Rethinking Oral Iron in India: A Comparative Evidence Review of Eight Iron Forms

Iron deficiency anaemia remains India's most common nutritional disorder, affecting 57% of women aged 15–49 years in the latest national survey. Oral iron is the first-line response, yet the dominant ferrous salts cause gastrointestinal side effects that undermine adherence. This narrative review compares the oral iron forms sold in India: ferrous sulphate, fumarate, ascorbate and bisglycinate, iron(III) polymaltose complex, ferric pyrophosphate, carbonyl iron and ferric maltol. Each form was scored on four predefined criteria: gastrointestinal tolerability, quality of efficacy evidence, evidence in people for whom ferrous iron fails, and the amount of free iron it leaves in the gut. Ferric maltol, a stable complex of ferric iron with three maltol ligands, stands out for combining tolerability with placebo-controlled phase-3 evidence. In the AEGIS 1/2 trials it raised haemoglobin by 2.25 g/dL over placebo at 12 weeks in patients who had failed or could not tolerate ferrous iron. Its limitations are also reviewed: it did not show non-inferiority to intravenous ferric carboxymaltose, it must be taken on an empty stomach, and Indian clinical data are lacking. Ferric maltol was the only form to achieve the maximum score on all four criteria (12 of 12), ahead of ferrous bisglycinate (10) and the ferrous salts that dominate the Indian market (6). We conclude that ferric maltol is the best-supported oral iron form available in India, particularly for people intolerant of ferrous iron, and that Indian trials should now confirm its benefit locally.