Recent studies in
iron-depleted women have challenged the current approach of treating
iron-deficiency anemia (IDA) with oral
iron in divided daily doses. Alternate day dosing leads to more fractional absorption of
iron. In this randomized controlled trial, we looked at the efficacy and safety of alternate-day (AD) versus twice-daily (BD) oral
iron in all severity of IDA. Total of 62 patients were randomized, 31 patients in BD arm received 60 mg elemental
iron twice daily while 31 patients in AD arm received 120 mg
iron on alternate days. The primary endpoint of 2 g/dl rise in
hemoglobin was met in significantly more patients in the BD arm at 3 weeks (32.3% vs. 6.5%, p < 0.0001) and 6 weeks (58% vs. 35.5%, p = 0.001). There was a significant rise in the median
hemoglobin at 3 (1.6 vs. 1.1, p = 0.02) and 6 weeks (2.9 vs. 2.0 g/dl, p = 0.03) in the BD arm. However, the median
hemoglobin rise in the AD arm at 6 weeks was not significantly different than the BD arm at 3 weeks. Alternate-day dosing for 6 weeks and twice-daily dosing for 3 weeks resulted in the provision of the same total amount of
iron. There were more reports of
nausea in the BD arm (p = 0.03). In conclusion, the choice of twice-daily or alternate-day oral
iron therapy should depend on the severity of
anemia, the rapidity of response desired, and patient preference to either regimen due to adverse events. Trial Registration: CTRI reg. no. CTRI/2018/07/015106 http://ctri.nic.in/Clinicaltrials/login.php.