Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 13 , ISSUE 3 ( May-June, 2021 ) > List of Articles


Ferrous Ascorbate: Current Clinical Place of Therapy in the Management of Iron Deficiency Anemia

Narendra Malhotra, Alka Kriplani, Bhaskar Pal, Vidya Bhat, Onkar Swami

Keywords : Efficacy, Ferrous ascorbate, India, Iron deficiency anemia, Supplemental iron, Tolerability

Citation Information : Malhotra N, Kriplani A, Pal B, Bhat V, Swami O. Ferrous Ascorbate: Current Clinical Place of Therapy in the Management of Iron Deficiency Anemia. J South Asian Feder Obs Gynae 2021; 13 (3):103-109.

DOI: 10.5005/jp-journals-10006-1896

License: CC BY-NC 4.0

Published Online: 09-09-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Iron deficiency anemia (IDA) is a major public health problem in India. Iron deficiency can easily be corrected with iron supplementations. Oral iron preparations are used for mild to moderate anemia and available for the supplementation of iron including ferrous sulfate, fumarate, gluconate, glutamate, succinate, and lactate, and the reference product of ferrous ascorbate. In clinical practice, ferrous ascorbate is the most widely prescribed oral iron supplement as it has a good efficacy and is well tolerated in both adults and children. Ferrous ascorbate has a better bioavailability, as high as 67%, and utilization of iron when compared to other iron preparations, including sucrosomial iron. Ferrous ascorbate lacks food interactions and can be administered without regard to food. Ferrous ascorbate is a stable chelate that does not dissociate in the gastrointestinal tract. Higher absorption of iron from ferrous ascorbate can be explained by the ascorbate component that prevents oxidation of the iron to a ferric state. A mean rise in hemoglobin (Hb) greater than 5.0 g/dL in 60 days and greater than 2.0 g/dL within 45 days is reported with once-daily therapy of ferrous ascorbate. Ferrous ascorbate is also efficacious for the prophylaxis of anemia in patients who undergo surgical procedures. Ferrous ascorbate is more effective than ferrous sulfate or carbonyl iron for the treatment of IDA. Thus, ferrous ascorbate has an important place in the clinical management of IDA in real-life scenarios.

