What can I take instead of ACCRUFER?: An Overview of Iron Deficiency Alternatives

October 7, 2025 •

4 min read

Up to 70% of patients report discontinuing traditional oral iron supplements due to gastrointestinal (GI) side effects, prompting many to ask, 'What can I take instead of ACCRUFER?'. While ACCRUFER is a well-tolerated prescription option, various other treatments are available depending on your specific health needs and tolerance.

Quick Summary

Alternatives to ACCRUFER for treating iron deficiency include various over-the-counter oral iron salts like ferrous sulfate, higher-absorption iron chelates, and intravenous iron infusions for more severe cases or intolerance. Dietary adjustments can also play a supportive role in management.

Key Points

Traditional oral iron salts: Inexpensive and effective, ferrous sulfate, ferrous gluconate, and ferrous fumarate are common over-the-counter options, though they can cause significant gastrointestinal distress.
Advanced oral formulations: Alternatives like iron amino-acid chelates or polysaccharide-iron complexes may offer improved absorption and better gastrointestinal tolerability for those sensitive to ferrous salts.
Intravenous (IV) iron therapy: Used for severe deficiency, oral iron intolerance, or malabsorption issues (like IBD), IV iron offers rapid replenishment but is more expensive and requires clinical administration.
Dietary modifications: Increasing intake of heme-iron rich foods (meat, fish) and combining non-heme iron sources (plants, legumes) with vitamin C can support iron levels, but diet alone is often insufficient for correcting a deficiency.
Medical consultation is crucial: All iron therapy decisions should be made in consultation with a healthcare provider to assess the underlying cause of iron deficiency and determine the most appropriate treatment, dose, and duration.
ACCRUFER vs. other options: Unlike cheaper generics, ACCRUFER is a brand-name prescription drug, making cost a significant factor for those seeking alternatives.

ACCRUFER (ferric maltol) is a newer, prescription-only oral iron supplement approved for iron deficiency with or without anemia. It is known for its better gastrointestinal tolerability compared to traditional oral iron formulations, making it a valuable option for patients who experience significant stomach upset. However, factors such as high cost, potential side effects, or poor absorption in certain conditions may lead patients to seek alternatives. This article explores the range of options available, from other oral supplements to more advanced therapies.

Oral Alternatives: Over-the-Counter (OTC) and Prescription

For many patients, especially those with mild to moderate iron deficiency, oral supplementation is the first-line treatment. Numerous options exist beyond ACCRUFER, varying in cost, absorption rates, and side effect profiles.

Traditional Ferrous Salts

Ferrous Sulfate: The most common and inexpensive oral iron supplement, widely available OTC. It's effective but has a high incidence of gastrointestinal side effects like nausea, constipation, and stomach upset.
Ferrous Gluconate: Another OTC option, often used for treating iron deficiency anemia. It is another form of ferrous salt, with similar efficacy and side effect profiles to ferrous sulfate, though some patients may find one form more tolerable than another.
Ferrous Fumarate: Another salt form of oral iron, also widely available.
Slow-Release Formulations: Some products, like Slow Fe, use a special coating to release iron more slowly in the digestive tract, which can help minimize GI side effects.

Advanced Oral Formulations

Polysaccharide-Iron Complexes: These formulations, such as Poly-Iron, are promoted for having a potentially lower metallic taste and less stomach upset compared to traditional ferrous salts.
Iron Amino-Acid Chelates (Ferrous Bisglycinate): This form of iron is chelated (bonded) to an amino acid, which can reduce dietary interactions and potentially lead to fewer side effects and better absorption. Thorne Iron Bisglycinate is an example of this type.
Heme Iron Polypeptides: Sourced from animal proteins, heme iron is absorbed differently and may offer superior absorption rates. However, it is not suitable for vegetarian or vegan diets.

Advanced Alternatives: Intravenous (IV) Iron

Intravenous (IV) iron therapy is a crucial alternative for patients who cannot tolerate oral iron, have severe iron deficiency requiring rapid repletion, or have conditions that impair iron absorption. It is administered in a clinical setting by healthcare professionals.

Indications: Recommended for patients with Inflammatory Bowel Disease (IBD) in an active flare-up, Chronic Kidney Disease (CKD), or after bariatric surgery, where oral iron may be ineffective or poorly tolerated.
Efficacy: IV iron delivers iron directly into the bloodstream, bypassing the gut, leading to a rapid and effective increase in iron stores.
Products: Common IV iron products include Iron Sucrose (Venofer), Ferric Carboxymaltose (Injectafer), and Ferumoxytol (Feraheme).
Considerations: While highly effective, IV iron is more costly and carries a small risk of allergic reactions, including anaphylaxis.

