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General medicine
Iron absorption from oral iron supplements given on consecutive versus alternate days in iron-depleted women
  1. Thomas M Goodsall1,2,
  2. Tim Walker1,3
  1. 1 School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
  2. 2 Department of Gastroenterology, John Hunter Hospital, Newcastle, New South Wales, Australia
  3. 3 Department of Medicine, Calvary Mater Newcastle, Waratah, New South Wales, Australia
  1. Correspondence to Dr Thomas M Goodsall, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; tomgoodsall{at}

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Alternate day dosing of oral iron as FeSO4 for 28 days leads to a higher fractional absorption of iron than daily dosing for 14 days, which is in part due to differences in hepcidin production. Careful consideration of the methods used and meaningful clinical endpoints should be considered before this strategy is incorporated into guidelines.

Summary of study

This Swiss study1 used FeSO4-labelled isotopes to accurately determine total and fractional iron absorption and serum hepcidin in alternate or consecutive daily dosing strategies with an equal total oral iron dose. Secondary endpoints were markers of gastrointestinal inflammation and safety/tolerability.

Healthy women with iron deficiency (ferritin <25 µg/L) without severe anaemia, obesity or inflammation were randomly assigned by a non-blinded study author who selected the best haemoglobin and serum ferritin match from nine permutations. Group assignment was not masked to participants or investigators. The intervention group received 60 mg labelled elemental iron as FeSO4 in the morning on consecutive days for 28 days while the comparator group received the same dose over 14 alternate days. Both groups were required …

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  • Contributors TW developed the idea and presented the original journal club discussion. TMG authored the manuscript and TW reviewed it.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement Powerpoint slides were presented at The Calvary Mater Hospital, Newcastle, Australia.

  • Presented at Presented at the Calvary Mater Newcastle Hospital Medical Journal Club, 5 February 2018.