Dawaa Reference

Clinical reference

Iron deficiency anemia

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

Huda T, Dibley M, El Arifeen S, et al. Assessing the Efficacy of Bovine Lactoferrin to Correct Iron Deficiency Anemia in Non-pregnant Non-lactating Women: A Randomized Controlled Trial. Current Developments in Nutrition 2019;3(Suppl 1):nzz044.FS08-02-19 (https://pmc.ncbi.nlm.nih.gov/articles/PMC6574033/): "Arm A, B and C received daily oral 200 mg bLf, 400 mg bLf and 60 mg ferrous sulfate. ... Treatment was for 12 weeks." The trial's own result was that neither lactoferrin arm raised haemoglobin - "Women on 200 mg bLf had a decrease in Hb of 0.3 g/dl" and "women on 400 mg bLf arm had no change in Hb: 0.0 g/dl" - while "women on ferrous sulfate arm had an increase in Hb: 1.1 g/dl". · WHO Iron Supplementation 2021 · Egyptian National Drug Formulary - Blood Disorder Medications 2025 (iron sucrose monograph) · Rahman et al, randomised controlled trial of bovine lactoferrin versus ferrous sulfate, Current Developments in Nutrition 2019 (PMC6574033)

Verified against4 documents
  • Huda T, Dibley M, El Arifeen S, et al. Assessing the Efficacy of Bovine Lactoferrin to Correct Iron Deficiency Anemia in Non-pregnant Non-lactating Women: A Randomized Controlled Trial. Current Developments in Nutrition 2019;3(Suppl 1):nzz044.FS08-02-19 (https://pmc.ncbi.nlm.nih.gov/articles/PMC6574033/): "Arm A, B and C received daily oral 200 mg bLf, 400 mg bLf and 60 mg ferrous sulfate. ... Treatment was for 12 weeks." The trial's own result was that neither lactoferrin arm raised haemoglobin - "Women on 200 mg bLf had a decrease in Hb of 0.3 g/dl" and "women on 400 mg bLf arm had no change in Hb: 0.0 g/dl" - while "women on ferrous sulfate arm had an increase in Hb: 1.1 g/dl".
  • Egyptian National Drug Formulary - Blood Disorder Medications 2025 (iron sucrose monograph)
  • Rahman et al, randomised controlled trial of bovine lactoferrin versus ferrous sulfate, Current Developments in Nutrition 2019 (PMC6574033)
  • Iron Deficiency and Microcytic Hypochromic Anemia - disease-level clinical article (iron-deficiency-anemia-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • Vague complaints span low energy, tiredness, trouble concentrating, mood swings, irritability, headaches, and breathlessness on exertion [breathlessness · fatigue · irritability · poor concentration]
  • Iron deficiency without anemia causes the same symptoms as with anemia, just milder
  • Pica - craving and eating non-food substances - occurs in about half of patients with true iron deficiency [pica]
  • Craving ice (pagophagia) is a fairly specific clue to iron deficiency [pica]
  • Restless legs syndrome links to low brain iron on MRI, and up to 40% of patients with restless legs have iron deficiency, with or without anemia
  • Urine can turn red after eating beets (beeturia), a nonspecific finding that is more common with iron deficiency

Signs — what you find (3)

  • Exam may be normal, or show dry skin, hair loss, a smooth atrophic tongue, cracked mouth corners, pallor, brittle nails, and spoon-shaped nails [atrophy · dry skin · hair loss · nail changes · pallor]
  • A systolic flow murmur may be heard on cardiac auscultation [heart murmur]
  • Pallor and pale conjunctivae only show up late in the course of iron deficiency anemia [anaemia · pallor]

Tests (12)

