water, and with iron or folic acid deficiency, intake can be increased from two to three capsules per day. It should be remembered that maintenance therapy should continue for at least a month after the hemoglobin level is normalized. This is necessary to increase serum ferritin, which reflects the created iron stores in the body. Interestingly, each capsule contains three small tablets of ferrous fumarate and one tablet of folic acid, so this drug is complex. Combined with folic acid, iron is known to have an improved absorption profile and absorption in the red bone marrow. This drug can be used for any iron deficiency anemia, and for prevention.

Advantages and disadvantages

The remedy also has contraindications. General contraindications include excessive iron content in the body, including aplastic anemia, various types of hemosiderosis and hemochromatosis, anemia of a different etiology, not associated with iron deficiency, but with iron absorption deficiency. The drug is of good German quality, but before starting treatment, it is necessary to determine not only the concentration of hemoglobin, but also iron and ferritin in the blood serum, and against the background of treatment there may also be dark staining of the stool. You can also use the drug together with ascorbic acid to improve absorption, and if you take the medicine together with an antacid drug, that is, reducing the acidity of gastric juice and enveloping the mucous membrane, then its effectiveness will be lower.

Iron gluconate + manganese gluconate + copper gluconate (Totem)

Rating: 4.7

Totem is a French drug that is sold as a solution to be taken by mouth. One pack of 20 ampoules of 10 ml each will cost you from 470 to 540 rubles. The medicine is produced in France, in the company Innotek. These are iron gluconate, manganese and copper gluconate, and it was said above that copper improves the absorption of iron, and Totem is indeed a very active remedy. One ampoule contains 50 mg of elemental iron, but this is quite enough to make up for the deficiency of iron and create its reserves in the body. In turn, manganese and copper can be used by various enzyme systems, and improve metabolism.

You can prescribe this medicine from the age of three months, and this is very convenient, since Totem is available in liquid form. In addition to iron deficiency anemia, the remedy can be used during pregnancy, as well as with iron deficiency in the diet. The contents of the ampoule are drunk before meals, previously diluted in ordinary or sweet water. For the treatment of clinically pronounced anemia, an adult needs, on average, 3 ampoules per day, and children older than 3 months – at a dose of 6 mg per kilogram of body weight per day, also divided into 3 doses. For pregnant women, starting from 4 months, one ampoule per day is enough for prevention. In the case of anemia treatment, its duration is individual, but not less than four to five months. The ampoule can be shaken before use.

Advantages and disadvantages

The big advantage is the complex composition, liquid dosage form, and ease of use. It is necessary to take into account standard contraindications, that is, anemia not associated with iron deficiency, excess iron in the body, peptic ulcer of the stomach and duodenum during an exacerbation, intoxication with manganese or copper, Konovalov’s disease, the child’s age is less than 3 months, as well as chronic lead intoxication . In the case of prolonged use in large doses of Totem, there may be a darkening of the enamel of the teeth, but the staining of feces in black is a normal reaction. In the case of treatment with Totem, you can not additionally use other iron-containing drugs.

Iron sulfate + ascorbic acid (Sorbifer Durules, Tardiferon, Ferrogradumet)

Rating: 4.6

This is a dosage form of inorganic iron, and most often you can purchase the drug Sorbifer Durules from the Hungarian manufacturer Egis. A standard package of tablets, of 30 pieces for a month of prophylactic administration, will cost from 450 to 530 rubles. This is a preparation of ferrous iron, and in one tablet, in terms of an element, it contains 100 mg. Also supplied together in one capsule and 60 mg of ascorbic acid, and the color of the tablet is light yellow.

The drug eliminates iron deficiency, and is also used for prevention. Tablets are resistant to the action of gastric juice, but dissolve under the influence of intestinal peristalsis, and with the use of this technology (Durules), you can count on a uniform supply of the drug. If you take one tablet twice a day, then the absorption of iron can be greater, only due to the active form of Durules, by 30% than other drugs. The indications of this remedy are standard: anemia, prelatent iron deficiency or deficiency prevention. Sorbifer should be taken by swallowing the tablet whole and drinking one glass of liquid. Adults and adolescents – one tablet twice a day, depending on the severity of anemia, the dose can be increased to 4 tablets per day. But during pregnancy and breastfeeding, one tablet per day is enough. As in other cases, after the normalization of laboratory parameters, it may be necessary to use the drug for another 2 months.

