Iron Supplement (Oral) Pregnancy: Use of any drug during the first trimester should be avoided if possible, so administration of iron in the first trimester requires definite evidence of iron deficiency; prophylaxis of iron deficiency during the remainder of pregnancy is justified (SPC §4.6).

Ferrous Sulphate

Brand names: Feospan, Ironorm

Ferrous sulphate is an oral iron salt used to treat iron-deficiency anaemia and, where indicated, to prevent iron deficiency.

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: One tablet (ferrous sulfate 200 mg coated tablet)

Route: Oral — tablets should not be sucked, chewed or kept in the mouth, but swallowed whole with water; take before meals or during meals depending on gastrointestinal tolerance

Frequency: Iron-deficiency anaemia, therapeutic: one tablet 2–3 times daily. Prophylaxis: one tablet daily.

SOURCE: UK SPC for Ferrous Sulfate 200 mg Coated Tablets (eMC §4.2). ELDERLY: as for adults. CHILDREN: 'This presentation is not recommended' — no paediatric dose is given in this SPC; for a child use a paediatric-appropriate iron preparation and verify against a children's formulary. DURATION: treatment should generally not exceed 3 months after correction of the anaemia (§4.4). Co-existing deficiency of vitamin B12 or folic acid should be ruled out, since combined deficiency produces a microcytic blood film (§4.4). Oral and parenteral iron preparations should not be used concomitantly (§4.3). Patients post-gastrectomy have poor absorption of iron; caution with a history of peptic ulcer, inflammatory bowel disease (including regional enteritis and ulcerative colitis), intestinal strictures or diverticulae (§4.4). Long-term treatment carries a definite risk of dental caries; the tablets contain sugar — administer with care in diabetes; not for patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency (§4.4). Label warning: contains iron, keep out of the sight and reach of children, as overdose may be fatal. NOTE the strength convention — this SPC expresses the dose as tablets of ferrous sulfate 200 mg and does not state the elemental iron content; confirm the elemental iron per tablet for the product being prescribed.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; 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
Haemosiderosis and haemochromatosis
Active peptic ulcer
Repeated blood transfusion
Haemolytic anaemia
Oral and parenteral iron preparations should not be used concomitantly

Side effects

Gastrointestinal: abdominal pain, nausea and vomiting (usually dose related)
Constipation, diarrhoea and dark stools
Contact irritation causing erosion or ulceration, particularly if a tablet becomes lodged in the upper gastrointestinal tract
Mouth ulceration (post-marketing, frequency not known) in the context of incorrect administration when tablets are chewed, sucked or kept in the mouth; elderly patients and those with deglutition disorders may also be at risk of oesophageal lesions or bronchial necrosis if the tablet takes a false route
Allergic reactions have been reported

Interactions

Calcium, magnesium (including antacids and mineral supplements), bicarbonates, carbonates, oxalates or phosphates may impair iron absorption — separate administration by at least 2 hours
Tetracyclines — iron and tetracyclines reduce each other's absorption; separate by 2 to 3 hours. Quinolones — iron may reduce absorption; separate by at least 2 hours. Chloramphenicol delays plasma clearance of iron and its incorporation into red cells by interfering with erythropoiesis
Bisphosphonates — absorption reduced when taken concurrently with iron; separate by at least 2 hours
Cholestyramine impairs iron absorption; concomitant oral iron and dimercaprol should be avoided
Oral iron may reduce absorption of dopaminergics such as co-careldopa, entacapone and levodopa, and may antagonise the antihypertensive effect of methyldopa
Absorption of iron is impaired by tea, eggs or milk

Clinical monograph

How it works

It supplies elemental iron for absorption in the duodenum, replenishing iron stores and supporting haemoglobin synthesis and erythropoiesis.

Prescribing in practice

Iron overdose is dangerous, particularly to young children — keep it well out of their reach.
Gastrointestinal upset (nausea, abdominal discomfort, constipation and black stools) is common; absorption is better on an empty stomach but it may be taken with food if not tolerated.
Separate it from levothyroxine, some antibiotics (such as tetracyclines and quinolones) and calcium, as iron reduces their absorption.

Monitoring

Recheck haemoglobin and other red-cell indices to confirm a response, and continue treatment for a period after the haemoglobin normalises to rebuild iron stores.

Counselling the patient

Keep this medicine out of the sight and reach of children — an overdose of iron is very harmful to them.
Your stools may turn black, which is harmless; taking it with a little food can help if it upsets your stomach.
Do not take it at the same time as indigestion remedies, calcium, your thyroid tablet or certain antibiotics — leave a gap between them.

Evidence & guidelines

Standard first-line oral iron replacement in NICE guidance on iron-deficiency anaemia.

Reference: NICE NG24; 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

Drugs

Ferrous Sulphate · Iron Supplement (Oral)

Pathways