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Best Iron Supplements UK

Best iron Supplements UK

In today’s post, I will discuss the best iron supplement in the UK. There is an endless number of iron and multivitamin supplements available in supermarkets and pharmacies.

Patients who are deficient in iron and require to take supplements can buy the best iron products from a pharmacy. Best of all, iron supplements available in UK pharmacies are cheap and effective. Patients who pay a prescription charge can buy iron tablets or capsules, which are very often available at a much lower cost.

Iron deficient anaemia common symtoms

What Is Iron Deficiency?

World Health Organisation (WHO) defines anemia as a condition characterized by ‘the number of red blood cells or the hemoglobin concentration lower than normal.’

As a result, people who are affected by anemia 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 typical symptoms of anemia, such as:

  • Tiredness/fatigue
  • Dizziness
  • Shortness of breath
  • Pale skin

Anemia can be caused by lack of iron, which is needed to produce red blood cells. This form of anemia is called iron-deficient anemia, the most common type of anemia. Patients who experience symptoms of anemia should speak to their GP. A blood test is taken to diagnose iron-deficient anemia.

Red blood cells and haemoglobin play crucial role in the transport of oxygen
Red blood cells and hemoglobin play a crucial role in the transport of oxygen

Iron Deficiency: Who Needs Iron Supplements?

Certain factors can predispose patients to have iron-deficient anemia. For example, having heavy periods or pregnancy is the most common cause of iron-deficient anemia. Another common cause of anemia is bleeding in the stomach caused, for example, by an ulcer due to treatment with Non-steroidal anti-inflammatory drugs (NSAID) such as naproxen.

Iron Preparations UK Legal Classification And Availability

Patients who are diagnosed with iron deficiency anemia 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. It is common therefore for a GP to recommend buying iron tablets from the pharmacy rather than getting it on prescription.

Most iron supplements in the UK found in dispensaries of high street pharmacies have a legal status of pharmacy-only medication (P). Some may be licensed as a food supplement. ‘P’ medicines can only be sold from a pharmacy, including online pharmacies.

‘P’ medicines are not available for self-selection by patients. In most cases, patients need to ask a member of the pharmacy team to get an iron supplement from the dispensary in the pharmacy.

Most Prescribed Iron Supplements In the UK:

Iron supplements in the UK are available in form of tablets, capsules, liquid form, and drops. The table below shows a number of items prescribed (NHS) for each iron supplement in the UK over the last 12 months.

Prescribing period: May’ 19—Apr ’20. Data source: OpenPrescribing.net (2020)
Position Iron Supplement (UK) Items Prescribed

1

Ferrous Fumarate 210 tabs

3,752,662

2 Ferrous Sulphate 200mg tabs

2,880,209

3 Ferrous Fumarate 305 caps

452,276

4

Ferrous Gluconate 300mg tabs

300,833

5

Ferrous Fumarate 322mg tabs

261,951

6

Ferrous Fumarate syrup

58,478

Treatment Recommendations With Iron Supplements (UK)

NICE guidelines (‘official’ treatment guide) on the management of iron-deficient anemia recommend the use of oral ferrous sulphate 200mg tablets in the first instance. Treatment with iron tablets should continue for three months after ‘levels’ of iron go back to normal.

Ferrous-Fumarate-210mg-Tablets

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 hemoglobin’ levels’ return to normal, patients should continue to take iron supplements for three months (ibid).

Iron Supplements UK Product 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 by 1.8, which is a standard markup for pharmacy products sold from the dispensary. The basic price for each preparation was taken from the AHH price list. AHH is one of the leading drug wholesalers in the UK.

1. Ferrous Fumarate 210mg Tablets:

Ferrous Fumarate 210mg tablets - the most popular iron supplement UK

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.

Recommended doses of Ferrous Fumarate 210mg tablets:

The dosage 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 anemia 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, 2020):

For prevention of iron-deficient anemia:

  • For Child 12–17 years: 210mg 1–2 times a day (one tablet is taken 1-2 times a day)
  • For Adult 210mg 1–2 times a day (one tablet is taken 1-2 times a day)

For the treatment of iron-deficient anemia:

  • For Child 12–17 years: 210 mg 2–3 times a day (one tablet is taken 2-3 times a day)
  • For Adult: 210 mg 2–3 times a day (one tablet is 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 does 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 a popular iron supplement UK
Ferrous Sulphate 200mg tablets are the second most popular iron supplement in the UK based on prescribing information. 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 also 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 for the treatment of iron-deficient anemia 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). The 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. Similar to the previously discussed iron supplement, the dose depends on the age of the patient and indicated use, for example, prevention vs treatment of iron-deficient anemia requires different dosing.

BNF recommended doses for Ferrous Sulphate (NICE, 2020):

For prevention of iron-deficient anemia:

  • For Child 6–17 years: 200 mg daily (one tablet daily)

For Adult:

  • 200 mg daily (one tablet daily)

For the treatment of iron-deficient anemia:

  • For Child 6–17 years: 200 mg 2–3 times a day (one tablet is taken 2-3 times a day)
  • For Adult: 200 mg 2–3 times a day (one tablet is 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. Ferrous Fumarate 305mg Capsules:

FerroEss 305 capsules - ferrous fumarate iron supplement UK

Ferrous fumarate supplement comes in the form of capsules. Each capsule contains 305mg of ferrous fumarate. Two common brands stocked in UK pharmacies are:

  • Galfer capsules
  • FerroEss capsules

How much iron do you get from ferrous fumarate 305 capsules?

