Ferrous gluconate

How it works

It supplies elemental iron in the absorbable ferrous form for duodenal uptake and incorporation into haemoglobin, supporting red cell production.

Prescribing in practice

• Iron salts are a major cause of accidental poisoning deaths in children, so emphasise secure storage out of their reach.
• Separate from tea, antacids, calcium and chelating drugs such as tetracyclines, quinolones, levothyroxine and bisphosphonates to preserve absorption of both agents.
• It contains less elemental iron per tablet than some other salts, so the regimen and tablet count differ even though gastrointestinal effects are similar.

Monitoring

Recheck haemoglobin and iron indices after several weeks to confirm response, continuing therapy to rebuild iron stores once levels normalise.

Counselling the patient

• Black stools are expected and not a cause for concern.
• Store safely away from children because overdose can be serious.
• Take separately from tea, milk and indigestion remedies.

Evidence & guidelines

NICE recommends oral ferrous salts as first-line therapy for iron-deficiency anaemia, reserving intravenous iron for intolerance or malabsorption.