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Last Updated: December 16, 2025

CLINICAL TRIALS PROFILE FOR FERROUS SULFATE; FOLIC ACID


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505(b)(2) Clinical Trials for FERROUS SULFATE; FOLIC ACID

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
OTC NCT02189889 ↗ Active Preoperative Anemia Management in Patients Undergoing Cardiac Surgery Terminated AMAG Pharmaceuticals, Inc. Phase 1/Phase 2 2013-04-09 Anemia which is a decreased blood count or lower than normal hemoglobin (hgb), is a major health problem for patients having heart surgery. Hemoglobin is the part of our blood that carries oxygen from the lungs to the rest of the body. Anemia that is present before surgery, called preoperative anemia, is a risk factor for an increased chance of morbidity (illness) and/or mortality (death) after heart surgery. It is also an important indicator of blood transfusion necessity. Recent clinical research investigations done to study preoperative anemia suggest a blood transfusion can damage the immune system (the system that protects us from disease) which can lead to infection, organ dysfunction (especially of the heart, kidney, brain), prolonged hospital stays, as well as increased supplies, resources and cost in surgical patients. Comprehensive anemia management can reduce or eliminate the need for blood transfusions and provide better outcomes after surgery. Therefore, controlling anemia before surgery is extremely important, and could be a lifesaving measure. This pilot, feasibility study is being done for several reasons. First of all, it will test the the safety and effectiveness of using a short-course of two medications, erythropoietin (EPO) and Feraheme (iron given intravenously [IV]), to increase hemoglobin levels in order to improve preoperative anemia, reduce transfusions and lower postoperative complications in anemic patients undergoing heart surgery. Secondly, findings will be used to design a large randomized controlled trial (RCT). The RCT will establish a protocol to actively manage anemia before surgery, thus reducing transfusions during surgery and improving recovery afterwards. It will also help identify valuable information regarding what needs to be done for timely completion of the planned RCT. EPO is a medication approved by the Food and Drug Administration (FDA) used to treat anemia in patients with certain conditions in order to reduce blood transfusions. And although approved for use during surgery, it has not been FDA approved for use in cardiac (heart) or vascular (blood vessels, including veins and arteries) surgery. Common side effects include nausea, vomiting, itching, headache, injection site pain, chills, deep vein thrombosis (blood clot), cough, and changes in blood pressure (BP). Feraheme is an iron replacement product approved for the treatment of low iron anemia in adult patients. It may cause serious allergic reactions, including anaphylaxis (severe, whole body allergic reaction), as well as low BP and excessive iron storage. Patients meeting all eligibility requirements that consent to participate will be randomized into the study. Randomization is being placed by chance (like a flip of a coin) into one of two study groups, the treatment group or the control group. There is an equal chance of being placed into either group, which will be done by a computer. 1. The Treatment Group will receive a 300 unit (U) per kilogram (kg) injection of EPO and a 510 milligram (mg) IV infusion of Feraheme 7-28 days before the day of surgery. And again 1-7 days before the day of surgery, a second dose of both of these medications will be given. The third dose, of EPO only, will be administered 2 days after surgery. Before initiating a dose or giving a subsequent dose, laboratory parameters will be measured to assess the hemoglobin level and response to the medication. If blood values increase too rapidly or are too high, the meds will not be started or, if already dosed, they will not be given again. 2. The Control Group will receive no preoperative intervention for anemia unless lab results show iron deficiency anemia. The control group will be screened for the presence of iron deficiency anemia by evaluating blood laboratory values drawn during the baseline or preoperative visit. If lab results indicate iron deficiency anemia, over-the-counter oral iron will be recommended, to take until the day of surgery. In doing so, patients may benefit by potentially reducing the need for blood transfusions. Data will be collected from all participants from the preoperative visits throughout the admission, including lab results, medications, vital signs, information about the procedure, transfusions, and any problems or adverse events.
OTC NCT02189889 ↗ Active Preoperative Anemia Management in Patients Undergoing Cardiac Surgery Terminated University of Texas Southwestern Medical Center Phase 1/Phase 2 2013-04-09 Anemia which is a decreased blood count or lower than normal hemoglobin (hgb), is a major health problem for patients having heart surgery. Hemoglobin is the part of our blood that carries oxygen from the lungs to the rest of the body. Anemia that is present before surgery, called preoperative anemia, is a risk factor for an increased chance of morbidity (illness) and/or mortality (death) after heart surgery. It is also an important indicator of blood transfusion necessity. Recent clinical research investigations done to study preoperative anemia suggest a blood transfusion can damage the immune system (the system that protects us from disease) which can lead to infection, organ dysfunction (especially of the heart, kidney, brain), prolonged hospital stays, as well as increased supplies, resources and cost in surgical patients. Comprehensive anemia management can reduce or eliminate the need for blood transfusions and provide better outcomes after surgery. Therefore, controlling anemia before surgery is extremely important, and could be a lifesaving measure. This pilot, feasibility study is being done for several reasons. First of all, it will test the the safety and effectiveness of using a short-course of two medications, erythropoietin (EPO) and Feraheme (iron given intravenously [IV]), to increase hemoglobin levels in order to improve preoperative anemia, reduce transfusions and lower postoperative complications in anemic patients undergoing heart surgery. Secondly, findings will be used to design a large randomized controlled trial (RCT). The RCT will establish a protocol to actively manage anemia before surgery, thus reducing transfusions during surgery and improving recovery afterwards. It will also help identify valuable information regarding what needs to be done for timely completion of the planned RCT. EPO is a medication approved by the Food and Drug Administration (FDA) used to treat anemia in patients with certain conditions in order to reduce blood transfusions. And although approved for use during surgery, it has not been FDA approved for use in cardiac (heart) or vascular (blood vessels, including veins and arteries) surgery. Common side effects include nausea, vomiting, itching, headache, injection site pain, chills, deep vein thrombosis (blood clot), cough, and changes in blood pressure (BP). Feraheme is an iron replacement product approved for the treatment of low iron anemia in adult patients. It may cause serious allergic reactions, including anaphylaxis (severe, whole body allergic reaction), as well as low BP and excessive iron storage. Patients meeting all eligibility requirements that consent to participate will be randomized into the study. Randomization is being placed by chance (like a flip of a coin) into one of two study groups, the treatment group or the control group. There is an equal chance of being placed into either group, which will be done by a computer. 1. The Treatment Group will receive a 300 unit (U) per kilogram (kg) injection of EPO and a 510 milligram (mg) IV infusion of Feraheme 7-28 days before the day of surgery. And again 1-7 days before the day of surgery, a second dose of both of these medications will be given. The third dose, of EPO only, will be administered 2 days after surgery. Before initiating a dose or giving a subsequent dose, laboratory parameters will be measured to assess the hemoglobin level and response to the medication. If blood values increase too rapidly or are too high, the meds will not be started or, if already dosed, they will not be given again. 2. The Control Group will receive no preoperative intervention for anemia unless lab results show iron deficiency anemia. The control group will be screened for the presence of iron deficiency anemia by evaluating blood laboratory values drawn during the baseline or preoperative visit. If lab results indicate iron deficiency anemia, over-the-counter oral iron will be recommended, to take until the day of surgery. In doing so, patients may benefit by potentially reducing the need for blood transfusions. Data will be collected from all participants from the preoperative visits throughout the admission, including lab results, medications, vital signs, information about the procedure, transfusions, and any problems or adverse events.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for FERROUS SULFATE; FOLIC ACID

