Modern iron replacement therapy: clinical and pathophysiological insights

Int J Hematol. 2018 Jan;107(1):16-30. doi: 10.1007/s12185-017-2373-3. Epub 2017 Dec 1.


Iron deficiency, with or without anemia, is extremely frequent worldwide, representing a major public health problem. Iron replacement therapy dates back to the seventeenth century, and has progressed relatively slowly until recently. Both oral and intravenous traditional iron formulations are known to be far from ideal, mainly because of tolerability and safety issues, respectively. At the beginning of this century, the discovery of hepcidin/ferroportin axis has represented a turning point in the knowledge of the pathophysiology of iron metabolism disorders, ushering a new era. In the meantime, advances in the pharmaceutical technologies are producing newer iron formulations aimed at minimizing the problems inherent with traditional approaches. The pharmacokinetic of oral and parenteral iron is substantially different, and diversities have become even clearer in light of the hepcidin master role in regulating systemic iron homeostasis. Here we review how iron therapy is changing because of such important advances in both pathophysiology and pharmacology.

Keywords: Anemia; Heart failure; Hepcidin; Iron deficiency; Iron therapy.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Anemia, Iron-Deficiency / drug therapy*
  • Anemia, Iron-Deficiency / epidemiology
  • Anemia, Iron-Deficiency / etiology
  • Cation Transport Proteins
  • Drug Compounding / trends*
  • Heart Failure / etiology
  • Hepcidins
  • Homeostasis
  • Humans
  • Infusions, Parenteral
  • Iron / administration & dosage*
  • Iron / metabolism
  • Iron / pharmacokinetics
  • Prevalence
  • Technology, Pharmaceutical / trends*


  • Cation Transport Proteins
  • Hepcidins
  • metal transporting protein 1
  • Iron