  • Core panel checks serum iron, transferrin, ferritin, iron-binding capacity, and how saturated the transferrin is
  • Iron studies should be drawn at least 9 hours after eating iron-containing food
  • True iron deficiency is diagnosed when ferritin is under 30 ng/mL or transferrin saturation is under 20%
  • A ferritin under 30 ng/mL predicts absent marrow iron stores with about 92% sensitivity and 98% specificity
  • Normal hemoglobin does not rule out iron deficiency, since hemoglobin only falls after substantial iron depletion; microcytosis is likewise not a sensitive marker
  • Soluble transferrin receptor rises in iron deficiency and can distinguish absolute from functional deficiency
  • Peripheral smear in thalassemia shows target cells, basophilic stippling, and uniformly small red cells
  • Reticulocyte hemoglobin content reflects iron available for red cell production over recent days and is useful for catching early deficiency and tracking response to IV iron
  • In beta-thalassemia trait, hemoglobin electrophoresis shows HbA2 above 3.5%, sometimes with raised HbF
  • In alpha-thalassemia, electrophoresis can look normal, so DNA testing for alpha-globin gene deletions is needed to confirm
  • Thalassemia often keeps red cell counts normal-to-high despite anemia, with MCV under 70 fL but a normal RDW - the reverse of iron deficiency's pattern
  • Basophilic stippling combined with lead-poisoning features or small pale red cells confirms lead toxicity outright

If not this — what else fits (6)

  • Fatigue-type conditions such as fibromyalgia, chronic fatigue syndrome, depression, other chronic disease, and hypothyroidism overlap with iron deficiency's nonspecific symptoms
  • Pica, eating disorders, psychiatric illness, malnutrition, neurological causes of restless legs, and pregnancy are also on the differential
  • Microcytosis without iron deficiency can come from thalassemia, sideroblastic anemia, lead poisoning, copper deficiency, or drugs like isoniazid and chloramphenicol
  • Thalassemia is distinguished from iron deficiency because iron studies come back normal or increased, rather than low
  • Reticulocyte hemoglobin content or zinc protoporphyrin can help tell iron deficiency apart from thalassemia
  • If iron deficiency and thalassemia coexist, iron studies must be read together with hemoglobin electrophoresis

SourceStatPearls "Iron Deficiency and Microcytic Hypochromic Anemia" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Intravenous iron - refer | Lactoferrin alternative

MAIN TREATMENT - choose one, plus any add-on marked below

1

FERROUS FUMARATE

1st line

Strength200 mg

Formoral.solid

Adult dose and duration

200 mg (65 mg elemental iron) 1-2 times daily on empty stomach x 3-6 months

Paediatric dose

3-6 mg/kg/day [child max 180 mg]

(Doses are for elemental iron (not salt), divided BID-TID; give between meals with fruit juice. Ceiling of 180 mg is the formulary maximum for a child: 20 mL/day of the 140 mg/5 mL syrup, which is 45 mg elemental iron per 5 mL. This is deliberately above the 130 mg an adult gets here: a growing child needs more elemental iron per kilogram, and modern adult practice is lower and less frequent dosing than the formulary allows. It is not an inversion to correct.)

Dose by weight
3kg9-18 mg/day
4kg12-24 mg/day
5kg15-30 mg/day
6kg18-36 mg/day
7kg21-42 mg/day
8kg24-48 mg/day
9kg27-54 mg/day
10kg30-60 mg/day
11kg33-66 mg/day
12kg36-72 mg/day
13kg39-78 mg/day
14kg42-84 mg/day
15kg45-90 mg/day
16kg48-96 mg/day
17kg51-102 mg/day
18kg54-108 mg/day
19kg57-114 mg/day
20kg60-120 mg/day
21kg63-126 mg/day
22kg66-132 mg/day
23kg69-138 mg/day
24kg72-144 mg/day
25kg75-150 mg/day
26kg78-156 mg/day
27kg81-162 mg/day
28kg84-168 mg/day
29kg87-174 mg/day
30kg90-180 mg/day
31kg93-180 mg/day (upper capped)
32kg96-180 mg/day (upper capped)
33kg99-180 mg/day (upper capped)
34kg102-180 mg/day (upper capped)
35kg105-180 mg/day (upper capped)
36kg108-180 mg/day (upper capped)
37kg111-180 mg/day (upper capped)
38kg114-180 mg/day (upper capped)
39kg117-180 mg/day (upper capped)
40kg120-180 mg/day (upper capped)
41kg123-180 mg/day (upper capped)
42kg126-180 mg/day (upper capped)
43kg129-180 mg/day (upper capped)
44kg132-180 mg/day (upper capped)
45kg135-180 mg/day (upper capped)
46kg138-180 mg/day (upper capped)
47kg141-180 mg/day (upper capped)
48kg144-180 mg/day (upper capped)
49kg147-180 mg/day (upper capped)
50kg150-180 mg/day (upper capped)
Dose source