Advantages and disadvantages

A relative disadvantage is the lack of a liquid form, which means that the medicine is not indicated for young children. It is also necessary to remember about contraindications, which include high iron levels, anemia of another cause not associated with iron deficiency, children under 12 years of age. Since the tablets are large enough, clinically significant esophageal stenosis would be a contraindication to the use of this drug. Side effects include nausea, diarrhea, or constipation, and side effects are dose dependent. Their increase is most likely at doses up to 400 mg, and will be quite frequent. It must be remembered that the use together with some antacids can reduce the absorption of iron, and it is advisable to take Sorbifer separately from drugs, maintaining an interval of 3 hours.

Iron protein succinylate (Ferlatum)

Rating: 4.5

This medicine belongs to the organic compounds of iron, which means that Ferlatum is well tolerated. This is a drug in liquid form, one bottle contains 15 ml of oral solution, which corresponds to 40 mg of pure ferric iron. At the same time, the patient consumes 800 mg of protein succinylate, that is, 20 times more. This drug is indicated for standard iron deficiency anemia, and for prevention. It must be used before meals, adults – one or two bottles a day in 2 doses, and children at a dosage indicated by a doctor, but equivalent to 4 mg per kilogram of body weight per day. This drug is produced by the Spanish company Italfarmaco, and one package of 20 such bottles will cost more than other drugs: from 800 to 1050 rubles.

Advantages and disadvantages

Dignity will be considered an organic form, and a liquid that can be safely given to children. He has standard contraindications, manufacturers, in addition to anemia of a different etiology, added chronic pancreatitis and cirrhosis of the liver, since the organic component is still a complex protein. Usually the drug is well tolerated, and the symptoms of overdose are mild, and even then at the very beginning of treatment, on the first day. A relatively high price can be called a relative disadvantage, and it is not often found in pharmacies, especially in the regions.

Iron sulfate + ascorbic acid + multivitamins (Fenyuls)

Rating: 4.4

Finally, in conclusion of a short review, consider the popular Indian drug Fenyuls, which is manufactured by Sun or Ranbaxy. This is an example of a complex preparation of iron sulfate, in terms of pure divalent sulfate – 45 mg per capsule, with the addition of various vitamins: vitamin C, riboflavin, a group of neurotropic vitamins B1, B6, and pantothenic acid.

This complex preparation does not contain much iron, in terms of elemental composition, and it is best used to prevent deficiency in adolescents, pregnant and lactating women, as well as in the case of delicate iron deficiency against the background of heavy and prolonged periods. In case of a hidden deficiency, one capsule 1 time per day for one to two months is quite enough. For the prevention of hidden deficiency, with polymenorrhea, that is, when there is still a supply of iron in the body, before menstruation, it is necessary to take 1 capsule 2 days before the start, during menstruation and within 2 days after they end. The cost of this drug is from 230 to 270 rubles for a package of 30 pieces, this is a very affordable cost on the iron preparation market.

Advantages and disadvantages

The contraindications and disadvantages of this remedy are standard, the same as for other iron remedies, maybe Fenyuls, as an inorganic, can feel somewhat rude, and there may be discomfort in the epigastrium at the beginning of the appointment, but they also soon pass. Having the right amount of the right vitamins can be considered a big plus, and this may be the drug of choice for the patient who is looking for both vitamins and an oral iron supplement. The choice of Fenyuls allows you to save money, the drug itself is inexpensive. The only relative minus is the staining of urine in yellow by the presence of riboflavin, and feces in a dark color due to the presence of non-absorbed iron, but these are rather “non-critical” minuses. And yet it can not be prescribed to children, since the drug is available only in capsules.

Conclusion

This was a very brief review of iron-containing preparations, but it included all the main qualitative representatives, both ferrous and ferric iron, contained in the form of both organic and inorganic molecules, in the singular, as a monopreparation, as well as in combination with other microelements and vitamins. In total, there are about 90 different drugs containing iron on the market, but the main groups have been represented. Perhaps, only iron preparations for parenteral, that is, intravenous administration, were not considered, but they are needed for a completely different reason, it does not make sense to treat them with ordinary iron deficiency anemia.

Attention! This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.