A 53-year-old woman with iron-deficiency anaemia reports stomach discomfort after taking ferrous sulfate 200 mg twice daily. How should she take the tablets to improve absorption and tolerability?

• A. Take with tea
• B. Take the tablets on an empty stomach, ideally with orange juice
• C. Take with meals
• D. Take at night

Answer: (B)

Iron absorption works best when iron is in a soluble ferrous form in an acidic environment. Taking ferrous sulfate on an empty stomach reduces the interference from foods and compounds that bind iron, so more iron can be absorbed. Adding a source of vitamin C, like orange juice, helps by both acidifying the gut and converting iron to the more absorbable ferrous state. This combination—empty stomach plus vitamin C—maximizes absorption, and can also help with tolerability compared to taking with food that slows absorption. Tea and other tannin-containing beverages inhibit iron uptake, and taking with meals lowers absorption, while the time of day (such as at night) does not affect absorption.