DAILY VS. ALTERNATE-DAY ORAL IRON THERAPY IN THE MANAGEMENT OF IRON DEFICIENCY ANEMIA

Abstract

Background:

Iron deficiency anemia (IDA) remains a major global and national health burden, particularly in low- and middle-income countries such as Pakistan. Conventional daily oral iron therapy is limited by gastrointestinal intolerance and hepcidin-mediated reductions in absorption. This study compares daily versus alternate-day oral iron supplementation over eight weeks in adults with IDA, evaluating hemoglobin response, ferritin recovery, tolerability, and adherence. The findings aim to inform evidence-based iron replacement strategies in high-prevalence settings.

Materials and Methods:

This comparative cross-sectional study enrolled 120 adults with iron deficiency anemia, randomly assigned to receive either daily (n = 60) or alternate-day (n = 60) oral iron for eight weeks. Hemoglobin and serum ferritin were measured at baseline and follow-up, while adherence and gastrointestinal adverse events were monitored. Data were analyzed to compare hematologic response, iron store replenishment, tolerability, and compliance between the two regimens. All data was entered and calculated using SPSS version 23.0. The statistical significance set at p ≤ 0.05.

Results:

Among 120 adults with iron deficiency anemia, baseline demographic and hematologic characteristics were comparable between the daily and alternate-day iron groups. After eight weeks, alternate-day therapy resulted in a significantly greater hemoglobin increase (+2.1 vs. +1.3 g/dL, p < 0.001) and higher ferritin levels (median 40 vs. 32 ng/mL, p = 0.012), with more patients achieving an Hb rise ≥2 g/dL (58.3% vs. 33.3%, p = 0.007). Gastrointestinal adverse events were less frequent with alternate-day dosing (13.3% vs. 30.0%, p = 0.028), while adherence remained high and comparable between groups.

Conclusion:

Alternate-day oral iron therapy in adults with iron deficiency anemia produced superior hemoglobin and ferritin responses and fewer gastrointestinal adverse events compared with daily dosing. Its simplicity, safety, and effectiveness make it a practical strategy for routine clinical use, though further studies are warranted to optimize dosing across diverse populations.