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Ferrous Ascorbate Uses, Dosage, Benefits & Side Effects | DrugsAtlas

Authoritative Clinical Reference

Therapeutic Class

Haematinic

Subclass

Oral Iron Supplement (Chelated Iron with Ascorbic Acid)

Speciality

Haematology

Schedule (India)

Not scheduled (OTC — available without prescription)

Routes

Oral

Formulations

Form	Strengths Available (Elemental Iron)
Tablet	30 mg, 50 mg, 100 mg elemental iron (with ascorbic acid 75–150 mg)
Capsule	100 mg elemental iron + folic acid combinations
Oral suspension	30 mg/5 mL elemental iron
Syrup	50 mg/5 mL, 100 mg/5 mL elemental iron
Drops	15 mg/mL, 25 mg/mL elemental iron

Note: All doses in this monograph refer to elemental iron content. Ferrous ascorbate is a synthetic molecule of iron with ascorbic acid in 1:2.8 molar ratio, offering enhanced bioavailability compared to conventional ferrous salts.

Adult indications

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

1. Iron Deficiency Anaemia (IDA) — Adults

Parameter	Dosing
Starting dose	100 mg elemental iron once daily
Titration	May increase to 100 mg twice daily if response inadequate at 4 weeks
Usual maintenance dose	100 mg/day (continued for 3–6 months after Hb normalisation to replenish stores)
Maximum dose	200 mg elemental iron/day in divided doses

Clinical Notes:

Preferably taken on empty stomach for optimal absorption; may take with food if GI intolerance occurs
Ascorbic acid component enhances iron absorption — no need for additional Vitamin C supplementation
Response expected: Hb rise of 1–2 g/dL in 3–4 weeks
Continue therapy 3–6 months after Hb normalises to restore ferritin

2. Antenatal Iron Supplementation (National Iron Plus Initiative — NIPI)

Parameter	Dosing
Starting dose	100 mg elemental iron once daily (or 60 mg as per facility protocol)
Titration	Not applicable
Usual maintenance dose	60–100 mg elemental iron/day + folic acid 0.5 mg
Maximum dose	200 mg/day (in documented moderate-severe IDA)
Duration	From confirmation of pregnancy (ideally 2nd trimester) to 6 months postpartum

Clinical Notes:

Part of national IFA supplementation programme
Weekly iron-folic acid (WIFS) for non-pregnant adolescent girls: 100 mg elemental iron + 0.5 mg folic acid once weekly

3. Postpartum Anaemia

Parameter	Dosing
Starting dose	100 mg elemental iron twice daily
Titration	Not applicable
Usual maintenance dose	100–200 mg elemental iron/day
Maximum dose	200 mg elemental iron/day
Duration	3–6 months or until ferritin normalises

4. Menorrhagia-Associated Iron Deficiency

Parameter	Dosing
Starting dose	100 mg elemental iron once daily
Titration	May increase to 100 mg twice daily based on severity and response
Usual maintenance dose	100–200 mg/day
Maximum dose	200 mg/day
Duration	3–6 months; reassess iron status periodically

Clinical Notes:

Address underlying cause of menorrhagia simultaneously
Monitor ferritin to guide duration of therapy

Secondary Indications — Adults Only (Off-label)

Indication	Dose	Duration	Supervision	Evidence
Iron deficiency in non-dialysis CKD (oral iron trial before IV)	100 mg elemental iron twice daily	1–3 months	Nephrologist; OFF-LABEL	Indian nephrology practice; KDIGO guidelines supportive — oral iron trial before IV iron in non-dialysis CKD
Preoperative anaemia optimisation (elective surgery)	100–200 mg/day	2–4 weeks pre-surgery	Surgeon/Anaesthetist; OFF-LABEL	Patient Blood Management protocols; RCT evidence supportive

Paediatric indications

PAEDIATRIC DOSING (Specialist Only)

Primary Indications (Approved / Standard in India)

