Modern strategies for safety of iron deficiency pharmacotherapy improving

The article considers strategies for improving the tolerance of oral iron preparations. The main strategy is a decrease of a single dose or a change to the use of drugs with a lower content of elemental iron, an increase in the interval between taking a drug, an intermittent dosing regimen. According to domestic clinical guidelines, it is advisable to use doses of low-range iron preparations. Higher doses potentially increase side effects due to excess unabsorbed iron remaining in the gastrointestinal tract. An opinion is being formed that a single daily dose of 40–60 mg is preferable to reduce undesirable effects and optimize the proportion of absorbed elemental iron. Among divalent compounds, iron sulfate is most often used, the percentage of iron absorption from which is the highest comparatively to other salts of this microelement. Modern dosage forms of ferrous sulfate with modified release have both high bioavailability and good tolerability. Oral iron preparations improve hematological status but also increase oxidative stress even in female patients with low iron stores. Folic acid deficiency contributes to the aggravation of the damaging effects of oxidative stress, as it leads to a decrease of methionine production, which leads to a decrease in the production of natural antioxidants (glutathione) and sulfur-containing amino acids (taurine and cysteine). Intake of iron in combination with folic acid improves the safety of pharmacotherapy by optimizing the activity of the antioxidant system through the regulation of transcription of genes associated with oxidative stress in liver, the activity of Fe²⁺ ion carriers (DMT1) and ZRT/IRT.