Why Ferric Citrate is the Ideal Solution for Iron Deficiency Anemia in Bangladesh: Benefits and Potentials?

Anemia, a condition characterized by a deficiency of red blood cells or hemoglobin, is a significant public health issue worldwide. It affects nearly a third of the global population and impacts individual health, productivity, and economic growth. One of the most prevalent causes of anemia is iron deficiency, which can result in fatigue, weakness, cognitive impairments, and even cardiovascular complications if left untreated. Severe cases may cause shortness of breath, pallor, and loss of consciousness, among other symptoms. In Bangladesh, anemia continues to affect millions, particularly women and children.
According to a recent meta-analysis, 46.8% of children and adolescents in Bangladesh suffer from anemia, with an even higher prevalence among children under two (61%). In this context, the role of Ferric Citrate as a treatment option for iron deficiency anemia (IDA) in Bangladesh is gaining significant attention.

This blog explores the potential of ferric citrate as an alternative to traditional iron supplements, its benefits, usage, and future implications in addressing the widespread iron deficiency problem in Bangladesh.

The Global and National Burden of Anemia

Anemia is a pressing health challenge across the globe, affecting women of reproductive age, pregnant women, and young children the most. These populations are at a higher risk of developing anemia due to increased nutritional demands and limited access to essential nutrients like iron.
In Bangladesh, where the diet is largely based on rice and lacks diversity in iron-rich foods, iron deficiency anemia remains a prevalent concern. A study has found that 41% of women aged 15–49 are anemic, with rural and low-income communities being the most affected [8]. Furthermore, children under five are particularly vulnerable, with 40% of children aged 6-59 months suffering from iron deficiency [6].

Despite efforts to address iron deficiency, such as public health programs and iron supplementation, the burden of anemia persists in Bangladesh. Inadequate diets, poor hygiene, infections, and parasitic infestations are some of the key factors contributing to the country’s high anemia rates. The limited effectiveness of traditional iron supplements, such as ferrous sulfate and ferrous fumarate, due to side effects like nausea, constipation, and gastrointestinal discomfort, further complicates efforts to reduce anemia rates.

Iron Deficiency and the Importance of Supplementation

Iron deficiency is the primary cause of anemia worldwide, and addressing it through proper supplementation is crucial in reducing the prevalence of anemia, especially among high-risk groups. In Bangladesh, iron supplements such as ferrous sulfate, ferrous fumarate, and iron sucrose are commonly prescribed to treat iron deficiency anemia. While effective, these supplements often cause gastrointestinal side effects, leading to poor adherence to the prescribed regimen.

This is where Ferric Citrate offers a promising solution. Ferric Citrate (also known as Iron(3+) citrate or Citric acid iron(III) salt) is an iron compound that has gained attention for its effectiveness in treating iron deficiency anemia with fewer side effects. Unlike ferrous sulfate, which can cause significant gastrointestinal issues, Ferric Citrate is better tolerated by the body, making it an ideal alternative for individuals who struggle with other iron supplements.

The Market Landscape of Iron Supplements in Bangladesh

Despite the many iron supplements available, ferric citrate remains a relatively new entrant in the Bangladeshi market, approved only in 2022. In contrast, other iron APIs like ferrous sulfate, ferrous fumarate, and iron sucrose have been available for decades, with multiple local manufacturers producing these compounds. According to data from the Directorate General of Drug Administration (DGDA), the following iron APIs are used in Bangladesh, with their approval dates and the number of local manufacturers:

While ferrous sulfate remains the most widely produced iron supplement, its side effects and poor patient compliance have created a need for alternative options like ferric citrate. Despite being newer to the market, ferric citrate holds significant promise for improving treatment outcomes due to its better tolerability and safer profile.

Despite these challenges, West Bengal chemical Industries Limited has been actively seeking new and improved iron APIs. However, efforts to find a superior alternative that effectively balances safety and efficacy have yet to yield significant results. This ongoing gap highlights the urgent need for more research and innovation in the field of iron supplementation.

WBCIL’s ferric citrate has emerged as a promising alternative, offering significant clinical benefits and improved tolerability compared to traditional iron salts. Its unique dual mechanism of action—both supplementing iron and acting as a phosphate binder—makes it a safer and more effective approach for managing iron deficiency anemia.

The current market landscape in Bangladesh reveals a notable disparity between the prevalence of older iron APIs and the availability of newer, more advanced alternatives.
Despite the wide availability of various iron APIs on the market, the search for an ideal formulation that combines maximum efficacy with minimal side effects continues to be elusive. Iron salts such as ferrous sulfate, ferrous fumarate, and iron sucrose are produced by a large number of manufacturers — 130 for ferrous sulfate, 20 for ferrous fumarate, and 23 for iron sucrose. However, these widely used compounds often come with significant gastrointestinal side effects, poor absorption, and low patient compliance, which ultimately lead to suboptimal treatment outcomes. As a result, iron deficiency anemia (IDA) remains a persistent public health challenge, particularly in countries like Bangladesh, where an optimal solution is still lacking.