Iron Deficiency Anaemia — Treatment

Age Group	Starting Dose	Titration	Usual Maintenance	Maximum Dose
6 months – 2 years	3 mg/kg/day in 1–2 divided doses	Not applicable	3–6 mg/kg/day	6 mg/kg/day
2–5 years	3 mg/kg/day in 1–2 divided doses	May increase to 6 mg/kg/day	3–6 mg/kg/day	6 mg/kg/day (max 60 mg/day)
5–12 years	3 mg/kg/day once or twice daily	Not applicable	3–6 mg/kg/day	6 mg/kg/day (max 120 mg/day)
>12 years	Adult dosing	As per adult	As per adult	200 mg/day

Duration: Minimum 3 months after Hb normalisation to replenish iron stores

Dosing Examples — Oral Suspension/Syrup

Age/Weight	Typical Daily Dose	Using 30 mg/5 mL suspension
6–12 months (8–10 kg)	25–50 mg/day	4–8 mL in divided doses
1–3 years (10–15 kg)	30–60 mg/day	5–10 mL in divided doses
3–6 years (15–20 kg)	45–90 mg/day	7.5–15 mL in divided doses
6–12 years (20–40 kg)	60–120 mg/day	10–20 mL in divided doses

Clinical Notes:

Use drops or suspension for infants and young children
Administer between meals for optimal absorption; may give with small meals if GI intolerance
Sweet taste of most formulations aids compliance

Iron Prophylaxis — As per IAP/MoHFW

Age Group	Dose	Frequency
6–12 months	2 mg/kg/day	Daily (high-risk) or weekly
1–5 years	2 mg/kg/day (max 30 mg/day)	As per nutritional status
5–10 years	30–45 mg/day	Weekly supplementation under WIFS

Secondary Indications — Paediatric Doses (Off-label)

Indication	Dose	Age	Supervision	Evidence
Prophylaxis in preterm/LBW infants	2–3 mg/kg/day elemental iron	Start at 2–4 weeks of age	Specialist only; OFF-LABEL	IAP and WHO recommendations supportive
ADHD with documented iron deficiency	3–6 mg/kg/day	School-age children	Specialist only; OFF-LABEL	Limited RCT evidence

Safety Monitoring — Paediatrics

Confirm iron deficiency before initiating treatment
Monitor Hb response at 4 weeks
Risk of accidental overdose — counsel caregivers on safe storage (keep out of children's reach)
Iron drops/syrups may stain teeth — rinse mouth after administration

⚠️ CLEAR STATEMENT: Not recommended in infants <6 months except under specialist supervision in confirmed iron deficiency (preterm, LBW, or documented deficiency).

Renal Adjustments

No dose adjustment required for oral ferrous ascorbate.

Additional Notes:

Oral iron is not nephrotoxic
In CKD stages 3b–5, oral iron often has limited efficacy due to hepcidin-mediated iron sequestration
IV iron preferred in dialysis patients and ESA-treated CKD patients
Avoid in patients with established iron overload

Hepatic adjustment

Contraindications

Known hypersensitivity to ferrous ascorbate or any component
Haemochromatosis (primary or secondary)
Haemosiderosis
Non-iron-deficiency anaemias (thalassaemia major, sideroblastic anaemia, haemolytic anaemia without concurrent IDA)
Active peptic ulcer disease with bleeding
Patients receiving regular blood transfusions with elevated ferritin
Concurrent parenteral iron therapy
Iron accumulation states

Cautions

History of peptic ulcer disease or gastritis — increased GI irritation risk
Inflammatory bowel disease — may worsen symptoms; consider IV iron
Elderly with constipation risk
Chronic liver disease — monitor for iron overload
History of intolerance to other oral iron preparations
GI strictures or diverticula — risk of retention
Concurrent conditions that may mask GI bleeding (dark stools from iron)
Patients on repeated transfusions — monitor ferritin

