Nowadays many patients are recommended by their GP to go to the pharmacy and purchase some iron supplements, usually after a blood test was taken. There is an endless number of iron and multivitamin supplements available in supermarkets and pharmacies. Patients who are deficient in iron can buy the same iron supplements from a pharmacy, which are often prescribed by GP. Iron supplements available in UK pharmacies are cheap and effective, most of the time available at a lower cost when compared to a prescription charge.
What is iron deficiency?
World Health Organisation (WHO) defines anaemia as a condition characterised by ‘the number of red blood cells or the haemoglobin concentration lower than normal.’ As a result, people who are affected by anaemia have a reduced number of red blood cells, and consequently a lower capacity to carry oxygen around the body where it is needed. This reduced capacity causes common symptoms of anaemia such as:
- Tiredness/fatigue
- Dizziness
- Shortness of breath
- Pale skin
Anaemia can be caused by a lack of iron, which is needed to produce red blood cells. This form of anaemia is called iron deficient anaemia, the most common type of anaemia.
Patients who experience symptoms of anaemia should speak to their GP. A blood test is taken to diagnose iron-deficient anaemia.
Iron deficiency: who needs iron supplements
Certain factors can predispose patients to have iron deficiency anaemia. For example, having heavy periods or pregnancy are the most common causes of iron deficient anaemia. Another common cause of anaemia is bleeding in the stomach caused for example by an ulcer due to treatment with drugs such as naproxen and other Non-steroidal anti-inflammatory drugs (NSAID).
Iron supplements UK legal classification and availability
Patients who are diagnosed with iron deficiency anaemia need to take iron supplements. A GP can prescribe iron supplements, however all iron preparations available ‘on prescription’ can also be purchased from a pharmacy.
Iron supplements in the UK have a legal status of pharmacy-only medication (P) or simply there are licensed as a food supplement. Pharmacy-only medicines can be sold from a pharmacy, including online pharmacies. ‘P’ medicines are not available for self-selection by patients, and in most cases, patients need to ask a member of the pharmacy team to get the iron supplement from the dispensary in the pharmacy.
Most prescribed iron supplements in the UK
Iron supplements in the UK are available in forms of tablets, capsules and liquid form. The table below shows the main classes of iron prescribed in NHS (prescription numbers).
| Position | Iron supplement (UK) | Items prescribed |
| 1 | Ferrous fumarate | 4,701,514 |
| 2 | Ferrous sulfate | 3,111,376 |
| 3 | Ferrous gluconate 300mg tabs | 276,731 |
Prescribing period: Oct ’21—Sep ’22. Data source: OpenPrescribing.net (2022)
Which iron supplement is the most popular?
|
Position |
Iron supplement (UK) | Items prescribed |
Elemental iron |
| 1 | Ferrous fumarate 210 tabs | 3,805,245 | 68.25mg |
| 2 | Ferrous sulfate 200mg tabs | 3,041,583 | 65mg |
| 3 | Ferrous fumarate 305 caps | 381,576 | 99mg |
| 4 | Ferrous gluconate 300mg tabs | 363,193 | 35mg |
| 5 | Ferrous fumarate 322mg tabs | 363,193 | 104.65mg |
| 6 | Ferrous fumarate syrup | 65,181 | 45mg |
Prescribing period: Oct ’21—Sep ’22. Data source: OpenPrescribing.net (2022)
Treatment recommendations and goal with iron supplements (UK)
NICE guideline (‘official’ treatment guide) on the management of iron deficient anaemia recommend the use of oral ferrous sulphate 200mg tablets. Treatment with iron tablets should continue for three months after the level of iron go back to normal.
Ferrous fumarate or ferrous gluconate iron tablets are recommended as second-line treatment, usually when ferrous sulphate tablets are not tolerated (NICE, 2018).
According to the treatment guide, patients who started taking an iron supplement should have a blood test (full blood count) after 2-4 weeks of commencing the treatment. Patients who respond to treatment should have blood tests every 2-4 months. Once haemoglobin levels return to normal, patients should continue to take iron supplements for 3 months (ibid).