Egyptian National Drug Formulary - Blood Disorder Medications 2025

Why

Ferrous fumarate is the Egyptian formulary's oral iron: a 200 mg tablet is 65.57 mg elemental, and there is a 140 mg/5 mL syrup for children. Dose by elemental iron, not tablet weight. No plain ferrous tablet is registered here - the packs below are combinations, mostly ferrous salt with folic acid and some carrying vitamin C or zinc instead, which is what an Egyptian pharmacy will hand over.

Cautions
  • Take 1 hour before meals; vitamin C aids absorption.
  • Constipation, dark stools, and epigastric discomfort are common.
  • Keep out of reach of children - overdose is fatal.
  • Egyptian products are labelled inconsistently - most are registered as "iron" with no salt named. Check the elemental iron content on the pack rather than the salt weight; 200 mg of ferrous sulphate or fumarate is about 65 mg elemental.
  • Most iron tablets in Egypt come with folic acid in them, though not all - check the pack. Folate corrects the blood picture of B12 deficiency while the neurological damage carries on - check B12 before starting if the anaemia is macrocytic, mixed, or unexplained.
  • The pack a pharmacy hands over is a combination rather than plain iron - besides folic acid, many Egyptian iron products add vitamin C, and some add zinc or B vitamins. A combination is an acceptable way to give oral iron: the formulary's ferrous fumarate monograph lists the dosage forms as a 200 mg tablet and a 140 mg/5 mL syrup, then adds combination products to that list, and states the adult dose in elemental iron (100 to 200 mg elemental iron daily). The vitamin C is wanted rather than merely tolerated - 200 to 500 mg alongside oral iron is recommended to enhance its absorption. Dose by the elemental iron the pack states, not by tablet weight and not by the other ingredients. The Egyptian register does not record elemental iron content for most of these products, so the carton has to be read.
Egyptian brands
Egyptian brandManufacturerIndicative price
FERROL 10 F.C. TABLET! also contains folic acidAMOUN2.00 EGP (0.20/unit)
FOLIFER 30 TAB.! also contains folic acidMISR7.20 EGP (0.24/unit)
FERROZINC-C 24 CAPS.! also contains vitamin c, zincSAFE PHARMA > PHARCO7.50 EGP (0.31/unit)
IROFOL 30 CAPS.! also contains copper, folic acid, pyridoxine, vitamin b12, zincMULTICARE40.50 EGP (1.35/unit)
HAEMACTIN 30 CAPS.! also contains folic acid, vitamin b12DELTA GRAND PHARMA > NOBEL PHARM. INDUSTRIES150.00 EGP (5.00/unit)
TESLAGLOBIN 20 CAP! also contains b12, b6, copper, folic acid, zincDAWA EGYPT INTERNATIONAL > TESLA140.00 EGP (7.00/unit)
CHEMARED CAPSULE! also contains calcium, methyl cobolamine, pyridoxinePHARMA ZAD > CHEMA HERB195.00 EGP
FERRONIL 125MG/5ML SYRUP 120 ML? strength differs? different route - not oral solidEL NILE.4.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Iron Deficiency and Microcytic Hypochromic Anemia - disease-level clinical article (iron-deficiency-anemia-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - iron deficiency requires investigation for an underlying cause (eg GI, uterine, or urinary bleeding); delayed diagnosis of an underlying malignancy causing the bleeding worsens outcomes.
3

