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Add Vitamin C to Oral Iron?
Iron deficiency is the most common cause of anemia in the world and is typically treated with oral iron. However, oral iron's effectiveness can be limited by gastrointestinal adverse events and poor absorption. To enhance absorption, some clinicians advise concomitant vitamin C, but the clinical benefit of this approach is controversial. To address this, investigators conducted a systematic review and meta-analysis that included 1 cohort study (N=148) and 10 randomized controlled trials (N=1782) comparing iron supplementation with vitamin C to iron alone.
Patients who took vitamin C had statistically significant mean increases in hemoglobin (0.14 g/dL) and ferritin (3.23 µg/L), but the researchers concluded these changes were not clinically meaningful. The overall incidence of adverse events did not differ with and without the addition of vitamin C.
Comment
I do not add vitamin C to oral iron when treating iron deficiency anemia, and these findings support my clinical practice. Rather, I counsel patients about adverse events to watch for, and I advise ferrous sulfate 325 mg every other day. I repeat labs in 4 weeks, and if there are no improvements, I consider intravenous iron. I avoid oral iron in patients with ongoing heavy blood loss and severe anemia, as well as those with known malabsorption (e.g., gastric bypass, Helicobacter pylori, atrophic gastritis), inflammatory bowel disease, or concurrent inflammation.
Citation(s)
Author:
Deng J et al.
Title:
Efficacy of vitamin C with Fe supplementation in patients with iron deficiency anemia: A systematic review and meta-analysis.
Source:
Blood Vessel Thromb Hemost
2024
Dec
; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Brady L. Stein, MD, MHS