Iron + folate supplement Pregnancy: Use may be considered during the first trimester of pregnancy if necessary; therapy is usually begun about the thirteenth week of pregnancy. There are no or limited data from the use of folic acid in pregnant women, therefore a minority of them are not protected by physiological doses. Breast-feeding: it is unknown whether ferrous fumarate and folic acid or their metabolites are excreted in human milk and a risk to newborns/infants cannot be excluded. Fertility: no data available.

Ferrous fumarate with folic acid

Brand names: Galfer FA, Pregaday

Used in: Anaemia

A fixed-dose oral combination of the iron salt ferrous fumarate with folic acid, used to prevent iron and folate deficiency in pregnancy and to treat or prevent iron-deficiency anaemia where concurrent folate supplementation is wanted.

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 (Pregaday 322 mg/0.35 mg film-coated tablets)

Route: Oral — taken by mouth

Frequency: Once daily

It is usual to begin therapy about the thirteenth week of pregnancy, either as routine prophylaxis or selectively if the haemoglobin concentration is less than 11 g/100 mL (less than 75% normal). Must not be used in the treatment of anaemias other than those due to iron deficiency. The development of anaemia despite prophylaxis calls for investigation. PAEDIATRIC — there is no relevant use of Pregaday Tablets in the paediatric population; keep out of the reach and sight of children as overdose may be fatal. PRECAUTIONS — some post-gastrectomy patients show poor absorption of iron; care is needed when treating iron deficiency anaemia in patients with treated or controlled peptic ulceration; caution when giving folic acid to patients who may have folate-dependent tumours; patients with microcytic anaemia resistant to therapy with iron alone should be screened for vitamin B12 or folate deficiency.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substances or to any of the excipients; known hypersensitivity to the product
Vitamin B12 deficiency
Paroxysmal nocturnal haemoglobinuria
Haemosiderosis; haemochromatosis
Active peptic ulcer
Repeated blood transfusion
Regional enteritis and ulcerative colitis
Must not be used in the treatment of anaemias other than those due to iron deficiency

Side effects

Gastro-intestinal discomfort (frequency not known)
Anorexia, nausea, vomiting (not known)
Constipation, diarrhoea (not known)
Darkening of the stools may occur (not known)
Allergic reactions may rarely occur (very rare, <1/10,000)

Interactions

Penicillamine — iron reduces its absorption
Fluoroquinolones, levodopa, carbidopa, thyroxine and bisphosphonates — iron compounds impair their bioavailability
Tetracycline — absorption of both iron and the antibiotic may be reduced if given together; oral chloramphenicol delays plasma iron clearance, delays incorporation of iron into red blood cells and interferes with erythropoiesis; neomycin may alter iron absorption
Zinc, antacids, cholestyramine, trientine, tea, eggs, milk and coffee — reduce iron absorption or bioavailability
Co-trimoxazole, chloramphenicol, sulphasalazine, aminopterin, methotrexate, pyrimethamine or sulphonamides — may interfere with folate metabolism
Anticonvulsant drugs — serum levels may be reduced by administration of folate
Methyldopa — administration of oral iron may increase blood pressure in patients receiving methyldopa

Clinical monograph

How it works

Ferrous fumarate provides elemental iron for haemoglobin synthesis and replenishment of iron stores, while folic acid is reduced to tetrahydrofolate, a cofactor for DNA synthesis and erythropoiesis.

Prescribing in practice

The folic acid content is intended for routine antenatal supplementation and does not provide the higher dose needed for women at increased risk of neural tube defects, who require a separate high-strength folic acid product.
Oral iron commonly causes gastrointestinal upset, constipation or dark stools, which can affect adherence; taking it with or after food and adjusting frequency may improve tolerability.
Iron reduces absorption of several drugs including levothyroxine, bisphosphonates and certain antibiotics such as tetracyclines and quinolones, so doses should be separated.

Monitoring

Monitor the haemoglobin and, where relevant, iron indices to confirm an adequate response and guide duration of treatment.

Counselling the patient

Stools may turn black, which is harmless, but seek advice if you have severe abdominal pain or persistent vomiting.
Keep well out of the reach of children, as iron overdose is dangerous to young children.
Separate this from indigestion remedies, calcium and certain other tablets by a couple of hours.

Evidence & guidelines

NICE antenatal care guidance supports folic acid supplementation in pregnancy and treatment of iron-deficiency anaemia, while reserving routine universal iron supplementation for those with demonstrated need.

Reference: NICE CG62/NG3; 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 sulfate with folic acid · Iron + folate supplement

Pathways