FERRIC HYDROXIDE POLYMALTOSE

2nd line

Strength100 mg

Formoral.solid

Adult dose and duration

100 mg elemental iron 1-2 times daily with or after meals x 3-6 months

Paediatric dose

3-5 mg/kg/day [child max 200 mg]

(Doses are for elemental iron (not salt), divided BID; give with or immediately after meals)

Dose by weight
3kg9-15 mg/day
4kg12-20 mg/day
5kg15-25 mg/day
6kg18-30 mg/day
7kg21-35 mg/day
8kg24-40 mg/day
9kg27-45 mg/day
10kg30-50 mg/day
11kg33-55 mg/day
12kg36-60 mg/day
13kg39-65 mg/day
14kg42-70 mg/day
15kg45-75 mg/day
16kg48-80 mg/day
17kg51-85 mg/day
18kg54-90 mg/day
19kg57-95 mg/day
20kg60-100 mg/day
21kg63-105 mg/day
22kg66-110 mg/day
23kg69-115 mg/day
24kg72-120 mg/day
25kg75-125 mg/day
26kg78-130 mg/day
27kg81-135 mg/day
28kg84-140 mg/day
29kg87-145 mg/day
30kg90-150 mg/day
31kg93-155 mg/day
32kg96-160 mg/day
33kg99-165 mg/day
34kg102-170 mg/day
35kg105-175 mg/day
36kg108-180 mg/day
37kg111-185 mg/day
38kg114-190 mg/day
39kg117-195 mg/day
40kg120-200 mg/day
41kg123-200 mg/day (upper capped)
42kg126-200 mg/day (upper capped)
43kg129-200 mg/day (upper capped)
44kg132-200 mg/day (upper capped)
45kg135-200 mg/day (upper capped)
46kg138-200 mg/day (upper capped)
47kg141-200 mg/day (upper capped)
48kg144-200 mg/day (upper capped)
49kg147-200 mg/day (upper capped)
50kg150-200 mg/day (upper capped)
Dose source

Egyptian National Drug Formulary - Blood Disorder Medications 2025

Why

Second line, and the reason is tolerance rather than strength. A ferrous salt is absorbed better and costs a tenth as much, but the constipation, black stools and epigastric pain are why patients stop taking it. Polymaltose is plain iron with no folic acid attached, is taken with food rather than on an empty stomach, and is what to move to when the ferrous salt has already been tried and abandoned - not before.

Cautions
  • Must be taken WITH meals (unlike a ferrous salt, which needs an empty stomach).
  • Does not stain teeth in liquid form.
  • Absorption is lower than a ferrous salt's. Expect the haemoglobin to rise more slowly and recheck at 4 weeks rather than assuming failure.
  • There is a lower incidence of GI irritation than with ferrous salts.
Egyptian brands
Egyptian brandManufacturerIndicative price
HAEMOPOWER 100MG 30 CHEW. TABS.AMRIYA25.20 EGP
HEMALTOSE 100 MG 30 CHEW. TABS.GLOBAL ADVANCED PHARMACEUTICALS (GAP)40.50 EGP
HAEMOJET 100 MG 36 S.G.CAPS.EUROPEAN EGYPTIAN PHARM. IND.58.50 EGP
GOLDEN FER 100 MG 30 CHEW. TABS.MEDIZEN PHARMACEUTICAL INDUSTRIES60.00 EGP
FERRITOP 15MG/5ML SYRUP 100 ML? strength differs? different route - not oral solidHIKMA PHARMA10.00 EGP
ANSCHLARIN SYRUP 120 ML? strength differs? different route - not oral solidAVERROES PHARMA-EGYPT10.50 EGP
4

ASCORBIC ACID

add-on - not a substitute

Formoral.solid

Adult dose and duration

200-500 mg orally in combination with oral iron

Paediatric dose

No paediatric dose is stated in the sources held for this drug.

