Iron dosage.

[Jeryatric]

A question for Sue.

I’ve been taking 3 x 200 mg ferrous sulphate tabs every other day as you advised but I’m experiencing side effects that I could do without at the moment. I don’t want to reduce the overall dosage and I want to ask if 2 tabs taken once daily would be a reasonable and safe alternative.

Thanks.

[SueJohnson]

Try switching to 75 mg to 100 mg iron bisglycinate.

[WideBody]

Jeryatric,

You should know there are two schools of thought regarding oral iron supplementation. My doctor explained it to me this way:

Let's say you take 100mg of iron bisglycinate every other day. The body will absorb approximately 75% of the iron (these numbers are hypothetical). Therefore, you will acquire 75mg of iron every two days, averaging 37.5mg of iron per day.

Alternatively, if you take 100mg of iron every day and the body absorbs 50%, you will receive 50mg of iron per day.

When I started taking iron, I used Liquid Ferrous Sulfate, 325mg twice a day (morning and night). I experienced gastric side effects, so the doctor recommended taking 650mg once a day at night. Remember, excess iron can bind with the protein in the stomach and cause black tarry stools.

You may also want to try a different formulation of iron. While iron bisglycinate is a good choice with fewer gastrointestinal issues, it is not quite as effective as liquid ferrous sulfate. I say this based on years of experience.

Lastly, have you checked your Vitamin D levels? Low iron and low Vitamin D have been correlated. The body produces hepcidin in response to iron. Hepcidin blocks iron absorption, so low iron and high hepcidin levels can be problematic. Vitamin D blocks hepcidin and improves iron absorption. I found that it made a significant difference for me. It has been more challenging to raise my Vitamin D levels than my iron levels.

[Jeryatric in reply to WideBody]

Wide body - thanks for that information. Food for thought.

I do take a Vitamin D supplement through autumn/ winter but my levels have not been checked. Have tended to assume the the winter supplement + summer sun (??) would be sufficient. Will have words with my GP if possible.

[fritzb43]

My first experience with iron therapy for RLS was in 2014. At the time my serum ferritin was 9, and my RLS was taking over my life. I was put on ferrous sulfate caplets, 325 mg twice a day on an empty stomach along with a vitamin C tablet, allegedly to improve iron absorption. I washed the doses down with orange juice.

After about a week I noticed my symptoms had improved slightly, so I continued this regimen. I fully expected to have GI side effects, especially constipation. I never did.

After about 6 months of this my symptoms stopped improving. I had another iron panel and my ferritin had risen to around 50. The Johns Hopkins University & Medical Center, a top RLS center in the US, said that 100 was the minimum for RLS, and preferably higher. They also said that iron infusion was the preferred treatment for RLS.

I traveled to Pittsburgh and saw a neurologist there, who wrote an Rx for an in fusion for me. I returned home, had the infusion and was completely symptom-free for nearly 13 months. I didn't believe it was happening, but there it was. An iron panel showed my ferritin was about 275. (The iron solution for that first infusion was low molecular weight iron dextran and took nearly 5 hours to administer.)

As my ferritin number fell (it always does) I asked my hematologist about another infusion. She agreed and I received another one, but with a different iron solution, called Injecti-fer. I received half one week and the other half the next week. Why the change in iron I don't know but I suspect it was cost or insurance specifications or both. But whatever, the results weren't nearly as positive as with the iron dextran. (There are a number of other iron solutions, but I have no experience with them.

I have had about 3 infusions in 5 years, all with Injecti-fer. My ferritin has been all over the place, once as high as 550. And with the higher number comes decreased symptoms. My hematologist told me that she believes that my ferritin should be at least 250.

I go to see the hematologist or her nurse-practioner about every six months. My ferritin is always below 250, but my insurance (I am on Medicare) won't pay for it regularly.

I should mention that I am 82 and for about 12 years I have been on ropinirol 0.5 mg and magnesium as MgO. I do pretty well, provided I avoid the usual triggers: sedating antihistimens and caffeine which is in coffee, tea, chocolate, etc.

Hope this helps.