Pregnancy

Aspect	Details
Overall safety	Safe; recommended as standard component of antenatal care in India
Risk category	Not formally classified; extensive safety data supports routine use
First trimester	May defer non-urgent supplementation to second trimester to reduce nausea
Second/Third trimester	Routine supplementation recommended per MoHFW/NIPI guidelines
Preferred alternatives	Ferrous ascorbate is preferred over ferrous sulphate due to better GI tolerance
Monitoring	Hb at booking, 28 weeks, 36 weeks; serum ferritin if available; assess GI tolerance

Lactation

Aspect	Details
Compatibility	Fully compatible with breastfeeding
Levels in breast milk	Very low; iron in breast milk is tightly regulated and not affected by maternal supplementation
Preferred alternatives	Not applicable — ferrous ascorbate is acceptable first-line
Infant monitoring	Generally not required; no interruption of breastfeeding needed

Elderly

Aspect	Recommendation
Starting dose	50–100 mg elemental iron once daily
Titration	Increase gradually based on tolerance; avoid high doses
Maximum dose	100–150 mg/day usually sufficient
Special risks	Constipation (common and troublesome), GI discomfort, pill-induced gastritis
Additional considerations	Investigate underlying cause of IDA (GI malignancy, occult blood loss); IV iron may be preferred if oral not tolerated or poor response

Major drug interactions

Tetracyclines (doxycycline, tetracycline)	Reduced absorption of both iron and tetracycline	Chelation in GI tract	Avoid concurrent use; separate by ≥3 hours
Fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin)	Reduced quinolone absorption (40–50%)	Chelation	Avoid concurrent use; separate by ≥2 hours (quinolone first)
Levothyroxine	Reduced thyroxine absorption and efficacy	Chelation	Separate doses by ≥4 hours; monitor TSH
Levodopa/Carbidopa	Reduced levodopa absorption	Chelation	Separate by ≥2 hours
Bisphosphonates (alendronate, risedronate)	Reduced bisphosphonate absorption	Chelation	Separate by ≥2 hours; take bisphosphonate first
Mycophenolate	Reduced mycophenolate absorption	Chelation	Separate by ≥4 hours
Penicillamine	Reduced absorption of both drugs	Chelation	Avoid concurrent use
Dimercaprol	Formation of toxic complex	Direct chemical interaction	CONTRAINDICATED

Moderate drug interactions

Interacting Drug	Effect	Management
Antacids (aluminium/magnesium hydroxide)	Reduced iron absorption	Separate by ≥2 hours
Proton pump inhibitors (omeprazole, pantoprazole)	Reduced iron absorption due to decreased gastric acid	Monitor Hb response; ascorbic acid component partially compensates
H2 blockers (ranitidine, famotidine)	Reduced iron absorption	Same as PPIs; monitor response
Calcium supplements	Reduced iron absorption	Separate by ≥2 hours; take iron between meals
Zinc supplements	Competitive absorption	Separate by ≥2 hours
Methyldopa	Reduced antihypertensive effect	Separate by ≥2 hours; monitor BP
Cholestyramine	Reduced iron absorption	Separate by ≥4 hours
ACE inhibitors	Potential enhancement of iron-induced GI side effects	Monitor GI tolerance

Common Adverse effects

Nausea (5–15%)
Epigastric discomfort, abdominal pain
Constipation (less common than with ferrous sulphate)
Diarrhoea (less common)
Black/dark stools (harmless; may mask melena)
Metallic taste
Heartburn
Teeth staining (with liquid preparations)

Serious Adverse effects'

Adverse Effect	Clinical Notes
Acute iron poisoning (accidental overdose)	Life-threatening, especially in children; presents with vomiting, bloody diarrhoea, haematemesis, shock — requires immediate hospitalisation and deferoxamine
Hypersensitivity reactions	Rare; rash, pruritus, angioedema — discontinue and treat appropriately
GI ulceration/bleeding	Very rare; in setting of pre-existing ulcer disease
Iron overload	With prolonged unnecessary use — monitor ferritin; discontinue when stores replete

