Iron: Contraindications and Precautions

Iron poisoning can occur due to accidental ingestion of excess iron supplements. As such, iron supplements should be kept in childproof bottles and out of the reach of children.

Caution should be exercised when supplementing iron to infants or children with apparently normal growth when the iron status of the child is unknown. A double-blind placebo-controlled trial showed that while iron therapy produced a significant improvement of mean monthly weight gain and linear growth in iron-deficient children, it significantly decreased the weight gain and linear growth of iron-replete children. This study confirms the results of earlier.

• Iron supplements should not be used in haemochromatosis, haemosiderosis, or iron-loading anaemias (thalassaemia, sideroblastic anaemia).

• Daily oral iron supplementation providing 50 mg elemental iron for 8 weeks did not result in increased oxidative damage in the plasma of college-aged women, although this does not rule out oxidative damage in tissues as demonstrated in animal studies. While the use of iron supplements may potentially result in oxidative damage, this is not likely to be significant in lower doses used to correct deficiency states; however, risk should always be assessed against benefit before prescribing iron supplements.

• Elevated levels of serum ferritin have been implicated in the pathogenesis of vascular (and other) diseases, although this remains controversial.

• Haem-rich flesh foods may need to be limited in people with insulin resistance due to a possible link with increased cancer risk mediated by iron excess in such populations.

• Iron supplementation should be prescribed on the basis of biological criteria, not on the assumption of anaemia alone, as unnecessary iron supplementation can result in adverse effects. The lowest safe and effective dose and frequency of dose should be recommended.

Pregnancy Use

Oral iron preparations are considered safe in pregnancy; however, unnecessary iron supplementation can result in uncontrolled lipid peroxidation, predictive of adverse effects for mother and foetus. Supplementation should be prescribed on the basis of biological criteria, not on the assumption of anaemia alone.