Iron replacement. Taking it every other day absorbs better and causes fewer side effects than taking it daily.
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Ferrous fumarate is an oral iron salt. It replaces the iron the body needs to make haemoglobin, the protein in red blood cells that carries oxygen.
Ferrous sulphate and ferrous gluconate do the same job with slightly different iron content and tolerability. If one disagrees with you, another often does not — which is worth knowing before giving up on iron altogether.
Standard doses are available over the counter, though the reason for the deficiency is what actually needs a doctor.
Take it once daily or every other day, not three times a day. This runs against older advice and is well supported: a dose of iron raises hepcidin, a hormone that then blocks absorption for the next day or so. Spacing doses out means you absorb more total iron, not less, with substantially fewer side effects.
Take it with vitamin C — a glass of orange juice or a tablet — which meaningfully improves absorption.
Avoid tea and coffee within an hour either side. Tannins bind iron and reduce absorption considerably.
Continue for at least three months after your haemoglobin normalises. Stopping as soon as the blood count recovers leaves the stores empty and the deficiency simply returns — this is the most common reason iron treatment fails.
Common and dose-related: constipation, nausea, stomach discomfort, and a metallic taste.
Black stools are expected and harmless. Iron darkens the stool, and this alarms people who were not warned. Note, though, that it can also mask genuine bleeding — tell a doctor if stools are black and tarry or you feel unwell.
Liquid preparations can stain teeth; use a straw and rinse afterwards.
Most side effects are dose-related, which is precisely why alternate-day dosing is preferable — similar absorption, far better tolerated.
Keep iron well out of reach of children. Iron overdose is one of the leading causes of poisoning deaths in young children, and a bottle of tablets looks like sweets.
The most important caution is not about the drug at all. Iron deficiency in a man, or in a woman past the menopause, should not simply be supplemented. In those groups it is a red flag for gastrointestinal blood loss and needs the cause investigated — often with bowel investigation — rather than topped up quietly.
Iron blocks the absorption of several drugs and is blocked by others. Separate by at least four hours from: levothyroxine, some antibiotics including tetracyclines and quinolones, bisphosphonates, and antacids or PPIs.
Monitoring: full blood count and ferritin at around three months. Ferritin is the number that tells you whether the stores have refilled, and checking haemoglobin alone is not enough.
One caveat that catches people out: ferritin rises with any inflammation, so a normal ferritin alongside raised inflammatory markers can conceal a real deficiency. Both should be checked together.
Yes — but iron tablets are cheap and available over the counter, so the value of a consultation is not the prescription. It is working out why the iron is low.
That is the part that is routinely skipped, and it is the part that matters. In a menstruating woman it is usually heavy periods, and treating those may matter more than the supplement. In a man or a post-menopausal woman it warrants investigation for bowel bleeding, and coeliac disease should be excluded in anyone.
What that involves: ferritin, full blood count and inflammatory markers together; coeliac screening; a proper menstrual and gastrointestinal history; and gastroenterology referral where the picture warrants it.
We can also arrange referral for intravenous iron where tablets are not tolerated or replacement is needed quickly.
This page is information, not an offer to supply.
Iron tablets are cheap and available over the counter. A month's supply costs a few pounds, and own-brand ferrous fumarate, ferrous sulfate and ferrous gluconate all work.
Do not pay a consultation fee to obtain iron. The value of a consultation here is not the prescription — it is working out why the iron is low, and that is a genuinely different question.
Look for the elemental iron content, not the tablet weight. Ferrous fumarate 210mg contains about 68mg of elemental iron; ferrous sulfate 200mg contains about 65mg.
Products advertising "20mg iron" are a third of a treatment dose, which is why they take forever to work.
Do not stop when your haemoglobin comes back normal. That is the halfway point, not the finish.
Continue for around three months after the blood count normalises, because the aim is to refill the iron stores — measured by ferritin — not merely to correct the anaemia. Stopping at a normal haemoglobin is the commonest reason anaemia comes straight back.
Before giving up, try alternate-day dosing. Taking iron every other day is now understood to produce as much or more absorption than daily dosing, because a dose raises a hormone called hepcidin that blocks absorption of the next one for about a day.
Half the doses, similar or better absorption, considerably less constipation and nausea. It is well supported and still not widely offered.
Taking it with food also helps, at some cost to absorption — a worthwhile trade if the alternative is stopping altogether.
Coeliac disease, inflammatory bowel disease and previous gastric surgery all limit absorption, and an iron infusion may be needed instead.
Why is the iron low? In a man of any age, or a woman past the menopause, unexplained iron deficiency needs investigating for a source of bleeding in the gut. That is not optional caution — it is how bowel cancer is found early.
Unabsorbed iron does that, and it is harmless and expected.
Black, tarry, foul-smelling stools are different and can indicate bleeding — if you are unsure, get it checked rather than assuming it is the tablets.
Alternate days is often better. A dose blocks absorption of the next one for about 24 hours, so every-other-day dosing absorbs as well or better with far fewer side effects.
It is well evidenced and under-used.
Vitamin C — a glass of orange juice, or taking it with a vitamin C tablet.
Tea, coffee, milk, calcium supplements and indigestion remedies all block it, so leave a couple of hours either side. Tea with your iron tablet is a very common and easily fixed mistake.
Energy often improves within two to four weeks, before the blood count fully normalises.
Full replenishment of stores takes three to six months.
Because a normal haemoglobin does not mean full iron stores. Continue about three months longer to refill ferritin.
Stopping early is why anaemia so often returns.
Yes, and iron overdose is dangerous, particularly in children. Keep it well out of reach — iron tablets look like sweets and are a genuine cause of serious childhood poisoning.
Do not take iron long term without a confirmed deficiency.
That is the important question. In menstruating women, heavy periods are the usual cause and worth treating in their own right.
In men, and in women after the menopause, unexplained iron deficiency needs investigating for gut bleeding — and this is regularly skipped.
Very often, yes. Coeliac disease is a common and easily missed cause of iron deficiency.
Get tested before removing gluten from your diet, or the test will be falsely negative.
It can contribute, since plant iron is absorbed less well.
It should not be assumed to be the whole explanation — diet is a comfortable answer that sometimes hides a bleeding source.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 24, 2026
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