Is ACCRUFeR the same as regular iron? Unpacking the Key Differences

October 8, 2025 •

3 min read

Clinical data indicates that up to 70% of patients discontinue traditional oral iron supplements due to gastrointestinal side effects. This statistic highlights a major drawback of standard treatment, prompting many to ask: Is ACCRUFeR the same as regular iron, or is its unique formulation the key to better patient tolerance?

Quick Summary

ACCRUFeR (ferric maltol) is a prescription oral iron with a special maltol shield for superior tolerability and absorption, unlike the standard, over-the-counter ferrous salts.

Key Points

Not the Same: ACCRUFeR is a distinct, prescription-only iron medication (ferric maltol), not the same as standard, over-the-counter ferrous salts like ferrous sulfate.
Maltol Shield: ACCRUFeR features a unique maltol shield that protects the iron from stomach acid, enabling targeted absorption in the small intestine and reducing GI side effects.
Superior Tolerability: The targeted absorption of ACCRUFeR leads to significantly fewer gastrointestinal issues like nausea, constipation, and abdominal pain compared to regular iron supplements.
Prescription vs. OTC: ACCRUFeR is a brand-name prescription drug, whereas regular iron is typically available generically over-the-counter.
Cost Difference: ACCRUFeR is more expensive than standard iron, but its improved tolerability can lead to better patient adherence and effectiveness, potentially offsetting the higher cost.
Targeted Therapy: ACCRUFeR is particularly beneficial for patients with sensitive stomachs, inflammatory bowel disease, or those who could not tolerate other oral iron products.

No, ACCRUFeR and regular iron are not the same; the critical differences lie in their chemical formulation, mechanism of action, and tolerability profile. While both are used to treat iron deficiency, ACCRUFeR (ferric maltol) is a novel, prescription-only medication, whereas "regular iron" typically refers to standard, over-the-counter (OTC) iron salts, most commonly ferrous sulfate.

The Unique Mechanism of ACCRUFeR (Ferric Maltol)

ACCRUFeR, known chemically as ferric maltol, is a stable complex of ferric (Fe$^{3+}$) iron and maltol. Its most significant feature is the "maltol shield". This shield protects the iron as it travels through the stomach, preventing premature breakdown and irritation. The iron is then released and absorbed in the small intestine, specifically the duodenum. This targeted delivery minimizes the amount of unabsorbed iron in the gut, reducing inflammation and common gastrointestinal (GI) side effects. This efficient, targeted absorption allows for effective iron level increases.

Understanding "Regular Iron" (Ferrous Salts)

Regular oral iron supplements, such as ferrous sulfate, ferrous fumarate, or ferrous gluconate, lack this protective shield. These iron salts break down easily in the stomach, releasing unbound ferrous (Fe$^{2+}$) iron. This unbound iron can irritate the stomach lining, leading to a high incidence of GI side effects like nausea, constipation, diarrhea, and abdominal pain. The absorption of these salts can also be inconsistent due to factors like food and other medications. For many patients, these side effects make adhering to treatment difficult, often resulting in discontinuation.

ACCRUFeR vs. Regular Iron: A Head-to-Head Comparison


Feature	ACCRUFeR (Ferric Maltol)	Regular Iron (Ferrous Sulfate)
Chemical Formulation	Ferric (Fe$^{3+}$) iron complexed with maltol.	Ferrous (Fe$^{2+}$) iron salt.
Mechanism of Action	Maltol shield protects iron in the stomach for targeted absorption in the small intestine, minimizing irritation.	Breaks down in the stomach, releasing unbound iron that can irritate the GI tract.
Gastrointestinal Tolerability	Significantly improved, with lower incidence of nausea, constipation, and abdominal pain.	Higher incidence of GI side effects, frequently leading to patient intolerance and treatment discontinuation.
Absorption	Exhibits high and efficient absorption due to its controlled release mechanism.	Variable and often less efficient absorption, influenced by food and other medications.
Prescription Status	Prescription-only medication.	Typically available over-the-counter (OTC).
Cost	More expensive, though the higher cost may be offset by better tolerability and adherence.	Generally lower in cost, especially in generic form.
Dosing Frequency	Specific dosing instructions should be followed as prescribed by a healthcare professional.	Specific dosing instructions should be followed as prescribed by a healthcare professional or indicated on the product packaging.
Ideal Patient	Patients with GI sensitivities, inflammatory bowel disease, or those who have failed other oral iron therapies.	First-line treatment for most people with iron deficiency who can tolerate the side effects.

Why the Differences Matter for Patients

The distinction between ACCRUFeR and regular iron is crucial for effective treatment. For individuals who experience significant GI distress from standard iron, ACCRUFeR's improved tolerability can dramatically enhance adherence, a key factor in successfully treating iron deficiency anemia. Clinical trials have shown that patients who previously couldn't tolerate or didn't respond well to other oral iron therapies saw significant improvements with ACCRUFeR, including those with chronic conditions like Inflammatory Bowel Disease (IBD) and Chronic Kidney Disease (CKD).

Who Should Take Which?

Selecting the right iron supplement requires a conversation with a healthcare provider.

For most patients: Regular iron supplements like ferrous sulfate are typically the initial, cost-effective choice and can be very effective if tolerated.
For sensitive patients: If standard iron causes significant GI side effects, or for individuals with underlying inflammatory conditions, ACCRUFeR may offer a better-tolerated alternative.

Conclusion: More Than Just “Iron”

To reiterate, is ACCRUFeR the same as regular iron? No, they are distinct. ACCRUFeR represents an advancement in oral iron therapy, designed to mitigate the common tolerability issues of standard ferrous salts. Its unique maltol shield ensures targeted absorption in the small intestine, leading to fewer GI side effects and better adherence. Regular iron is a valid and affordable option, but ACCRUFeR provides an alternative for those unable to tolerate it. For more detailed information, consult resources like GoodRx.

Frequently Asked Questions

ACCRUFeR is not necessarily "better" for everyone, but it offers significant advantages, particularly for patients who experience severe gastrointestinal side effects from regular iron (ferrous salts). Its unique formulation improves tolerability and absorption, making it a more viable option for some individuals, even at a higher cost.

While any iron supplement can potentially cause constipation, ACCRUFeR is specifically designed with a maltol shield to significantly minimize GI side effects, including constipation. In clinical studies, side effects were generally mild to moderate.

Yes, ACCRUFeR (ferric maltol) is a prescription-only medication and is not available over-the-counter like standard iron supplements.

Specific instructions on taking ACCRUFeR with or without food should be discussed with a healthcare professional or found on the prescription information.

Clinical data suggests that iron from ferric maltol can be absorbed at least as well as, or even more efficiently than, ferrous sulfate, thanks to its protected transport and targeted release in the small intestine.

ACCRUFeR is a newer, brand-name medication with a patented formulation that improves tolerability and absorption through its maltol shield. Standard iron supplements like ferrous sulfate are generic and have been available for a long time, making them significantly cheaper.

While ACCRUFeR is effective for many adults with iron deficiency, standard oral iron is often the first-line treatment. ACCRUFeR is particularly suited for those who experience intolerance to standard iron or have underlying conditions like IBD.

Yes, a key advantage of ACCRUFeR is its improved tolerability profile. Due to its unique mechanism, it generally causes fewer gastrointestinal side effects such as nausea, constipation, diarrhea, and abdominal pain compared to standard ferrous salt supplements.

The time it takes for ACCRUFeR to raise iron levels can vary depending on the individual and the severity of their iron deficiency. Consistent use as prescribed by a healthcare professional is important for achieving therapeutic benefits over time.