Iron supplements UK availability
Below is the review of iron supplements UK products listed according to popularity reflected by prescribing statistics in the last 12 months. Prices for each product were calculated by taking the basic cost of the product and multiplying it by 1.8 which is a standard markup of pharmacy products sold from the dispensary.
1. Ferrous Fumarate 210mg tablets
Ferrous fumarate 210mg is the most prescribed type of iron supplement in the UK. Ferrous fumarate is available as ‘generic’ products or as a branded supplement. For example, a popular brand of ferrous fumarate 210mg tablets is FerroEss. Pharmacies may stock none, one, or more brands of the same iron supplement. Iron supplements can be ordered at the patient’s request for the same or next-day delivery. Ferrous fumarate 210mg tablets brands:
- Ferrodose F 210mg tablets
- Ferroess 210mg tablets
Recommended doses of Ferrous Fumarate 210mg tablets
The dose for Ferrous Fumarate 210mg tablets depends on the age, type of formulation used (tablets or liquid) and the indication of the treatment, for example, a different dose is taken when iron-deficient anaemia is treated and prevented. Follow the instructions from your GP on the dosing. British National Formulary (BNF) recommends the following doses for Ferrous Fumarate 210mg tablets (BNF, 2022):
For prevention of iron deficient anaemia:
- For children 12–17 years: 210mg 1–2 times a day (one tablet taken 1-2 times a day)
- For adults 210mg 1–2 times a day (one tablet taken 1-2 times a day)
For the treatment of iron deficient anaemia
- For children 12–17 years: 210 mg 2–3 times a day (one tablet taken 2-3 times a day)
- For adults: 210 mg 2–3 times a day (one tablet taken 2-3 times a day)
How much iron do you get from ferrous fumarate 210mg tablets?
One 210mg ferrous fumarate tablet is equivalent to approximately 68.25mg of elemental iron.
How much do ferrous fumarate 210mg tablets cost?
A pack of 210mg ferrous fumarate tablets (84) costs approximately £4.45 when purchased in a high street pharmacy.
2. Ferrous Sulphate 200mg tablets
Ferrous sulphate 200mg tablets are the second most popular iron supplement in the UK based on prescribing information (OpenPrescribing.net, 2022). Ferrous sulphate 200mg tablets are usually available as a generic product, there is no specific brand stock by high street pharmacies. Ferrous sulphate 200mg tablets are a pharmacy-only product.
Ferrous sulphate is available as a combination product with vitamin C called Ferrograd C. Ferrograd C is not commonly prescribed in the UK.
Each Ferrograd C prolonged-release tablet contains 325mg of ferrous sulphate and 500mg of vitamin C. Ferrograd C is used in the treatment of iron deficient anaemia and vitamin C deficiency (both present at the same time).
Vitamin C is added in the formulation of Ferrograd C to improve the absorption of iron into the body (how much iron gets into the body). Controlled-release formulation of Ferrograd C tablets is designed to slowly release iron in the body to reduce the chance of stomach irritation, which is a common side effect with many iron supplements.
Ferrograd C can be purchased online. Alternatively, a request can be made to order Ferrograd C in the pharmacy for the same or next-day in-pharmacy delivery.
Recommended doses for Ferrous Sulphate 200mg tablets
When prescribed, follow the directions of your GP for dose instructions. The dose depends on the age of the patient and indicated use, for example, prevention vs treatment of iron deficient anaemia requires different dosing.
BNF recommended doses for Ferrous Sulphate (NICE, 2020):
For prevention of iron deficient anaemia:
- For children 6–17 years: 200 mg daily (one tablet daily)
For Adult:
- 200 mg daily (one tablet daily)
For treatment of iron deficient anaemia:
- For children 6–17 years: 200 mg 2–3 times a day (one tablet taken 2-3 times a day)
- For adults: 200 mg 2–3 times a day (one tablet taken 2-3 times a day)
How much iron do you get from Ferrous sulphate 200mg tablet?
When taken ferrous sulphate 200mg gives a similar amount of iron per tablet as compared to ferrous fumarate 210mg tablets. Each tablet of ferrous sulphate 200mg is equivalent to 65mg of ferrous iron.
How much does a pack of ferrous sulphate 200mg cost?
A pack of 28 tablets of ferrous sulphate 200mg costs around £2.60.
3. Ferrograd (ferrous sulphate) 325mg modified-release tablets
Ferrograd is a brand of tablets containing 325mg of iron, which is equivalent to 105mg of elemental iron per tablet. In contrast to the popularity of ferrous sulphate 200mg tablets, Ferrograd tablets are much less popular in terms of prescribing (not commonly prescribed). Not many patients know this formulation of high-strength ferrous sulphate tablets.
Ferrograd is formulated as a modified-release tablet. Modified-release tablets are designed to release a drug, or in this case iron slowly. The idea behind a modified-release formulation is to slow down the absorption of iron. Slower absorption time may reduce the occurrence of gastrointestinal side effects, like an ‘upset’ stomach.
4. Ferrous fumarate 305mg capsules
Ferrous fumarate supplement comes in form of capsules. Each capsule contains 305mg of ferrous fumarate. Two common brands stock in UK pharmacies are:
- Galfer capsules
- FerroEss capsules
- Ferrodose F 305mg capsule
How much iron do you get from ferrous fumarate 305 capsules?
There is almost no difference between the Galfer and FerroEss brands of ferrous fumarate in terms of how much iron each capsule provide:
- For FerroEss 305mg, each capsule provides 99mg of elemental iron.
- For Galfer 305mg, each capsule provides 100mg of elemental iron.
Ferrous fumarate is available in combination with folic acid, branded as Galfer FA capsules.
Each Galfer FA capsule contains 305mg of ferrous fumarate and 350 micrograms of folic acid. Galfer FA capsules are used to treat iron and folic acid deficiency in pregnancy. Galfer FA capsules are a pharmacy-only iron supplement. Not all pharmacies may stock this product, however as with other iron supplements, patients may request to order Galfer FA capsules on an individual basis.
The recommended dose for Ferrous Fumarate 305mg capsules (NICE, 2022)
Galfer capsules
For prevention of iron deficient anaemia:
- For children 12–17 years: 305 mg daily (one capsule daily)
- For adults: 305 mg daily (one capsule daily)
For treatment of iron deficient anaemia:
- For children 12–17 years: 305 mg twice daily (one capsule twice a day)
- For adults: 305 mg twice daily (one capsule twice a day)
How much do ferrous fumarate 305mg capsules cost?
When bought in high street pharmacies one would expect to pay the following:
- Galfer capsules: a pack of 100 capsules costs around £4.19
- FerroEss capsules: a pack of 100 capsules costs around £3.55
5. Ferrous Gluconate 300mg Tablets
Ferrous Gluconate 300mg tablets are available as a generic product with no specific brands sold in the UK.
How much iron do you get from Ferrous Gluconate 300mg tablets?
Each Ferrous Gluconate 300mg tablet provides 35mg of iron. Ferrous Gluconate 300mg tablets provide the smallest amount of iron out of all iron supplements discussed.
The recommended dose for Ferrous Gluconate 300mg tablets (NICE, 2020)
For prevention of iron deficient anaemia:
- For Children 6–11 years: 300–900 mg daily (one to three tablets daily)
- For Children 12–17 years: 600 mg daily (two tables daily)
- For Adults: 600 mg daily (two tablets daily)
For treatment of iron deficient anaemia:
- For children 6–11 years: 300–900 mg daily (one to three tablets daily).
- For Children 12–17 years: 1.2–1.8 g daily in divided doses (4-6 tablets daily in divided doses)
- For Adults: 1.2–1.8 g daily in divided doses (4-6 tablets daily in divided doses)
How much do Ferrous Gluconate 300mg tablets cost?
A box of 28 tablets of Ferrous Gluconate 300mg tablets costs around £2 when bought in a high street pharmacy.
7. Ferrous Fumarate 322mg Tablets
Ferrous Fumarate 322mg tablets are the least popular iron supplement in the UK based on prescribing information.
How much iron do you get from ferrous fumarate 322mg tablets?
Each tablet is equivalent to approximately 104.65mg of iron (FerroEss 322mg tablets). Based on this information ferrous fumarate provides the highest amount of iron per tablet.
How much does Ferrous Fumarate 322mg costs?
Patients may be expected to pay around £1.50 for a pack of 28 Ferrous Fumarate tablets (brand FerroEss).
The recommended dose for Ferrous Fumarate 322mg tablets
At the point of writing of this post, BNF does not specify dosage recommendations for Ferrous Fumarate 322 tablets. Check the dosage information on the product’s box.
8. Ferrous fumarate, folic acid (Pregaday 322mg / 0.35mg)
Ferrous fumarate is available in combination with folic acid as Pregaday tablets. Pregaday is rarely prescribed in the UK, however, it is a pharmacy-only product, therefore patients can purchase it in the UK.
Pregaday tablets are indicated for the prevention of iron deficient anaemia and megaloblastic anaemia (reduced number of red blood cells) second and third trimesters of pregnancy.
Liquid iron supplements
A limited number of liquid iron supplements exist. Liquid iron supplements are pharmacy-only medicines.
9. Ferrous Fumarate 140mg/5ml Syrup
Ferrous Fumarate 140mg/5ml Syrup is a pharmacy-only product available from high street pharmacies or online pharmacies.
How much iron do you get from ferrous fumarate 140mg/5mL syrup?
Each 5mL of contains 140mg of ferrous fumarate which is equivalent to 45mg of elemental iron.
Liquid ferrous fumarate comes as a branded supplement, for example, Ferroess sugar-free solution (contains ferrous fumarate 140mg per 5ml of solution) or Aadfer ferrous fumarate 140mg/5ml oral solution and Galfer syrup (ferrous fumarate 140mg/5ml).
Dosage recommendations for Ferrous Fumarate Syrup (Galfer syrup)
For prevention of iron deficient anaemia:
- For Child 1 month–11 years: The dose is based on the weight of the child. BNF recommended dose is 0.25 mL/kilogram twice daily. The total daily dose may optionally be given in three divided doses
- For Children 12–17 years: 10 mL once daily.
- For Adults: 10 mL once daily.
For treatment of iron deficient anaemia:
- For Child 1 month–11 years: dose is based on the weight of the child.
- 0.25 mL/kilogram twice daily. The total daily dose can be given in 3 divided doses. The maximum recommended dose is 20 mL per day.
- For children 12–17 years: 10 mL 1–2 times a day.
- For Adults: 10 mL 1–2 times a day.
How much does Ferrous Fumarate 140mg/5ml syrup cost?
When purchased in a high street pharmacy one would expect to pay approximately £8.26 for 200mL of Ferrous Fumarate 140mg/5ml Syrup and around £9.60 for a branded version of Ferrous Fumarate 140mg/5ml (Galfer
10. Ferrous sulphate drops (Ironorm drop)
I decided to include Ironorm drop in this summary of iron supplements (UK). Although rarely prescribed (due to high cost) Ironorm drops can be purchased (ordered) from a pharmacy. Each mL of Ironorm drops contains 125mg of ferrous sulphate equivalent to 25mg to iron per mL. A pack of 15ml of Iron drops costs around £40, making it a very expensive iron supplement.
11. Spatone liquid and sachets
Spatone liquid is a well-advertised form of iron. Spatone is made of naturally rich in iron water. Spatone liquid is low in iron providing 5mg of iron per sachet, which is much less than all other iron supplements available directly from the pharmacy.
12. Floradix Iron Supplement Tablets
Floradix is another common brand of iron supplements available online and from high street pharmacies. As with previously reviewed Spatone, Floradix provides a little amount of iron, just 7mg per recommended dose. Floradix can be used for the prevention of latent iron deficiency.
