First-lineFerrograd / generic

Ferrous Sulfate

Oral iron replacement

First-line iron for pregnancy anaemia — cheap, effective, GI-heavy.

Oral

First-line for

Iron-deficiency anaemia in pregnancy (Hb <110 T1/T3 or <105 T2)
Postpartum anaemia (Hb <100)

Mechanism

Delivers ferrous (Fe²⁺) iron for duodenal DMT-1 absorption → haemoglobin synthesis.

"Iron loves acid, hates food"

Take with vitamin C, empty stomach if tolerated
Alternate-day dosing ↑ absorption, ↓ side effects
Reticulocytosis in 1 week, Hb rise 1 g/dL per 3 weeks

Dosing

Standard: 200 mg (65 mg elemental) OD or alternate-day
Prophylaxis (high-risk): 200 mg OD

Contraindications

AbsoluteHaemochromatosis, iron overload states
CautionActive peptic ulcer, IBD flare

Side effects

Nausea, epigastric pain
Constipation or diarrhoea
Black stools (harmless, expected)
Metallic taste

Fetal & maternal notes

• Standard of care — no teratogenic risk
• Prevents low birthweight in deficiency states

Key interactions

Levothyroxine
Caution
↓ absorption — separate 4 h
Tetracyclines / fluoroquinolones
Caution
Chelation — separate 2–4 h
Antacids / PPIs
Caution
↓ absorption

Clinical pearls

💡 Alternate-day dosing (Cochrane 2023) matches daily for Hb rise with fewer GI effects
💡 Recheck Hb at 2–3 weeks; escalate to IV if intolerant or inadequate

Content last reviewed: REPLACE_ME (e.g. 2026-07)

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