Why intravenous iron is better than oral iron

July 10, 2024

Medicine has a problem. We offer subpar treatments because it’s just what we’ve always done, ‘til enough people demand better which can only happen when we know better.

Iron infusions are better.

Let’s unpack the reasons why iron infusions are not offered first line.

1. Way back, we used to use iron that killed 4 in every 100,000 infusions. These deaths were from anaphylaxis.
2. Nowadays, we don’t use those iron formulations. Newer products are much safer where the anaphylaxis rate is 1 in 400,000.
3. Many hospitals haven’t recovered from the trauma of old school iron formulations and their side effects. The rest of us have moved on, especially given the challenges with oral iron supplementation. ref
4. Oral iron is considered less invasive so is offered as first line therapy. Meanwhile, it’s wrought with side effects and is less effective and costlier.
5. Iron infusions can cost roughly between $300 and $500, depending on where you live and how much you need. Over time this is cheaper than oral iron. One infusion is usually enough to replete a person’s iron stores. But who is paying for that one infusion? A publicly funded healthcare system doesn’t have the capacity nor the will to replenish up to 50% of women who are iron deficient.
6. Good thing infusion clinics are popping up all over to fill this iron gap and to pay respect to iron deficiency, which is under-recognized at best.

What’s wrong with just sticking to oral iron?

We’re kidding ourselves if we think recommending oral iron is the best strategy.

1. 1. People don’t take iron long enough to correct their deficiency and often give up.
  2. This might also be the reason why doctors don’t test and retest for iron deficiency. It’s extremely common and people are really bad at taking their iron. Can you blame them?
  3. The side effects of oral iron are bloating, stomach cramps, nausea, constipation and vomiting. More than 10% of people get these.
  4. If somehow you can stomach oral pills, we have to trust that your body can even absorb the iron. Assuming you can result in 3-6 months of taking something that may not actually be getting into your body and then you’re right back to square one.
  5. If somehow you do manage to tolerate the iron and absorb it, you’ve got to overcome the problem that got you there in the first place. Oral iron has to make up for your existing deficiency and then some. 6 months is the typical time it takes to replenish your iron stores IF you’ve corrected the root cause of the deficiency.
  6. Six months later you’ve spent $300 out-of-pocket and you’re nowhere better than you were when you started this iron journey.

How much better is IV iron than oral iron?

1. 1. Hemoglobin significantly rises in 5x more people given IV iron vs oral iron. One infusion can save a person years of effort trying to get iron up orally.
  2. IV iron is 15x more effective at raising ferritin levels. ref
  3. Side effects with IV iron are less common and more short-lived than oral iron.
  4. Women bear the brunt of iron deficiency. Oral iron just doesn’t cut it to keep up with the iron losses sustained in the average woman’s menstruating life and then especially in pregnancy. Iron infusions are feminist forward medicine.

Iron hot tip: If you’re taking oral iron for 2 weeks, your hemoglobin should rise by 10 mmol/L , otherwise taking it further won’t do anything. You should switch to IV iron.

Just because your doctor is unaware of these facts, doesn’t make you less deserving of getting effective treatment.

Intravenous iron is more effective, better tolerated, and improves quality of life more than oral iron. Once we get over our prejudices and misconceptions about it, we’ll all realize that it’s just better medicine.

IV Iron

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IV iron safety Side effects