Iron supplement making me want to throw up

[seekingsomeadvice]

Hi all! I'm 29 weeks pregnant and had a text from my GP earlier this week to say I'm becoming anaemic. I was prescribed 2 x ferrous fumarate tablets to take a day before eating to aid absorption. Took one a couple of days ago before breakfast and about an hour later I almost threw up 😫and had pretty bad stomach issues for the rest of the day (opposite to constipation!). It was bad enough I took the day off work.

I impulse bought some Spatone as I was determined not to have that experience again, but having now examined the iron levels in Spatone they don't really scratch the surface of the Ferrous Furmate.

Spatone = 36% of NRV (x 2 a day = 72% NRV)
Ferrous Fumarate = 486% of NRV (x 2 a day = 972% NRV)

I also take Pregnacare supplements every day which have 121% of Iron NRV and am trying to include more iron naturally in my diet, but wary that if I avoid the Ferrous Fumarate I'm nowhere close to what the GP prescribed.

Contacted the midwife last week for advice but she's yet to respond.

TBF I have been feeling like cr*p recently - very tired - so know the iron will help, but I don't know if I can bear to take another Ferrous Fumarate tablet.

Has anyone else had similar issues with Ferrous Fumarate? Are there any alternatives you'd recommend? Or an alternative way to take it? E.g. will the effects be minimised if I take it with some food at first and then build up to taking it without food?

Sorry for the long post! Any advice would be really appreciated.

Do the instructions say to take it on an empty stomach?

If not, don't. I thought iron supplements needed to be taken with food/with vit c and b12 to absorb properly.

If so, take 2 hours after a meal rather than first thing in the morning, and maybe half the dose to take twice per day rather than all at once.

I can’t remember what the HP prescribed me, but I definitely felt Illl with it. I now take the Ironcare supplement from an online company called Healthspan. I take it at night and have had no problems with it, plus my iron levels (low from very heavy periods) are normal now.

I was on iron tablets for months when I had a uterine fibroid, made me feel so sick! They're better absorbed on an empty stomach but try with a source of vitamin c and eat a little with it. Don't have dairy though, it won't absorb as well.

Agree with the other posters that if it’s making you feel sick, take with food and spread out the tablets. Take them with something high in vitamin c to help the absorption.

If you don’t get on with ferrous fumarate, you could try ferrous sulphate.

Spatone doesn’t work if you have high iron needs unfortunately.

Thank you all so so much for responding so quickly! Agree with you all that Spatone is probably not going to be enough if I've been prescribed something much stronger.

@Whataretheodds - the instructions did recommend taking with an empty stomach, but also with some orange juice which I didn't have when I first tried it so maybe that's part of the issue?

@GCAcademic - I was thinking I might try and take the Ferrous Furmate at night after dinner and see if that helps - maybe I'll sleep through the nausea?

@orbitalcrisis - thank you for that recommendation! Will avoid dairy and I'm trying to avoid caffeine as I heard that can reduce absorption as well?

@Merryclaire - will speak to my GP/midwife about Ferrous Sulphate if things don't improve - did you find it effective?

I might start taking the Ferrous Fumarate with food today and see if I cope any better with it. Will report my results. Definitely feeling fed up with being this tired so I probably need to suck it up and give it another go.

I've been prescribed the same thing and had the exact same issues as you, whether I take it before or after food 😩 I stopped taking it coz I just couldn't bare the feeling/being sick or being stuck on the loo 24/7! I'm waiting to see my midwife again to ask about an alternative! It's rough isn't it 😩😩 hope you're starting to feel a little better!

@gonewithtthewind - glad I'm not alone! I felt very seen by the comment on the box that said "might cause mild issues with people who have sensitive stomachs"... guess that's us💁let me know how you get on with your midwife! feel like pregnancy is always one thing after the other...

I actually started on ferrous sulphate but switched to fumarate after about 15 years as I found sulphate started to give me an upset tummy mixed when I was taking a higher dose (6 tablets a day at that point). But different people respond to them differently.

Even now I feel a bit nauseous when I take fumarate on an empty stomach and don’t eat for a while afterwards.

So I’d try teaming it with food first and if that doesn’t help ask to try ferrous sulphate. Yes, an empty stomach first thing with orange juice is ideal but if you can’t stomach that it’s fine to take it with non dairy food.

Ring the GP and tell them that you're not able to tolerate them. They can change it to ferrous sulphate (slightly less effective but better than nothing).
Orange juice is for vitamin C which aids absorption of iron.
Tea is something that also prevents absorption of iron. Do you drink much tea?
Would you eat steak with a side salad with fresh spinach (mix in some other type leaves if you are not fond of spinach?)

I was the same! Everyone seems to have the opposite problem with the tummy issues! I'd much prefer to be constipated from it than what I am 🤣 it's grim. I just couldn't bare it I could hardly leave the house!

I will do. There has to be something more gentle we can take 😩

Oh definitely! It's tough!

@Merryclaire - thank you for sharing your experience. 6 tablets a day sounds like a lot! Sounds like you were able to build up a tolerance to the effects which is good.

I've just bitten the bullet (or tablet maybe ha?) and taken another one, this time post breakfast with some orange juice. No dairy beforehand and no caffeine.

@Dalint - Thank you for your suggestions - I think I will be ringing the GP/Midwife next week if I don't get on with the tablet today. I have reduced my caffeine intake during pregnancy to one coffee a day (I love coffee) but I've decided to go without today to see if that helps absorption.

I have bought a load of spinach in this week's shop and lentils, eggs, etc. I'm veggie (which is probably what's contributing to the iron deficiency) so I can't eat steak but I would be lying if I said it didn't sound really appealing right now over the tablets!

