Oral ferric iron

Ferric maltol

Brand names: Feraccru, Accrufer

Ferric maltol is an oral iron preparation used to treat iron-deficiency anaemia, including in adults with inflammatory bowel disease.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 30 mg (one 30 mg capsule, containing 30 mg iron as ferric maltol)

Route: Oral — take on an empty stomach 1 hour before or 2 hours after meals. Swallow capsules whole; do not open, break or chew.

Frequency: Twice daily

SOURCE: no UK SPC was fetched in this bundle — this draft is distilled from the US ACCRUFER prescribing information and must be verified against the UK SPC. DURATION: treatment duration depends on the severity of iron deficiency, but generally at least 12 weeks of treatment is required; continue as long as necessary to replenish body iron stores and until ferritin levels are within the normal range. IBD: avoid use in patients with an active inflammatory bowel disease flare, because of the potential risk of increased gastrointestinal inflammation. IRON OVERLOAD: do not give to patients with evidence of iron overload or to patients receiving intravenous iron; assess iron parameters before starting and monitor them during therapy. ACCIDENTAL INGESTION: accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6 years — keep out of the reach of children and contact a doctor or poison control centre immediately in case of accidental overdose. PAEDIATRIC: the US label gives the same recommended dosage — 30 mg orally twice daily — for adults and children aged 10 years and above. No per-kg paediatric dose and no dose for children under 10 years is stated, so paedDose has not been structured. Verify any paediatric use against a children's formulary.

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients — reactions could include shock, clinically significant hypotension, loss of consciousness and/or collapse
Haemochromatosis and other iron overload syndromes — use may result in iron overdose
Patients receiving repeated blood transfusions — use may result in iron overload

Side effects

Flatulence (most common, incidence over 1%)
Diarrhoea and constipation
Discoloured faeces
Abdominal pain and abdominal discomfort/distension
Nausea and vomiting

Interactions

Dimercaprol — concomitant use with iron products may increase the risk of nephrotoxicity; avoid concomitant use
Oral medications whose bioavailability may be decreased by ferric maltol, including mycophenolate, ethinylestradiol, ciprofloxacin and doxycycline — where a reduction in bioavailability could be clinically significant, separate administration by at least 4 hours and monitor clinical response
Concomitant oral medications may themselves reduce the bioavailability of iron after ferric maltol — separate administration (the interval depends on the absorption characteristics of the other drug) and monitor clinical response to ferric maltol

Clinical monograph

How it works

It provides ferric iron complexed with maltol, which dissociates to allow iron absorption from the gut for incorporation into haemoglobin and iron stores.

Prescribing in practice

As with all iron, store securely out of reach of children because overdose is a serious poisoning risk.
Avoid during a flare of inflammatory bowel disease and in patients with iron overload disorders.
Separate administration from antacids and certain other medicines that impair iron absorption.

Monitoring

Check haemoglobin and iron indices periodically to confirm response and guide duration of treatment.

Counselling the patient

It may cause abdominal discomfort, wind, constipation or diarrhoea, and can darken the stools.
Take as directed and keep out of the reach of children.
Continue treatment for the recommended period to restore iron stores.

Evidence & guidelines

Oral ferric maltol provides an alternative oral iron option, with use supported by NICE in iron-deficiency anaemia where conventional oral salts are unsuitable.

Reference: NICE TA489; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways