Low-Dose Iron Therapy Effective, Well Tolerated in the Elderly
Iron deficiency is a common problem among elderly individuals aged ³80 years, but people in this age-group are also very susceptible to the side effects of oral iron supplementation. Therefore, using low-dose iron therapy, if proved therapeutic, could reduce the risk of adverse effects associated with high doses.
Ephraim Rimon, MD, of Kaplan Medical Center, Rehovot, Israel, undertook a study to determine whether low-dose iron therapy can replace conventional higher-dose therapy for geriatric patients with iron-deficiency anemia (Am J Med. 2005;118:1142-1147).
Included were a total of 90 patients hospitalized with iron-deficiency anemia. They were given 15 or 50 mg of iron as liquid ferrous gluconate, or 150 mg of ferrous calcium citrate tablets, for 60 days. Another group of 30 nonameic patients were given 15 mg of iron for 60 days and acted as controls.
Hemoglobin (Hb) and serum ferritin levels rose significantly and similarly with all forms of therapy, beginning 15 minutes after the initial dose, in all but the nonanemic patients. Significant and similar increases in Hb and ferritin concentrations were seen at 2 months in all 3 groups (ie, Hb levels rose by 10.0-11.3 g/dL with 15 mg/d of iron therapy and by 10.2-11.6 g/dL with 150 mg/d). In addition, side effects, such as abdominal discomfort, nausea, vomiting, changes in bowel movements, and black stools, were significantly more frequent with the higher doses.
These findings are significant because the adverse events associated with oral iron therapy in the elderly can lower compliance and even increase morbidity, according to the investigators.
“This study demonstrates that small iron doses, one tenth of what is generally recommended, efficiently raise hemoglobin and iron stores in elderly patients without producing substantial adverse effects,” Dr Romon and colleagues wrote. “Further studies will be needed to determine the optimal dose of iron that can restore iron status as fast as possible, with minimal adverse effects and drug interactions.” —R.M.