I only take one tablet a day as a maintenance dose now. Problem was, I’d stop taking them and then get very anaemic over the course of a few months, then have to go on a high dose for a while.

I don’t really struggle with one tablet a day, but I avoid leaving a long gap between tablet and breakfast as it can unsettle your tummy.

I used Sytron liquid. I started with a tiny dose, which still made me feel awful. But over a couple of weeks I built up to the full dose. Started taking it with food but can now manage on an empty stomach. Really, I am amazed I have no side effects at all now, even though it was grim at first on even a lower dose. The only thing I still can’t manage is to take it with orange juice.

Op I was told by a HCP that they used to prescribe ferrous sulphate as the main treatment, but the switch to fumerate as the default drug was done by the NHS due to cost reasons as it’s cheaper. I had horrific stomach pain with fumerate, swapped to sulphate which was just as effective for my anaemia and no more pain. Definitely call GP and ask for a prescription switch.

I had the same issue in both my pregnancies. The tablets made me feel so poorly and I came off them in my first pregnancy as it was only my stores that were low. In my second pregnancy I requested liquid iron which is much easier on the digestive system. I didn't know it was a thing in my first pregnancy! Speak to your midwife and she should prescribe it for you if you can't tolerate the tablets which is very common as they're known for their horrid side effects! I had absolutely no problems with the liquid iron x

I also just remembered my bf is veggie anr has been since age 13. She decided to have a temporary weekly pause from her veggie eating while she was pregnant on health grounds, because of her anaemia and this really helped her. She went straight back to being 100% veggie once her dd was born. I don’t know if this is an option you might consider.

Sorry for the slow response all - have been at work since 7am this morning so had to put the phone down for a bit. I really can't thank you all enough for your suggestions and advice.

Since I took the FF tablet at 07:30 I've been feeling surprisingly ok. A bit of nausea and I can tell my stomach feels a little unsettled, but nowhere near as bad as when I took it on an empty stomach - so I've got some hope for today.

I will keep monitoring it though, and any issues I will call my GP tomorrow. My plan is to build up tolerance as previous posters have suggested, so might just stick with one with food today and then go up to two as I go.

@MissHavershamReturns - thank you so much for your advice! I saw other forum posts that confirmed what you said, that the FF version is cheaper than the FS so will bear that in mind if I need to have that conversation with GP. I am considering whether there are alternative iron sources to include in my diet - I feel like I might not go back to meat just yet but if it comes to a safe pregnancy then maybe it's something to consider.

@Willdoitlater - thanks for the suggestion of Sytron! Wish I hadn't jumped the gun and spent £24 on Spatone and done a bit more research. Will look into Sytron as an alternative.

@newtolineofduty - thank you for your story, it's comforting to hear that other people had the same reaction and it's not just me! Will definitely speak to MW about liquid iron - sounds a lot easier on the stomach!

It's quite important for you (I'm pretty sure that your baby is fine as one teacher I had described babies as parasites 😮 because they take all the nutrients from the Mum but a better way to describe it is that Mum prioritises giving all her nutrients to her baby 😍) because during birth (with potential for blood loss) and after giving birth you will need to have a lot of iron in your system to cope with it all. Worst case scenario, you may need a blood transfusion so try your best to keep those iron levels up. If you're borderline needing a blood transfusion, they won't give it even when it would really benefit the Mum.

I'm pretty sure that it's not caffeine that affects the absorption of iron. I think it's the tannins in tea.
A lemon and ginger tea in the morning is something some people enjoy (I personally hate them as they remind me of lemsip 😐).

Vitamin C is very important for absorption of iron.
Hopefully google or other vegetarians can advise you on best iron sources.

And keep steak in mind just in case. I don't know your reasons for being vegetarian, but sometimes, being a Mum comes at a price! 😩

Just to add Sytron is prescribable for pregant women who have already tried and failed to tolerate other formulations. You can also buy it yourself but its expensive.

There are three different iron supplements. Ferrous Fumerate is the preferred one as it gets into the system more readily. Many people can’t tolerate it though (me included). Ask your GP for a different one. I’m fine on Ferrous Sulphate.

ferrous fumarate and ferrous sulfate both made me really sick during pregnancy. What worked for me was ferrous gluconate I used to have them after a meal and then have some orange juice as vitamin c helps absorb the iron.

I found I couldn't tolerate most forms of iron - even low doses of iron sulphate, fumerate, bisglycinate or gluconate give me awful cramps and diarrhoea.

I've found that I'm fine with a haem iron supplement (the form found in meat, derived from animal products so not suitable if you're vegetarian). There are a few supplements but they're more expensive, I used to take Optifer and now use Three Arrows Simply Heme, occasionally available on Amazon UK but otherwise has to be imported from the US. Proferrin is another one I've used in the past but that's even more expensive. I've found these have no side effects for me and are supposed to absorb much better.

I have low ferritin levels caused by pregnancy and couldn’t tolerate tablets so my GP pharmacist put me on Galfar, which is a chocolate orange flavour liquid and it’s v palatable.

Im also vegetarian. My obstetrician told me it’s highly unlikely that it has anything to do with my diet and is simply a side effect of pregnancy. She also said the only way to treat such a severe deficiency as mine is with proper prescription based iron supplements, eating steak and mainlining spinach won’t make much difference to your levels

Ask for ferrograd. It's a particular preparation @seekingsomeadvice. I couldn't take ferrous fumarate at all it gave me violent diarrhoea and nausea even though it's meant to be more gentle! Ferrograd has a special time realise coating - obviously it's more expensive, which is why the doctors try other stuff first!

Just to add ferrograd is a prep of ferrous sulphate.