There is almost no difference between 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 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, 2020):

Galfer capsules

Ferrous-Fumarate-140mg5ml-Syrup

For prevention of iron-deficient anemia:

  • For Child 12–17 years: 305 mg daily (one capsule daily)
  • For Adult: 305 mg daily (one capsule daily)

For the treatment of iron-deficient anemia:

  • For Child 12–17 years: 305 mg twice daily (one capsule twice a day)
  • For Adult: 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 cost around £4.19
  • FerroEss capsules: a pack of 100 capsules costs approximately £3.55

 4. Ferrous Gluconate 300mg Tablets:

Iron supplements UK - 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 for 35mg of iron.

Ferrous Gluconate 300mg tablets provide for the smallest amount of iron from the iron supplement discussed.

The recommended dose for Ferrous Gluconate 300mg tablets (NICE, 2020)

For prevention of iron-deficient anemia:

  • For Child 6–11 years: 300–900 mg daily (one to three tablets daily)
  • For Child 12–17 years: 600 mg daily (two tablets daily)
  • For Adult: 600 mg daily (two tablets daily)

For the treatment of iron-deficient anemia:

  • For Child 6–11 years: 300–900 mg daily (one to three tablets daily).
  • For Child 12–17 years: 1.2–1.8 g daily in divided doses (4-6 tablets daily in divided doses)
  • For Adult: 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.

5. 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.

6. 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 contains 140mg of ferrous fumarate which is equivalent to 45mg of elemental iron.

Dosage recommendations for Ferrous Fumarate Syrup (Galfer syrup)

For prevention of iron-deficient anemia:

  • For Child 1 month–11 years: 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 Child 12–17 years: 10 mL once daily.
  • For Adult: 10 mL once daily.

For the treatment of iron-deficient anemia:

  • For Child 1 month–11 years: a 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 of 20 mL per day.
  • For Child 12–17 years: 10 mL 1–2 times a day.
  • For Adult: 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 syrup).

7. 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 anemia and megaloblastic anemia (reduced number of red blood cells) second and third trimester of pregnancy.

8. Ferrous Sulphate Drops (Ironorm Drop):

Drops

I decided to include the Ironorm drop in this summary of iron supplements (UK). Although rarely prescribed (due to high cost) Ironorm drops can be purchased (ordered) from 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 costly iron supplement.

Iron preparations: common side effects

Regardless of which iron preparation is taken, common and very common side effects associated with the use of iron supplements include:

  • Diarrhea
  • Constipation
  • Gastrointestinal discomfort
  • Nausea

Other less common side effects may include:

  • Decreased appetite
  • Discoloration of feces
  • Vomiting

Iron Supplements Available Off The Shelf In The UK

There are many iron supplements 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, I can deduct 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 or prevention of iron-deficient anemia. Popular iron supplements on Amazon.co.uk
Get iron supplements on Amazon.co.uk

Should I Take Iron 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 that supports enhanced iron absorption when taken with Vitamin C/ascorbic acid (Abbaspour et al, 2014). Additionally, the World Health Organisation (WHO) lists Vitamin C (ascorbic acid) as a significant factor enhancing iron absorption (WHO, 1989).

Which Iron Supplement In The UK Is The Best?

Quick FAQ

Can you take iron and B12 together?
There were no interactions found between iron and vitamin B12

The above question is very vague. Few factors may affect the decision on the selection of iron supplements.

Individual patients may find a specific formulation of iron tablets/capsules more acceptable, for example, with fewer side effects such as stomach irritation (constipation/diarrhea). Certain patients may need to take a specific form of iron supplements, for example, lactose-free formulation (iron capsules) or vegetarian formulation, for instance, 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 excellent value for money and provide for adequate amounts of iron.

Both Ferrous Fumarate 305mg capsules and Ferrous Fumarate 322mg Tablets offer much higher amounts of iron per 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 The UK: Conclusion

Quick FAQ

Can I eat a banana with an iron supplement?
You can eat bananas with iron supplements as they do not affect iron absorption. The amount of iron absorbed between cooked and raw bananas is the same.

Patients have a good choice of iron supplements in the UK. Most iron supplements, which are used for treatment or prevention of iron-deficient anemia, are licensed as pharmacy-only products. Iron tables/capsules available from the pharmacy provide for a much higher amount of iron than over-the-counter supplements available online and in supermarkets.

Quick FAQ

Can you check your iron levels at home?
You can check iron levels at home unless you purchase a third-part test kit to perform the test.
Can you buy iron tablets over the counter uk?
Iron supplements can be purchased over the counter in the UK. The best iron supplements can be purchased from a pharmacy, which holds iron supplements as part of dispensary stock.
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 Sciences19(2), 164–174. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999603/ Accessed on 08/07/2020

Baynes, R.D. and Bothwell, T.H., 1990. Iron deficiency. Annual review of nutrition10(1), pp.133-148. Available at: https://www.annualreviews.org/doi/pdf/10.1146/annurev.nu.10.070190.001025 Accessed on 08/07/2020

Zimmermann, M.B. and Hurrell, R.F., 2007. Nutritional iron deficiency. The lancet370(9586), pp.511-520. Available at: https://www.sciencedirect.com/science/article/pii/S0140673607612355 Accessed on 08/07/2020