Iron Pill Aspiration in the Age of Polypharmacy: Time to Rethink the Risks

Iron pill aspiration represents an underrecognized but clinically significant cause of airway injury, particularly in the context of aging populations and increasing polypharmacy. While foreign body aspiration is commonly associated with food particles and small objects, medicinal pills such as ferrous sulfate present a distinct risk due to their corrosive biochemical properties. Oxidative injury resulting from ferrous ion conversion can cause mucosal necrosis, airway inflammation, and long-term complications, including bronchial stenosis and lobar collapse. Diagnosis is often delayed because aspiration events are typically unwitnessed, initial symptoms are nonspecific, and standard imaging modalities lack sensitivity. This editorial reframes iron pill aspiration as a preventable adverse drug event and explores its association with presbyphagia, medication burden, and patient safety. It summarizes current evidence on pathophysiology, diagnostic challenges, and clinical outcomes, with an emphasis on the need for proactive prevention. Recommended strategies include deprescribing medications that impair swallowing, reducing pill burden through alternate-day dosing, and incorporating dysphagia screening into routine prescribing practices. For patients at higher risk, considering liquid preparations may also help reduce harm. As iron supplementation remains central to anemia management worldwide, clinicians must balance therapeutic benefit with airway safety. Iron pill aspiration should no longer be considered rare but a foreseeable complication requiring systematic prevention efforts globally.