Accrufer (ferric maltol) is a prescription oral iron supplement used to treat iron deficiency in adults and children ages 10 and older. First approved by the FDA in 2019 for adults, it received expanded approval for pediatric patients as the first prescription oral medicine specifically indicated for iron deficiency in that age group.
How Accrufer Works
Unlike traditional iron supplements that use simple iron salts like ferrous sulfate, Accrufer pairs iron with a compound called maltol. This pairing keeps the iron tightly bound and stable as it travels through your digestive system. The iron only separates from the maltol when it reaches the absorption site in your gut, where transport receptors on the intestinal wall have an even stronger pull on the iron than the maltol does. Once released, the iron crosses into your bloodstream efficiently.
This design matters because free iron sitting in the gut is what causes the notorious side effects of most iron supplements: nausea, cramping, and constipation. By keeping the iron locked up until the moment of absorption, Accrufer aims to deliver iron where it’s needed while minimizing the irritation that makes many people quit their iron supplements.
What to Expect During Treatment
The standard dose is one 30 mg capsule taken twice a day. You need to take it on an empty stomach, either one hour before eating or two hours after a meal. The capsules should be swallowed whole, not opened, broken, or chewed.
Most people need at least 12 weeks of treatment, though your doctor may extend this depending on the severity of your deficiency. Clinical data from Health Canada’s review showed a meaningful hemoglobin increase of 1 g/dL as early as week four. Ferritin levels, which reflect your body’s iron stores, improved steadily from an average of 8.6 mcg/L at baseline to 26.0 mcg/L at week 12. Treatment typically continues until ferritin levels return to the normal range.
Side Effects
In clinical trials involving 175 patients with inflammatory bowel disease or chronic kidney disease, the most common side effects were constipation (4%) and nausea (1.7%). For comparison, less than 1% of patients taking a placebo reported constipation. These rates are generally lower than what’s typically seen with traditional iron salts, which is a key reason Accrufer exists as an alternative for people who can’t tolerate standard supplements.
That said, gastrointestinal side effects can still happen. If constipation or nausea becomes bothersome, it’s worth discussing with your prescriber rather than stopping on your own, since iron stores take weeks to rebuild.
Who Should Not Take Accrufer
Accrufer is not safe for everyone. It is specifically contraindicated in three situations:
- Iron overload conditions. People with hemochromatosis or other syndromes that cause the body to accumulate too much iron should not take Accrufer, as it could push iron levels to dangerous highs.
- Repeated blood transfusions. Transfused blood delivers a significant iron load on its own. Adding oral iron on top of that can lead to iron overload.
- Allergy to the medication. Anyone with a history of hypersensitivity to ferric maltol or any of its inactive ingredients should avoid it. Severe allergic reactions, including dangerously low blood pressure and loss of consciousness, are possible.
How Accrufer Differs From Over-the-Counter Iron
Standard iron supplements you can buy without a prescription typically contain ferrous sulfate, ferrous gluconate, or ferrous fumarate. These are effective at raising iron levels, but many people struggle with side effects severe enough to stop taking them. Stomach pain, dark stools, constipation, and nausea are common complaints.
Accrufer’s chelated formulation was designed specifically to address this tolerability problem. Because the iron stays bound to maltol through the digestive tract, less free iron comes into contact with the stomach and intestinal lining. This makes it a practical option for people who genuinely cannot tolerate cheaper over-the-counter alternatives, particularly those with underlying gut conditions like inflammatory bowel disease where intestinal irritation is already a concern. It’s a prescription medication, so it typically costs more than drugstore iron supplements and requires a doctor’s involvement.
Practical Tips for Taking It
The empty stomach requirement is important. Food can interfere with how much iron your body absorbs from Accrufer. Many people find it easiest to take the first capsule in the morning before breakfast and the second in the late afternoon before dinner, building it into their daily routine.
If you’re also taking antacids or medications that reduce stomach acid, talk to your prescriber about timing, since these can affect iron absorption. The same applies to certain antibiotics and thyroid medications, which can interact with iron products in general. Spacing doses apart from other medications by at least two hours is a common strategy, but your doctor or pharmacist can give you a schedule tailored to everything you’re taking.