The current market landscape in Bangladesh reveals a notable disparity between the prevalence of older iron APIs and the availability of newer, more advanced alternatives. As illustrated in the data, ferrous sulfate, introduced in the 1970s, is the most widely produced iron supplement, with 130 manufacturers. Ferrous fumarate and ferrous gluconate, both introduced in the 1980s, are produced by 20 and 7 manufacturers, respectively. Likewise, iron sucrose, approved in the 2000s, is manufactured by 23 companies, while iron (III) hydroxide polymaltose, introduced in the same decade, is produced by 13 manufacturers. The more recent ferric maltol, approved in the 2020s, is produced by 10 companies. In contrast, ferric citrate, approved only in 2022, is produced by just three manufacturers, highlighting its limited market penetration despite its clinical advantages.

A concerted effort to build a stronger platform for ferric citrate, coupled with broader adoption by healthcare providers, could position it as a leading choice in the management of iron deficiency anemia. This would ultimately contribute to better patient outcomes and address the ongoing gaps in iron supplementation efforts.

The Promise of Ferric Citrate

Despite the widespread use of ferrous sulfate and other iron supplements in Bangladesh, their frequent side effects have significantly impacted patient adherence and therapeutic outcomes. As a result, iron deficiency anemia remains a persistent public health challenge. The need for a more tolerable and effective iron supplement is clear.

Ferric Citrate (also known as Ferric Ammonium Citrate or Iron(3+) Citrate) has emerged as a promising alternative with several advantages over traditional iron supplements. Its unique characteristics make it an attractive choice for addressing iron deficiency anemia in Bangladesh, where poor adherence to traditional iron supplements is a key issue.

1. Better Tolerability: One of the primary advantages of ferric citrate is its low incidence of side effects, especially gastrointestinal discomfort. Studies show that ferric citrate is well tolerated, with mild gastrointestinal effects compared to other iron salts like ferrous sulfate and ferrous fumarate. This makes it a more viable option for long-term treatment, particularly for vulnerable groups such as pregnant women and children.
2. Dual Mechanism of Action: Unlike other iron supplements, ferric citrate also acts as a phosphate binder, which is especially beneficial for individuals with chronic kidney disease (CKD). This dual action provides added value in treating patients with both iron deficiency anemia and high phosphate levels, a common issue in CKD.
3. Controlled Iron Release: Ferric citrate provides controlled iron release, which helps reduce the risk of oxidative stress—a concern with traditional iron supplements that use ferrous salts (Fe²⁺). This controlled release mechanism ensures a steady supply of iron without overwhelming the body.

In Bangladesh, iron deficiency anemia (IDA) is a critical public health issue, with high prevalence rates, particularly among children, pregnant women, and lactating mothers. Despite the availability of various iron supplements, such as ferrous sulfate and iron sucrose, these traditional forms of iron supplementation often cause significant gastrointestinal side effects, such as nausea, constipation, and abdominal discomfort, which limit patient adherence and treatment efficacy. Given these challenges, there is an urgent need for a safer and more effective solution to combat iron deficiency. Ferric citrate, as a newer iron supplement, offers a promising alternative. It has been shown to have improved tolerability, with fewer side effects compared to conventional iron salts like ferrous sulfate. Moreover, ferric citrate not only provides effective iron supplementation but also acts as a phosphate binder, offering an added benefit for those with concurrent conditions like chronic kidney disease. Its unique properties make it an ideal choice for the diverse and vulnerable populations in Bangladesh who need a high-quality ferric citrate API for optimal treatment.

Significance of West Bengal chemical industries Limited as the best Ferric Citrate Manufacturer in India

As we witness the growing demand for ferric citrate in Bangladesh, the need for reliable, pharmacologically compliant active pharmaceutical ingredients (APIs) becomes even more critical. In the expanding market for iron supplements, it is essential for ferric citrate API suppliers to adhere to strict industry standards, including Good Manufacturing Practices (GMP), and comply with USP/BP/EP pharmacopoeial guidelines to ensure the safety and efficacy of the products. That’s where West Bengal Chemical Industries Limited comes in as a trusted and experienced manufacturer of ferric citrate.

With our years of expertise in the pharmaceutical industry, we at West Bengal Chemical Industries Limited are proud to supply high-quality ferric citrate APIs that meet both local and international regulatory requirements. By sourcing ferric citrate API in bulk from us, pharmaceutical companies in Bangladesh can be confident of receiving consistent and reliable products for treating iron deficiency anemia (IDA). We understand the critical nature of iron supplementation in regions like Bangladesh, and we take pride in offering products that align with global health standards.

Our commitment goes beyond just providing ferric citrate. We ensure that all our products are fully supported with comprehensive documentation, including MSDS (Material Safety Data Sheets) and COA (Certificate of Analysis). This not only gives our clients the assurance of product quality but also demonstrates our full compliance with international standards. As the demand for ferric citrate continues to rise, West Bengal Chemical Industries Limited remains a trusted partner in supplying ferric citrate APIs that meet the highest standards of quality and safety.

Our dedication to GMP compliance and regulatory adherence makes us a leading player in ensuring that iron supplementation continues to make a positive impact on public health outcomes in both Bangladesh and India. We are committed to supporting the fight against iron deficiency anemia and helping improve health outcomes for millions across the region.