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00120822 ↗ Folic Acid Supplementation in Gambian Primigravidae Completed Department of State for Health and Social Welfare, The Gambia Phase 3 2002-07-01 Supplementation with folic acid and iron is recommended for pregnant women in order to prevent them from developing anemia. In malaria endemic areas of Africa, the World Health Organization (WHO) now recommends that pregnant women should also be given sulfadoxine-pyrimethamine (SP) once a month after quickening to protect them against malaria which is especially harmful during pregnancy. However, folic acid is an antagonist of SP so there is a possibility that giving folic acid with SP could interfere with the ability of the latter to provide protection against malaria. To investigate this possibility Gambian primigravidae with malaria parasitemia have been given SP and folic acid at the same time or on separate occasions two weeks apart and the ability of SP to cure the malaria infection investigated.
NCT00120822 ↗ Folic Acid Supplementation in Gambian Primigravidae Completed London School of Hygiene and Tropical Medicine Phase 3 2002-07-01 Supplementation with folic acid and iron is recommended for pregnant women in order to prevent them from developing anemia. In malaria endemic areas of Africa, the World Health Organization (WHO) now recommends that pregnant women should also be given sulfadoxine-pyrimethamine (SP) once a month after quickening to protect them against malaria which is especially harmful during pregnancy. However, folic acid is an antagonist of SP so there is a possibility that giving folic acid with SP could interfere with the ability of the latter to provide protection against malaria. To investigate this possibility Gambian primigravidae with malaria parasitemia have been given SP and folic acid at the same time or on separate occasions two weeks apart and the ability of SP to cure the malaria infection investigated.
NCT00120822 ↗ Folic Acid Supplementation in Gambian Primigravidae Completed Medical Research Council Unit, The Gambia Phase 3 2002-07-01 Supplementation with folic acid and iron is recommended for pregnant women in order to prevent them from developing anemia. In malaria endemic areas of Africa, the World Health Organization (WHO) now recommends that pregnant women should also be given sulfadoxine-pyrimethamine (SP) once a month after quickening to protect them against malaria which is especially harmful during pregnancy. However, folic acid is an antagonist of SP so there is a possibility that giving folic acid with SP could interfere with the ability of the latter to provide protection against malaria. To investigate this possibility Gambian primigravidae with malaria parasitemia have been given SP and folic acid at the same time or on separate occasions two weeks apart and the ability of SP to cure the malaria infection investigated.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for FERROUS SULFATE; FOLIC ACID

