Ferrous sulfate with folic acid

How it works

Ferrous sulfate supplies absorbable iron for haemoglobin synthesis, while folic acid provides the folate required for DNA synthesis and normal red cell maturation, together supporting erythropoiesis and neural tube development.

Prescribing in practice

• The folic acid dose in these prophylactic combinations is intended for prevention and is insufficient for established megaloblastic anaemia or for high-risk neural tube defect prophylaxis, which require dedicated higher-dose folic acid.
• Folic acid can mask the haematological signs of vitamin B12 deficiency while allowing neurological damage to progress, so exclude B12 deficiency before relying on folate alone.
• Standard iron absorption interactions apply, so separate from tea, antacids, calcium and chelated drugs such as tetracyclines and levothyroxine.

Monitoring

Monitor haemoglobin during pregnancy and review the formulation if treatment of an established anaemia rather than prophylaxis is required.

Counselling the patient

• This product is for preventing iron and folate deficiency, usually in pregnancy.
• Stools may turn black, which is harmless.
• Keep out of reach of children because of iron overdose risk.

Evidence & guidelines

NICE advises folic acid supplementation before and in early pregnancy to reduce neural tube defect risk, with combination iron-folate products used for routine antenatal prophylaxis.