A typical Western diet contains about 10-15mg of elemental iron per day, of which about 10% is absorbed from the stomach, duodenum and upper jejunum. Heme iron, i.e. that which is bound to heme and is contained mainly in red and secondarily in white meat, is absorbed at a rate of 10-20%, while the non-heme iron, contained in plant foods, at a rate of 1-2%. Under normal conditions, iron homeostasis moves between an intake of 1mg/day and a loss of 1mg/day, while the aforementioned pregnancy and lactation cause a shift in the required amount between 2 and 5mg/day, which cannot usually be covered by the diet and therefore supplementation is required.
Common forms of iron are:
-ferrous compounds (ferrous sulfate, ferrous gluconate, ferrous thioglycinate)
-ferrous iron compounds (ferric polymaltose, ferrous sucrose, ferrous protein succinate)
The question we are often asked to answer is, what is the best form in terms of effectiveness but, at the same time, with the fewest possible side effects. In recent days, the question that dominates among patients and pharmacists mainly is: "How is it possible that the insurance price, i.e. the amount paid by the insurance fund, of oral protein succinate iron (the most frequently prescribed iron, especially in pregnancy, with a monthly treatment cost of around 44 euros for 80mg of elemental Fe3+ per day) correspond to only 1/5 of its value?”
Let's start things from the beginning. Despite frequent assurances to the contrary, the data to date show that trivalent iron preparations do not have better bioavailability than divalent ones. In fact, all forms of iron must be reduced to the divalent form in order to cross the intestinal mucosa, resulting in divalent iron preparations being absorbed up to 3 times faster (Pharmacist's Letter, 2008). A recent paper comparing oral formulations of divalent and trivalent iron in the treatment of iron deficiency concluded that the classic and inexpensive slow-release ferrous sulfate solution offered the golden ratio between bioavailability, efficacy, and tolerability (Santiago, 2012).
The most frequent adverse effect from the use of iron supplements is gastrointestinal disturbance and is believed to be due to the direct irritating effect of iron ions on the epithelial cells of the mucous membrane, and is "quantitative", i.e. its effect increases as the iron content of the dose increases, if the release is too fast, etc. This is also emphasized in the most recent version of the British National Prescription, where the daily dose of elemental iron for the treatment of iron deficiency is determined in the range of 100mg-200mg and it is emphasized that the primary role in the occurrence of adverse effects is played by the amount of iron and not the form (BNF, 2014).
Despite the differences on the different forms of iron which are a clinical pharmacy discussion, people who experience side effects with iron but they need the supplementation can have a huge benefit by supplementing with sucrosomial iron!
Sucrosomial® iron (SI) is an innovative oral iron formulation in which ferric pyrophosphate is protected by a phospholipid bilayer plus a sucrester matrix (sucrosome), which is absorbed through para-cellular and trans-cellular routes (M cells). This confers SI unique structural, physicochemical and pharmacokinetic characteristics, together with high iron bioavailability and excellent gastrointestinal tolerance. The analysis of available evidence supports oral SI iron as a valid option for ID treatment, which is more efficacious and better tolerated than oral iron salts. SI has also demonstrated similar effectiveness, with lower risks, in patients usually receiving IV iron (e.g., chronic kidney disease, cancer, bariatric surgery). Thus, oral SI emerges as a most valuable first option for treating ID, even more for subjects with intolerance to or inefficacy of iron salts. Moreover, SI should be also considered as an alternative to IV iron for initial and/or maintenance treatment in different patient populations.