Iron supplements – common side effects
Regardless of which iron preparation is taken, common and very common side effects associated with the use of iron supplements include:
- Diarrhoea
- Constipation
- Gastrointestinal discomfort
- Nausea
Other less common side effects may include:
- Decreased appetite
- Discolouration of faeces
- Vomiting
Iron supplements available off the shelf in the UK
There are many iron supplement products in the UK. Some of the most popular iron supplements available on Amazon.co.uk are listed below. After a quick review of nutritional information for popular supplements, it can be deduced that all supplements provide a significantly much lower amount of iron per tablet/capsule compared to any of the pharmacy-only preparations discussed in this post. The low availability of iron makes those supplements unsuitable for the treatment of prophylaxis of iron-deficient anaemia. Popular iron supplements on Amazon.co.uk
Should I take iron supplements with orange juice?
Many online articles and posts suggest taking iron supplements with orange juice enhances the absorption of iron. Occasionally, when iron preparation is prescribed, a GP or other qualified prescriber instructs to take a dose of iron with orange juice. There is some research which supports enhanced iron absorption when taken with Vitamin C/ascorbic acid (Abbaspour et al, 2014). Additionally, World Health Organisation (WHO) lists Vitamin C (ascorbic acid) as a major factor in enhancing iron absorption (WHO, 1989).
Which iron supplement in the UK is the best?
The above question is very vague. A few factors may affect the decision on the selection of an iron supplement.
Individual patients may find a specific formulation of iron tablets/capsules more acceptable, for example with fewer side effects such as stomach irritation (constipation/diarrhoea). Certain patients may need to take a specific form of iron supplements, for example, lactose-free formulation (iron capsules) or vegetarian formulation, for example, FerroEss ferrous fumarate 210mg tablets.
There is not much difference in terms of price between different iron supplements available in the UK. Both Ferrous Fumarate 210mg tablets and Ferrous Sulphate 200mg tablets offer good value for money and provide adequate amounts of iron.
Both Ferrous Fumarate 305mg capsules and Ferrous Fumarate 322mg tablets offer much higher amounts of iron per capsule/tablet, however, this may come at the expense of side effects.
A patient who experiences side effects with one formulation of iron supplement should try switching to another form to see if the same side effects are experienced.
Best iron supplements UK: Conclusion
Patients have a good choice of iron supplements in the UK. Most iron supplements, which are used for the treatment or prevention of iron deficiency anaemia are licensed as pharmacy-only products. Iron tablets/capsules available from the pharmacy provide a much higher amount of iron than over the counter supplements available online and in supermarkets.
References:
Abbaspour, N., Hurrell, R., & Kelishadi, R. (2014). Review on iron and its importance for human health. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 19(2), 164–174. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999603/ Accessed on 03/12/2022
BNF (2022). Ferrous fumarate: Indications and dose. Available at: https://bnf.nice.org.uk/drug/ferrous-fumarate.html Accessed on 03/12/2022
NICE (2022). Management of iron deficiency anaemia. From age 12 years onwards. Available at: https://cks.nice.org.uk/anaemia-iron-deficiency#!scenario Accessed on 03/12/2022
NICE (2022). BNF. Ferrous Gluconate: Indications and dose. Available at: https://bnf.nice.org.uk/drug/ferrous-gluconate.html Accessed on 03/12/2022
NICE (2022). BNF. Ferrous sulphate: indications and dose. Available at: https://bnf.nice.org.uk/drug/ferrous-sulfate.html Accessed on 03/12/2022
NICE (2022). BNF. Ferrous fumarate: Indications and dose. Available at: https://bnf.nice.org.uk/drug/ferrous-fumarate.html Accessed on 03/12/2022
OpenPrescribing.net (2022), EBM DataLab, University of Oxford, 2017. Available at https://openprescribing.net/ Accessed on 03/12/2022
WHO (1989). Preventing and controlling iron deficiency anaemia through primary health care. Available at: https://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/9241542497.pdf Accessed on 03/12/2022
