Ferrous sulfate with ascorbic acid

How it works

Ferrous sulfate provides absorbable iron[II] for haemoglobin synthesis, while ascorbic acid acts as a reducing agent that helps keep iron in the ferrous state and may modestly enhance its intestinal absorption.

Prescribing in practice

• As with all iron products, accidental overdose is dangerous and potentially fatal in children, so secure storage out of reach is the priority safety point.
• The same absorption interactions apply as for plain ferrous sulfate, requiring separation from tea, antacids, calcium and chelated drugs such as quinolones, tetracyclines and levothyroxine.
• The added ascorbic acid offers only a modest absorption benefit and does not reduce the gastrointestinal side effects typical of oral iron.

Monitoring

Reassess haemoglobin and iron indices after several weeks, continuing treatment beyond normalisation to replenish stores.

Counselling the patient

• Black stools are normal with this iron-containing product.
• Keep away from children because of the risk of serious overdose.
• Avoid taking with tea, milk or indigestion remedies at the same time.

Evidence & guidelines

Oral ferrous salts are first-line for iron-deficiency anaemia per NICE; the contribution of added vitamin C to absorption in practice is generally regarded as small.