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Ferrous sulfate oral

Updated 2 Feb 2023 | Oral iron


Oral formulations containing ferrous sulfate.

Drugs List

  • ferrous sulfate 125mg/ml oral drops sugar-free
  • ferrous sulfate 200mg tablets
  • ferrous sulfate 325mg modified release tablet
  • IRONORM 125mg/ml drops
  • Therapeutic Indications


    Prophylaxis of iron deficiency anaemia
    Treatment of iron deficiency anaemia



    Oral drops
    2.4ml to 4.8ml daily (60mg to 120mg of elemental iron)
    200mg once a day.
    150mg modified release capsules
    150mg to 300mg once a day.
    325mg modified release tablets
    325mg once a day.

    Oral drops
    4ml once or twice daily (100mg to 200mg of elemental iron)
    200mg two to three times daily.
    150mg modified release capsules
    150mg to 300mg once a day.
    325mg modified release tablets
    325mg once a day.


    Not all available brands are licensed for children.

    Oral drops
    Children aged 6 to 18 years: 2.4ml daily (60mg of elemental iron)
    Children under 6 years: 0.5ml to 1.2ml daily (12.5mg to 30mg of elemental iron)

    Alternative sources suggest:
    Children aged 12 to 18 years: 2.4ml to 4.8ml daily.
    Children aged 6 to 12 years: 2.4ml daily.
    Infants aged 1 month with established mixed feeding to 6 years: 0.5ml to 1.2ml daily (12.5mg to 30mg of elemental iron)
    Infants aged over 1 month until mixed feeding is established: 0.2ml daily (5mg of elemental iron). Higher doses of up to 0.08ml per kg body weight daily (2mg per kg body weight of elemental iron per day) might be needed to cover the needs of growing, exclusively breastfed infants.

    Children aged 6 to 18 years: 200mg once a day.

    150mg modified release capsules
    Children aged over 1 year: 150mg once a day.

    325mg modified release capsules
    Children aged 12 to 18 years: 325mg once a day.

    Oral drops
    Children aged 1 month to 18 years: 0.12ml to 0.24ml (3mg to 6mg of elemental iron) per kg body weight, up to a maximum of 8ml (200mg of elemental iron) given daily in two or three divided doses.

    Children aged 12 to 18 years
    200mg two to threee times a day

    Children aged 6 to 12 years
    Children weighing over 22kg: 200mg once a day
    Children weighing over 44kg: 200mg twice a day
    Children weighing over 66kg: 200mg three times a day

    150mg modified release capsules
    Children aged over 1 year
    150mg once a day

    325mg modified release capsules
    Children aged 12 to 18 years: 325mg once a day


    Neonates under 1 month
    Gastrointestinal obstruction
    Hereditary fructose intolerance
    Peptic ulcer
    Repeated blood transfusions

    Precautions and Warnings

    Diabetes mellitus
    First trimester of pregnancy
    Gastrointestinal diverticula
    Gastrointestinal stenosis
    Glucose-galactose malabsorption syndrome
    Haemolytic anaemia
    History of peptic ulcer
    Inflammatory bowel disease
    Lactose intolerance

    Consider alternative formulations to tablet if risk of aspiration
    Exclude non-iron deficiency anaemia
    Not all available brands are licensed for all age groups
    Oral solution contains sodium metabisulfite: May cause allergic reaction
    Presentations with sorbitol unsuitable in hereditary fructose intolerance
    Some formulations contain glucose
    Some formulations contain lactose
    Some formulations contain sucrose
    Tablet formulation not suitable for children under 6 years
    Check B12 and folate levels if no response in microcytic anaemias
    Oral iron may mask signs of occult blood loss
    Continue treatment for 3 months once haemoglobin levels are normalised
    Advise patient to seek medical attention if suspected aspiration of tablet
    Advise patient to take after food to reduce gastro-intestinal disturbances

    Pregnancy and Lactation


    Use ferrous sulfate with caution during the first trimester of pregnancy.

    Plasma volume expansion during pregnancy results in a physiological decrease in haemoglobin concentrations ([Hb]) which typically fall in the second trimester and then rise to approach pre-pregnancy levels at term. Mean Cell Volume (MCV) is unaffected during pregnancy and offers a better indicator of iron-deficiency anaemia. Iron treatment of low [Hb] in the absence of other signs of deficiency is seldom required.

    Adverse outcomes in pregnancy such as low birth-weight, pre-term birth and perinatal death in states of mild to moderate anaemia have been found in studies, although the causality and also preventability by iron supplements remain unclear. Additionally, iron supplements have been shown to result in an increase in low birth-weight and pre-term delivery.

    Iron should be given if there is evidence of deficiency in the first trimester and later based on [Hb] below 10g/dL or MCV below 82fL.

    Iron supplements should be considered in women with increased risk of iron deficiency anaemia such as those who have had recent menorrhagia, repeated closely spaced pregnancies or miscarriages and those with poor dietary intake.

    Some manufacturers note that the administration of iron during the first trimester requires definite evidence of iron deficiency but that prophylaxis of iron deficiency during the remainder of pregnancy is justified.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Ferrous sulfate is considered safe for use in breastfeeding.

    No adverse effects have been reported in breastfeeding.

    The use of relatively high doses in breastfeeding mothers is probably not contraindicated, due to the fact that iron transports very poorly into the milk compartment.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Allergic reaction
    Black faeces
    Bronchial stenosis
    Epigastric pain
    Faecal impaction
    Gastric erosions
    Gastric ulceration
    Gastro-intestinal discomfort
    Hypersensitivity reactions
    Increase in dental caries
    Staining of teeth


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: May 2016

    Reference Sources

    Summary of Product Characteristics: Feospan Spansule Capsules. Intrapharm Laboratories Limited. Revised April 2013.

    Summary of Product Characteristics: Ferrograd Tablets. Teofarma S.r.l. Revised March 2008.

    Summary of Product Characteristics: Ironorm Drops. Wallace Manufacturing Chemists Ltd. Revised April 2015.

    Summary of Product Characteristics: Ferrous Sulphate 200mg tablets. Accord UK Ltd. Revised June 2018.

    Summary of Product Characteristics: Ferrous Sulfate tablets 200mg. Sandoz Limited. Revised December 2018.

    Summary of Product Characteristics: Ferrous Sulfate 200mg coated tablets. Wockhardt UK Ltd. Revised September 2017.

    Therapeutics in Pregnancy and Lactation (2000) Lee, A., Inch, S. and Finnigan, D. Radcliffe Medical Press, Abingdon.

    NICE Evidence Services Available at: Last accessed: 19 July 2019

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