Dose source

Iron deficiency anemia - disease-level clinical article (iron-deficiency-anemia-clinical.txt)

Why

Given concurrently with oral iron therapy to reduce ferric iron to ferrous iron and enhance gastrointestinal absorption.

Cautions
  • May cause gastrointestinal disturbances and nephrolithiasis at doses >1 g daily, and may interfere with blood and urine glucose measurements at doses ≥2 g daily.
  • Do not exceed 1 g daily during pregnancy.
  • Using vitamin C in large quantities without concomitant deferoxamine use carries a higher risk for fatal arrhythmias.
Egyptian brands
Egyptian brandManufacturerIndicative price
C-VITON 500 MG 20 TABSKAHIRA8.00 EGP (0.40/unit)
CEVAROL 500MG 20 TAB.MEMPHIS12.00 EGP (0.60/unit)
C-SAFE 500 MG 36 CAPS.SAFE PHARMA35.00 EGP (0.97/unit)
MUNITO C 1000 MG 60 F.C. TABS.MULTICARE156.50 EGP (2.61/unit)
VITAMIN C 500 MG 30 TABS. (NEW BOSTON)COPAD > NEW BOSTON PHARMACEUTICALS120.00 EGP (4.00/unit)
VITACID C 1 GM 12 EFF. TAB.CID54.00 EGP
ADVANCED VITAMIN C 30 GUMMIESVITACARE > VITALIFE599.00 EGP
VITAMIN C 1000 MG 100 CAPLETS (PURITANS PRIDE)PURITANS PRIDE > ARAB IMPORTERS TRADING (AIT)850.00 EGP
CEBION 100MG/ML ORAL DROPS 30 ML? strength differs? different route - not oral solidAMOUN > MERCK KGAA F.R.GERMANY5.50 EGP
UR-C ORAL DROPS 15 ML? strength differs? different route - not oral solidHI-PHARM6.00 EGP

INTRAVENOUS IRON - REFER

5

IRON

Intravenous iron - refer

3rd line

Forminjection

Adult dose and duration

Iron sucrose 100-200 mg elemental iron by slow intravenous injection or infusion, one to three times a week depending on the haemoglobin. Total dose = body weight (kg) x (target Hb - actual Hb in g/L) x 0.24, plus 500 mg storage iron at 35 kg and above - until the calculated total dose is given

Paediatric dose

The formulary states use has not been studied in children. A child who needs intravenous iron is a paediatric referral, not a primary-care prescription.

Dose source

Egyptian National Drug Formulary - Blood Disorder Medications 2025 (iron sucrose monograph)

Why

Third line, and not something to start in the clinic - it is what to refer for. The three reasons to reach it are malabsorption that oral iron cannot overcome (coeliac disease, gastric surgery, inflammatory bowel disease), intolerance of both oral options above, and a haemoglobin that has to come up faster than oral iron can manage. The packs are listed so the cost of that referral is known before it is made - 9 EGP to 1,600 EGP is the spread.