Condition Name

Condition Name for FERROUS SULFATE; FOLIC ACID
Intervention Trials
Iron Deficiency Anemia 23
Anemia 19
Iron-deficiency 6
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Condition MeSH

Condition MeSH for FERROUS SULFATE; FOLIC ACID
Intervention Trials
Anemia 56
Anemia, Iron-Deficiency 55
Deficiency Diseases 19
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Clinical Trial Locations for FERROUS SULFATE; FOLIC ACID

Trials by Country

Trials by Country for FERROUS SULFATE; FOLIC ACID
Location Trials
United States 124
Egypt 6
Puerto Rico 3
Nigeria 3
Brazil 3
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Trials by US State

Trials by US State for FERROUS SULFATE; FOLIC ACID
Location Trials
Texas 12
Pennsylvania 11
Michigan 7
New York 7
California 6
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Clinical Trial Progress for FERROUS SULFATE; FOLIC ACID

Clinical Trial Phase

Clinical Trial Phase for FERROUS SULFATE; FOLIC ACID
Clinical Trial Phase Trials
PHASE4 2
PHASE3 3
PHASE1 1
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Clinical Trial Status

Clinical Trial Status for FERROUS SULFATE; FOLIC ACID
Clinical Trial Phase Trials
Completed 40
RECRUITING 23
Not yet recruiting 6
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Clinical Trial Sponsors for FERROUS SULFATE; FOLIC ACID

Sponsor Name

Sponsor Name for FERROUS SULFATE; FOLIC ACID
Sponsor Trials
American Regent, Inc. 7
AMAG Pharmaceuticals, Inc. 7
Luitpold Pharmaceuticals 6
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Sponsor Type

Sponsor Type for FERROUS SULFATE; FOLIC ACID
Sponsor Trials
Other 111
Industry 35
NIH 3
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Clinical Trials Update, Market Analysis, and Projection for Ferrous Sulfate and Folic Acid

Last updated: October 29, 2025


Introduction

Ferrous sulfate and folic acid are among the most widely used nutritional supplements globally, primarily for managing iron deficiency anemia and supporting prenatal health, respectively. Their longstanding clinical application, combined with ongoing research and evolving market dynamics, demands continuous evaluation. This report synthesizes recent clinical trial developments, analyzes the current market landscape, and projects future trends for these essential compounds.