Monitoring requirements

Phase	Parameters
Baseline	Hb, MCV, MCH, serum ferritin, transferrin saturation (if available); peripheral blood smear
After 3–4 weeks	Hb (expect rise of 1–2 g/dL); reticulocyte count (peaks at 7–10 days)
After 2–3 months	Hb (should normalise); serum ferritin to assess store repletion
Long-term (>3 months)	Ferritin every 3 months to prevent overload; investigate if inadequate response (occult blood loss, malabsorption, non-compliance, incorrect diagnosis)
Pregnancy	Monthly Hb during 2nd and 3rd trimesters

Brands in India

Orofer-XT	Emcure	Tablet	FDC with folic acid
Livogen-Z	East India	Tablet	FDC with folic acid, zinc
Fefol-Z	GSK	Capsule	FDC with folic acid, zinc
Feronia-XT	Eris	Tablet	FDC with folic acid
Autrin	Sarabhai	Capsule	FDC with folic acid, B12, zinc
Hemfer-XT	Hetero	Tablet,Drops	Plain and FDC variants
Orofer-S	Emcure	Syrup,Drops	Paediatric formulations
Aciron	Troikaa	Tablet	Plain ferrous ascorbate
Ferium-XT	Systopic	Tablet	FDC with folic acid
Tonoferon Plus	East India	Drops,Syrup	Paediatric formulations

Note: Most brands are FDCs with folic acid ± zinc ± Vitamin B12. Always verify elemental iron content per unit when prescribing.

Price range (INR)

Formulation	Price Range	Notes
Tablet (100 mg elemental iron)	₹3–₹8 per tablet	Brand-dependent
Tablet with folic acid (FDC)	₹4–₹10 per tablet	Most common formulation
Syrup (100 mL)	₹60–₹150 per bottle	Unidentified
Drops (15–30 mL)	₹40–₹100 per bottle	Paediatric formulation

Government Supply: Available free under National Iron Plus Initiative (NIPI) and ANC programmes in many public health facilities. Not specifically listed in NLEM 2022 as single entity (ferrous sulphate is NLEM-listed).

Clinical pearls

Better tolerability than ferrous sulphate: Ferrous ascorbate causes fewer GI side effects (especially constipation) compared to ferrous sulphate, making it useful in patients who discontinued other iron preparations due to intolerance.
Built-in absorption enhancer: Ascorbic acid in the formulation improves non-haeme iron absorption by 2–3 fold — no need for additional Vitamin C supplementation.
Counsel about dark stools: Proactively inform patients that black stools are expected and harmless — prevents unnecessary alarm and workup; however, melenic (tarry/sticky) stools warrant evaluation.
Confirm deficiency before long-term use: Avoid empirical prolonged iron therapy in undiagnosed anaemia — risk of iron overload in thalassaemia trait, anaemia of chronic disease, or sideroblastic anaemia.
Drug timing matters: Separate from tetracyclines, quinolones, levothyroxine, antacids, and calcium by 2–4 hours to avoid chelation-related reduced absorption.
Storage safety in households with children: Iron overdose is a leading cause of fatal poisoning in children <6 years — emphasise safe storage away from children's reach.

Version

RxIndia v1.0 — 05 May 2025

Reference

- CDSCO approved product information
- Indian Pharmacopoeia 2022
- API Textbook of Medicine (11th Edition)
- ICMR Guidelines for Control of Nutritional Anaemia
- MoHFW National Iron Plus Initiative (NIPI) Operational Guidelines
- IAP Guidelines on Prevention and Treatment of Iron Deficiency Anaemia in Children
- AIIMS Antenatal Care Protocols
- Goodman & Gilman's The Pharmacological Basis of Therapeutics (pharmacokinetic references)
- WHO Guideline: Daily Iron Supplementation (supportive)

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This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.

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