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  1. WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and mineral nutrition information system. Geneva, World Health Organization; 2011 (WHO/NMH/NHD/MNM/11.1). Available from: [Accessed August 20, 2020].
  2. Tandon R, Jain A, Malhotra P. Management of iron deficiency anemia in pregnancy in india. Indian J Hematol Blood Transfus. 2018;34(2):204–215. DOI: 10.1007/s12288-018-0949-6.
  3. WHO. Anemia. Available from: [Accessed on August 20, 2020].
  4. Guideline: daily iron supplementation in adult women and adolescent girls. Geneva: World Health Organization; 2016. Available from: [Accessed on August 20, 2020].
  5. Rai RK, Fawzi WW, Barik A, et al. The burden of iron-deficiency anaemia among women in India: how have iron and folic acid interventions fared? WHO South-East Asia J Public Health 2018;7(1):18–23. DOI: 10.4103/2224-3151.228423.
  6. Ministry of Health and Family Welfare (2015–2016) Govt. of India, National Family Health Survey (NFHS-4), State Fact Sheet. Mumbai: International Institute for Population Sciences. Available from:
  7. Ministry of Health and Family Welfare (2019–2020) Govt. of India, National Family Health Survey (NFHS-5), State Fact Sheet.
  8. Gulec S, Anderson GJ, Collins JF. Mechanistic and regulatory aspects of intestinal iron absorption. Am J Physiol Gastrointest Liver Physiol 2014;307(4):G397–G409. DOI: 10.1152/ajpgi.00348.2013.
  9. Raja KB, Jafri SE, Dickson D, et al. Involvement of iron (ferric) reduction in the iron absorption mechanism of a trivalent iron-protein complex (iron protein succinylate). Pharmacol Toxicol 2000;87(3):108–115. DOI: 10.1111/j.0901-9928.2000.870302.x.
  10. Nagpal J, Choudhury P. Iron formulations in pediatric practice. Indian Pediatr 2004;41(8):807–815.
  11. Panchal PJ, Desai MK, Shah SP, et al. Evaluation of efficacy, safety and cost of oral and parenteral iron preparations in patients with iron deficiency anemia. J App Pharm Sci 2015;5(03):066–072. DOI: 10.7324/JAPS.2015.50311.
  12. Santiago P. Ferrous versus ferric oral iron formulations for the treatment of iron deficiency: a clinical overview. Sci World J 2012;2012:846824. DOI: 10.1100/2012/846824.
  13. Berber I, Diri H, Erkurt MA, et al. Evaluation of ferric and ferrous iron therapies in women with iron deficiency anaemia. Adv Hematol 2014;2014:297057. DOI: 10.1155/2014/297057.
  14. Agarwal MB. Ferrous ascorbate: the novel, highly bioavailable iron. BMJ South Asia Ed 2007;23(1):17–19.
  15. HERS Study Group. The HERS trial report: a prospective, open-label study on efficacy and tolerability of ferrous ascorbate. Int J Gynecol Obstet 2005;8(4):23–30.
  16. Kaltwasser JP, Hansen C, Oebike Y, et al. Assessment of iron availability using stable 54Fe. Eur J Clin Invest 1991;12(4):436–442. DOI: 10.1111/j.1365-2362.1991.tb01392.x.
  17. Hallberg L, Hulthen L. Prediction of dietary iron absorption: an algorithm for calculating absorption and bioavailability of dietary iron. Am J Clin Nutr 2000;71(5):1147–1160. DOI: 10.1093/ajcn/71.5.1147.
  18. Kaushansky K, Kipps TJ. Haematopoietic agents: growth factors, minerals, and vitamins. In: Brunton LL, Chabner BA, Knollmann BC, editors. Goodman and Gilman's the pharmacological basis of therapeutics. 12th ed. USA: McGraw Hill; 2011. p. 1076–1085.
  19. Hazra M. A study on the aspects of pharmacoepidemiology and pharmacohaemovigilance of ferrous ascorbate, ferrous fumarate, ferrous sulphate and ferric ammonium citrate, among the rural anaemic women, in the Indian spectrum. Int J Basic Clin Pharmacol 2019;8(12):2751–2758. DOI: 10.18203/2319-2003.ijbcp20195291.
  20. Plug CM, Dekker D, Bult A. Complex stability of ferrous ascorbate in aqueous solution and its significance for iron absorption. Pharm Weekbl Sci 1984;6(6):245–248. DOI: 10.1007/BF01954553.
  21. Narsinga Rao BS, Prasad S, Apte Sv. Iron absorption in Indians studied by whole body counting: a comparison of iron compounds used in salt fortification. Br J Haematol 1972;22(3):281–286. DOI: 10.1111/j.1365-2141.1972.tb05674.x.
  22. Gonzalez H, Mendoza C, Viteri FE. Absorption of unlabelled reduced iron of small particle size from a commercial source. A method to predict absorption of unlabeled iron compounds in humans. Arch Latinoam Nutri 2001;51(3):217–224.
  23. Valenzuela C, Olivares M, Brito A, et al. Is a 40% absorption of iron from a ferrous ascorbate reference dose appropriate to assess iron absorption independent of iron status? Biol Trace Elem Res 2013;155(3):322–326. DOI: 10.1007/s12011-013-9797-2.
  24. Walczyk T, Kastenmayer P, Storcksdieck Genannt Bonsmann S, et al. Ferrous ammonium phosphate (FeNH4PO4) as a new food fortificant: iron bioavailability compared to ferrous sulfate and ferric pyrophosphate from an instant milk drink. Eur J Nutr 2013;52(4):1361–1368. DOI: 10.1007/s00394-012-0445-y.
