What is the best way to treat true iron deficiency anemia in a vegetarian without inducing constipation or epigastric discomfort? The patient, a 24-year-old woman, has been diagnosed with rheumatoid arthritis and underwent gastric bypass surgery more than a year ago. I usually recommend that my patients take iron 325 mg with vitamin C 500 mg on an empty stomach, but this is difficult for most people to digest.
—Cecelia Madrid, MD, Los Angeles
The iron dose can be given at bedtime or reduced if necessary. Liquid preparations may be employed. Constipation should be treated symptomatically and is not dose-related. If these interventions fail, parenteral iron should be considered. For a review of this issue, see Am J Hematol. 2008;83:403-409.
—Michael J. Flamm, MD, assistant professor of clinical medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York City (127-12)