Comparison Table: ACCRUFER vs. Common Alternatives


Medication / Method	Type	Cost (Relative)	Key Benefit	Potential Drawback
ACCRUFER (Ferric Maltol)	Oral (Prescription)	High	Better gastrointestinal tolerability than ferrous salts.	Prescription required, high cost, potential for GI side effects.
Ferrous Sulfate	Oral (OTC / Generic)	Low	Inexpensive, widely available, effective.	High incidence of GI side effects (constipation, nausea).
Iron Amino-Acid Chelates	Oral (OTC)	Moderate	Less GI upset and fewer dietary interactions than ferrous salts.	May be more expensive than ferrous salts.
IV Iron (e.g., Injectafer)	Intravenous	Very High	Rapidly corrects severe iron deficiency, avoids GI tract.	Higher cost, requires clinical administration, potential for allergic reactions.

Non-Pharmacological Strategies

Dietary and lifestyle changes are supportive measures that can work alongside or in place of supplements, especially in milder cases or for long-term maintenance.

Increase Dietary Iron Intake

Heme Iron: Found in animal products like red meat, poultry, and fish. It is more readily absorbed by the body than non-heme iron.
Non-Heme Iron: Found in plant-based foods such as beans, lentils, spinach, and fortified cereals. To maximize absorption, pair these with a source of vitamin C. Cooking in a cast iron skillet can also increase the iron content of foods.

Optimize Absorption

Boost with Vitamin C: Consume vitamin C-rich foods (e.g., orange juice, tomatoes, bell peppers) with iron-rich meals or oral supplements to significantly enhance absorption.
Avoid Inhibitors: Substances like calcium (in dairy), tannins (in tea, coffee, wine), and phytates (in grains) can inhibit iron absorption. It's recommended to separate their consumption by a few hours.

Lifestyle Adjustments

Manage Underlying Conditions: For those with conditions like IBD, managing inflammation is key to improving iron status.
Rest and Exercise: Anemia can cause fatigue, so listening to your body and incorporating gentle, anemia-friendly exercises like walking or yoga is important.

Conclusion

Whether due to side effects, cost, or severity of the condition, numerous effective alternatives exist for patients seeking a substitute for ACCRUFER. The best choice depends on individual factors, including the underlying cause and severity of the deficiency, gastrointestinal tolerance, cost considerations, and how quickly iron levels need to be restored. A consultation with a healthcare provider is essential to determine the most appropriate and safe treatment plan for your specific needs.

For more detailed information on iron-related conditions, consult authoritative sources like the Cleveland Clinic website.

Frequently Asked Questions

The main difference lies in gastrointestinal tolerability. ACCRUFER (ferric maltol) is a newer prescription formulation designed to cause fewer GI side effects compared to standard, less expensive oral supplements like ferrous sulfate, which are known for often causing constipation and stomach pain.

IV iron is typically reserved for more severe cases, when rapid iron repletion is needed, or if a patient cannot tolerate oral iron due to severe GI issues, poor absorption (as with some inflammatory bowel diseases), or chronic kidney disease.

Switching to an OTC supplement like ferrous sulfate is possible, but you should do so under the guidance of a healthcare provider. The cheaper formulations may cause more significant GI side effects, and your doctor will need to monitor your iron levels to ensure the change is effective.

Yes, some alternatives like iron amino-acid chelates (e.g., ferrous bisglycinate) and polysaccharide-iron complexes are reported to have better absorption and less GI upset compared to traditional ferrous salts. Heme iron polypeptides also offer superior absorption.

Dietary changes can support iron levels, though they are often not enough to correct a deficiency alone. Consuming iron-rich foods (especially red meat and poultry for better-absorbed heme iron) and pairing them with vitamin C can boost absorption. Avoid substances like calcium, coffee, and tea around the time of iron consumption.

Yes, ACCRUFER and Feraccru contain the same active ingredient, ferric maltol. The difference is in branding and the regions where they are marketed; ACCRUFER is the brand name in the United States, while Feraccru is used in Europe and other markets.

While generally well-tolerated, common side effects of ACCRUFER can include gas, diarrhea, constipation, discolored stools, and stomach pain. Patients with Inflammatory Bowel Disease should be particularly cautious during a flare-up.