  25. Kaltwasser JP, Werner E, Niechzial M. Bioavailability and therapeutic efficacy of bivalent and trivalent iron preparations. Arzneimittel-Forschung 1987;37(1):122–129.
  26. Walter T, Pizarro F, Abrams S, et al. Bioavailability of elemental iron powder in white wheat bread. Eur J Clin Nutr 2004;58(3):555–558. DOI: 10.1038/sj.ejcn.1601844.
  27. Bovell-Benjamin AC, Viteri FE, Allen LH. Iron absorption from ferrous bisglycinate and ferric trisglycinate in whole maize is regulated by iron status. Am J Clin Nutr 2000;71(6):1563–1569. DOI: 10.1093/ajcn/71.6.1563.
  28. Devasthali SD, Gordeuk VR, Brittenham G, et al. Bioavailability of carbonyl iron: a randomized, double-blind study. Eur J Haematol 1991;46(5):272–278. DOI: 10.1111/j.1600-0609.1991.tb01538.x.
  29. Rao BS, Prasad S, Apte SV. Iron absorption in Indians studied by whole body counting: a comparison of iron compounds used in salt fortification. Br J Haematol 1972;22(3):281–286. DOI: 10.1111/j.1365-2141.1972.tb05674.x.
  30. Derman DP, Bothwell TH, Torrance JD, et al. Iron absorption from ferritin and ferric hydroxide. Scand J Haematol 1982;29(1):18–24. DOI: 10.1111/j.1600-0609.1982.tb00556.x.
  31. Fidler MC, Davidsson L, Zeder C, et al. Iron absorption from ferrous fumarate in adult women is influenced by ascorbic acid but not by Na2EDTA. Br J Nutr 2003;90(6):1081–1085. DOI: 10.1079/bjn2003995.
  32. Yeung CK, Glahn RP, Miller DD. Inhibition of iron uptake from iron salts and chelates by divalent metal cations in intestinal epithelial cells. J Agric Food Chem 2005;53(1):132–136. DOI: 10.1021/jf049255c.
  33. Agarwal MB, Rathi SA. An open-label, randomized, comparative clinical study to assess the efficacy and tolerability of ferrous ascorbate versus carbonyl iron in the treatment of iron deficiency anaemia. Int J Gynaecol Obstet India 2005;8:23–30.
  34. Guinea JM, Lafuente P, Mendizábal A, et al. [Results of preoperative autotransfusion with ferrous ascorbate prophylaxis in orthopedic surgery patients] Sangre (Barc) 1996;41(1):25–28.
  35. Patil P, Geeverhese P, Khaire P, et al. Comparison of therapeutic efficacy of ferrous ascorbate and iron polymaltose complex in iron deficiency anemia in children: a randomized controlled trial. Indian J Pediatr 2019;86(12):1112–1117. DOI: 10.1007/s12098-019-03068-2.
  36. Yasa B, Agaoglu L, Unuvar V. Efficacy, tolerability and acceptability of iron hydroxyl polymaltose complex versus ferrous sulfate: a randomized trial in pediatric patients with iron deficiency anemia. Int J Pediatr 2011;2011:524520. DOI: 10.1155/2011/524520.
  37. Rafael BJ, Cicero RE, Dibildox MM, et al. Iron poymaltose complex vs. iron sulfate in the treatment of iron deficiency in infants. Rev Mex Pediatr 2000;67(2):63–67.
  38. Bopche AV, Dwivedi R, Mishra R, et al. Ferrous sulfate versus iron polymaltose complex for treatment of iron deficiency anemia in children. Indian Pediatr 2009;46(10):883–885.
  39. Ganguly S, dewan B, Philipose N, et al. Comparison between ferrous ascorbate and colloidal iron in the treatment of iron deficiency anemia in children from Kolkata, India. Br J Med Medical Res 2012;2(2):195–205. DOI: 10.9734/BJMMR/2012/900.
  40. Yewale VN, Dewan B. Treatment of iron deficiency anemia in children: a comparative study of ferrous ascorbate and colloidal iron. Indian J Pediatr 2013;80(5):385–390. DOI: 10.1007/s12098-012-0906-6.
  41. Singhal SR, Kadian V, Singh S, et al. Comparison of various oral iron salts in the treatment of iron deficiency anemia in pregnancy. Indian J Obstet Gynecol Res 2015;2(3):155–158. DOI: 10.5958/2394-2754.2015.00005.3.
  42. Gómez-Ramírez S, Brilli E, Tarantino G, et al. Sucrosomial® Iron: a new generation iron for improving oral supplementation. Pharmaceuticals (Basel) 2018;11(4):97. DOI: 10.3390/ph11040097. PMID: 30287781; PMCID: PMC6316120.
  43. Galloway R, McGuire J. Determinants of compliance with iron supplementation: supplies, side effects, or psychology? Soc Sci Med 1994;39(3):381–390. DOI: 10.1016/0277-9536(94)90135-x.
  44. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci 2019;1450(1):15–31. DOI: 10.1111/nyas.14092. PMID: 31008520; PMCID: PMC6697587.
  45. Kaur M. Dietary intake, prevalence, and the effect of anemia on various morphophysiological variables of postmenopausal women of North India. J Midlife Health 2018;9(2):72–78. DOI: 10.4103/jmh.JMH_2018.
  46. Kapil U, Kapil R, Gupta A. National iron plus initiative: current status & future strategy. Indian J Med Res 2019;150(3):239–247. DOI: 10.4103/ijmr.IJMR_1782_18.
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