Iron replacement options: oral and intravenous formulations

SUMMARY Lack of iron is one of the main causes of anemia in the general population and iron deficiency anemia (IDA) is associated with increased morbidity and mortality. Treatment of iron deficiency with oral iron supplements is a simple and inexpensive, but oral iron is a less‐than‐ideal treatment because of gastrointestinal side‐effects and long treatment times needed to resolve anemia and replenish body iron stores. Nonadherence is common, and even in compliant patients poor intestinal absorption fails to compensate for the iron need in the presence of ongoing blood losses or inflammatory conditions. Modern intravenous (IV) iron formulations have emerged as safe and effective alternatives to oral iron for the treatment of IDA. Given their demonstrated effectiveness and favorable safety profile in a broad spectrum of diseases associated with IDA, the current paradigm that oral iron is first‐line therapy should be reconsidered. In the past few years, three new IV iron compounds (ferric carboxymaltose, ferumoxytol and iron isomaltoside 1000) have been released for clinical use in patients with IDA. These new preparations with more favorable administration regimens have the potential to improve the convenience and cost‐effectiveness of IV iron therapy.