Ferosom (Ferrous Sulphate (Iron II))
Also sold as: Ferosom, Tardyferon, Orofer, Autrin, Fefol
Pregnancy
Cat A
Lactation
Safe
Schedule
OTC
Forms
Tablet 200mg (= ~65mg elemental iron) +3
Indications
- Iron deficiency anaemia (IDA) — most common cause of anaemia in India
- Iron deficiency without anaemia (serum ferritin < 30 mcg/L)
- Prevention in high-risk groups: pregnancy, toddlers, adolescent girls (India NFHS data — 50–60% anaemia in women)
- Restless leg syndrome (associated with iron deficiency — ferritin < 75 mcg/L)
Adult Dosing
IDA treatment
65 mg elemental iron PO 2–3 times daily (= 200 mg ferrous sulphate BD–TDS)
Take on empty stomach (absorption 40% better fasting). If GI intolerance, take with small amount of food. Add Vitamin C (100–200 mg) to each dose to enhance absorption. Continue for 3 months after Hb normalises (to replenish stores).
Prophylaxis in pregnancy (India National programme)
60 mg elemental iron + 500 mcg folic acid PO daily from 1st trimester
Throughout pregnancy and 6 months postpartum (National Iron Plus Initiative)
IDA without anaemia (low ferritin)
65 mg elemental iron once daily or on alternate days
Alternate day dosing emerging evidence: similar or better absorption with fewer GI side effects
Pediatric Dosing
Drops/syrup preferred for infants. Dilute with water/juice to reduce GI irritation and tooth staining.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CKD (on dialysis) | Oral iron poorly absorbed in dialysis patients — IV iron (ferric carboxymaltose, iron sucrose) preferred for CKD/dialysis anaemia |
Hepatic Adjustment
Caution in haemochromatosis (iron overload risk); severe liver disease — ferritin is an acute phase reactant, making assessment difficult
Pregnancy & Lactation
Pregnancy: Category A
Essential in pregnancy — iron deficiency anaemia increases risk of maternal mortality, preterm birth, low birth weight. India's National Iron Plus Initiative mandates 180 tablet IFA supplementation in pregnancy.
Lactation: Safe
Iron supplements during breastfeeding are safe and recommended if iron deficient. Breast milk iron content is low — term infants need supplemental iron from 4–6 months.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Levothyroxine | Iron reduces thyroid hormone absorption — separate doses by at least 4 hours | Moderate |
| Calcium supplements, antacids | Reduce iron absorption significantly — separate by 2–4 hours | Moderate |
| Fluoroquinolones (ciprofloxacin, levofloxacin), tetracyclines | Iron chelates these antibiotics — drastically reduces antibiotic absorption. Separate by at least 2 hours. | Major |
| Proton pump inhibitors / H2 blockers | Reduce iron absorption (iron requires acid) — take iron before PPI dose if possible, or switch to ferric ammonium citrate | Moderate |
| Vitamin C (ascorbic acid) | ENHANCES iron absorption — beneficial interaction; take together | Minor |
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Side Effects
Common
- Nausea and epigastric discomfort (most common)
- Constipation
- Diarrhoea (especially liquid iron)
- Black/dark stools (expected — harmless but warn patient)
- Tooth staining (liquid iron — use straw, rinse mouth)
- Metallic taste
Serious / Discontinue If
- Iron poisoning (acute — especially in children; accidental overdose — vomiting, bloody diarrhoea, haemorrhagic gastroenteritis → shock; store locked away from children)
- Iron overload (haemochromatosis — hereditary or transfusion-dependent anaemia — check diagnosis before supplementing)
Contraindications
- Haemolytic anaemia (without iron deficiency)
- Haemochromatosis / haemosiderosis
- Non-iron-deficiency anaemia (anaemia of chronic disease — iron stores adequate/high; IV iron or EPO needed)
- Repeated blood transfusion-dependent anaemia
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Tardyferon 150mg SR | Serdia | 30 tab ₹155 |
| Orofer S (Iron sucrose — IV) | Emcure | Hospital supply |
| Fefol (Ferrous sulphate 150mg + Folic acid 0.5mg) | GlaxoSmithKline | 30 cap ₹65 |
| Autrin (Ferrous fumarate 300mg + FA + B12) | Pfizer/Upjohn | 30 cap ₹185 |
Monitoring Required
- Haemoglobin (at 4–8 weeks — should rise by > 1 g/dL/month with adequate treatment)
- Serum ferritin (at 3 months after Hb normalises — confirm stores replenished: target > 50 mcg/L)
- Reticulocyte count (early response — peaks at 7–10 days)
- Stool occult blood (rule out ongoing GI blood loss as cause)
- Serum iron and TIBC (if diagnosis uncertain)
Patient Counseling Points
- Take on empty stomach for best absorption — 1 hour before or 2 hours after meals
- If stomach upset occurs, take with a small meal; avoid taking with full meal if possible
- Take with orange juice (vitamin C) — significantly improves iron absorption
- Your stools will turn black — this is harmless and expected
- ⚠️ KEEP TABLETS LOCKED AWAY FROM CHILDREN — iron poisoning is a common and serious cause of accidental childhood death
- Antibiotics (ciprofloxacin, doxycycline): take iron 2 hours after, not with, the antibiotic
- Continue for at least 3 months after blood level normalises — to refill iron stores
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Clinically reviewed by: Dr. Suresh Menon, DM (Endocrinology), Consultant Endocrinologist
Last reviewed: 2026-04-01
References
- ICMR Iron Deficiency Anaemia Guidelines
- National Iron Plus Initiative (Ministry of Health India)
- WHO Global Anaemia Guidelines 2020
- BNF — Ferrous Sulphate
- Lancet — Iron Absorption Alternate Day Dosing (2017)