Cautions
  • The register does not name the salt on most of these vials. Iron dextran carries a materially higher anaphylaxis risk than iron sucrose or ferric carboxymaltose - read the vial, do not go by the trade name.
  • Never give intravenous iron where the anaemia is not iron deficiency. Confirm with ferritin and transferrin saturation first.
  • Contraindicated in iron overload, haemochromatosis, and in known serious hypersensitivity to any parenteral iron product.
  • Resuscitation facilities must be available for the first dose.
Egyptian brands
Egyptian brandManufacturerIndicative price
FERROJECT 12.5MG/ML AMP. FOR I.V. INF. OR SLOW I.V. INJ.ADWIA9.00 EGP
HYDROFERRIN 100MG/2ML 3 AMP.BORG33.00 EGP
EMIFERRON-S 100MG/5ML 1 AMP. I.V INJ./INF.HIKMA SPECIALIZED PHARMACEUTICALS38.50 EGP
HAEMOPOWER 100MG/2ML 5 AMP. FOR I.M INJ.AMRIYA75.00 EGP
AMPOFER 20MG/ML 5 AMPS. I.V. INJ./INF.DELTA GRAND PHARMA > EGYPHARMA-EGYPT275.00 EGP
INTEROFER 100MG/5ML 5 AMP FOR I.V. INJ.SUNNY MEDICAL > MULTIPHARMA275.00 EGP
COSMOFER 50MG/ML FOR INF. 5 AMPS.PHARMACOSMOS A/S > PHAROPHARMA470.00 EGP
INJECTAFER 500MG/10ML 1 VIAL FOR I.V. INJ./INFUSIONIDT BIOLOGICA GMBH > HIKMA PHARMA1600.00 EGP

LACTOFERRIN ALTERNATIVE

6

LACTOFERRIN

Lactoferrin alternative

3rd line

Strength200 mg

Formoral.solid

Adult dose and duration

200 mg once daily. 400 mg once daily was also tested in the trial below and was no more effective x 12 weeks in the trial, with haemoglobin and ferritin rechecked monthly

Paediatric dose

No paediatric dose could be sourced from a regulatory document. Childhood iron deficiency anaemia should be treated with an iron salt at a properly calculated mg/kg dose, not with lactoferrin.

Dose source

Huda T, Dibley M, El Arifeen S, et al. Assessing the Efficacy of Bovine Lactoferrin to Correct Iron Deficiency Anemia in Non-pregnant Non-lactating Women: A Randomized Controlled Trial. Current Developments in Nutrition 2019;3(Suppl 1):nzz044.FS08-02-19 (https://pmc.ncbi.nlm.nih.gov/articles/PMC6574033/): "Arm A, B and C received daily oral 200 mg bLf, 400 mg bLf and 60 mg ferrous sulfate. ... Treatment was for 12 weeks." The trial's own result was that neither lactoferrin arm raised haemoglobin - "Women on 200 mg bLf had a decrease in Hb of 0.3 g/dl" and "women on 400 mg bLf arm had no change in Hb: 0.0 g/dl" - while "women on ferrous sulfate arm had an increase in Hb: 1.1 g/dl".

Why

38 live Egyptian products and one of the most-prescribed anaemia preparations in Cairo, so a search must not come back empty. It is placed at line 3 with the negative trial evidence stated first in the cautions, not hidden.

Cautions
  • THE EVIDENCE DOES NOT SUPPORT IT AS A SUBSTITUTE FOR AN IRON SALT. In a 555-woman randomised trial, haemoglobin fell 0.3 g/dL on 200 mg lactoferrin and did not change on 400 mg, while it rose 1.1 g/dL on 60 mg ferrous sulfate. Ferritin rose 2.8-3.5 micrograms/L versus 41.1 micrograms/L.
  • The one consistent advantage is tolerability: abdominal pain, indigestion, diarrhoea and black stool were all significantly commoner with ferrous sulfate.
  • Trials in pregnancy have been more favourable but are smaller and mostly single-centre - the evidence is not equivalent.
  • Use it only where an iron salt genuinely cannot be tolerated and parenteral iron is not available. Recheck haemoglobin at 4 weeks and switch if it has not risen.
  • It is sold as a food supplement in Egypt, so the actual lactoferrin content is not regulated to medicine standards and varies between brands.
  • Never let a lactoferrin prescription substitute for finding the cause of the iron deficiency - the investigation matters more than the tablet.
Egyptian brands
Egyptian brandManufacturerIndicative price
DEVAFERRIN 200 MG 20 CAPS.DEVARTLAB > BIOERA325.00 EGP (16.25/unit)
CORETIDE 200 MG 7 SACHETS> CORE PHARM109.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.