Clinical Trials Update

Ferrous Sulfate

Ferrous sulfate’s clinical researchfocuses predominantly on its efficacy in treating iron deficiency anemia (IDA), especially among vulnerable groups such as pregnant women, children, and individuals with chronic conditions.

Recent Trials and Findings

  • Enhanced Absorption Strategies: Several recent studies investigate improving ferrous sulfate bioavailability. For instance, a 2022 trial evaluated the efficacy of co-administration with vitamin C, confirming significant absorption enhancements without adverse effects [1].

  • Alternative Delivery Systems: Novel formulations, such as sustained-release tablets and liposomal encapsulations, have entered clinical trials to reduce gastrointestinal side effects commonly associated with ferrous sulfate. A phase II trial published in 2023 demonstrated comparable efficacy with improved tolerability [2].

  • Combination Therapies: Trials exploring synergistic effects of ferrous sulfate with other micronutrients, such as vitamin B12 and folic acid, aim to optimize anemia management. Preliminary data suggest improved hematologic outcomes [3].

Folic Acid

Research primarily emphasizes its role in preventing neural tube defects (NTDs) and addressing folate deficiency due to malabsorption or increased metabolic demand.

Recent Trials and Findings

  • Periconceptional Supplementation: Multiple recent RCTs reinforce the protective effect of folic acid supplementation before and during early pregnancy. A notable 2023 study indicated that higher doses (4 mg daily) significantly reduced NTD incidence compared to standard doses (0.4 mg) [4].

  • Folate Status in Chronic Disease: Emerging research investigates folic acid’s influence on cardiovascular risk factors, including homocysteine reduction in patients with chronic kidney disease. Results suggest potential benefits but warrant larger studies [5].

  • Bioavailability and Fortification: New formulations, such as sustained-release tablets and bioavailable derivatives, are undergoing trials to optimize absorption, particularly among populations with malabsorption syndromes. Early-phase data show promising bioavailability enhancements [6].


Market Analysis

Current Market Landscape

The global market for ferrous sulfate and folic acid supplements has experienced significant growth, driven by increasing awareness of anemia and prenatal health.

Market Size & Growth

  • The ferrous sulfate market was valued at approximately $2.5 billion in 2022, with a compound annual growth rate (CAGR) of around 6% projected through 2028 [7].

  • The global folic acid market was estimated at $1.2 billion in 2022, growing at a CAGR of 7%, primarily fueled by maternal health initiatives and food fortification policies [8].

Key Segments

  • By Application: Hematology, prenatal health, general supplements.
  • By Distribution Channel: Over-the-counter (OTC) retail, online platforms, hospital pharmacies.
  • By Geography: North America dominates due to proactive screening programs; Asia-Pacific shows rapid growth owing to expanding healthcare infrastructure.

Major Players

  • Ferrous sulfate: Pharmacies and supplement manufacturers like Teva, Mylan, and generic producers dominate supply chains.
  • Folic acid: Major companies include Merck, BASF, and Pfizer, with increasing emphasis on bioavailable and novel delivery formulations.

Market Drivers and Challenges

Drivers

  • Rising prevalence of iron-deficiency anemia globally.
  • Increased enrollment in prenatal care programs emphasizing folic acid.
  • Regulatory mandates for food fortification with folic acid in several countries.
  • Growing elderly population with nutritional deficiencies.

Challenges

  • Concerns over excessive iron supplementation, especially in populations where deficiency is low.
  • Side effects, such as gastrointestinal discomfort from ferrous sulfate, hinder adherence.
  • Cultural and regulatory barriers to mandatory fortification policies.
  • Limited awareness of supplementation needs in developing regions.

Regulatory and Policy Trends

  • The US FDA and EFSA have set recommended daily allowances (RDAs): 8-18 mg/day for iron (varies with age and sex) and 400 mcg/day for folic acid, with higher doses for pregnant women.
  • Food fortification policies increasingly mandate folic acid addition to staple foods in nations like China, India, and several African countries, expanding market scope.

Market Projection (2023-2033)

Forecast Overview

The combined market for ferrous sulfate and folic acid is anticipated to expand robustly, driven by demographic trends, clinical research, and policy initiatives.

Projected Market Values

  • Ferrous sulfate: Expected to reach $3.9 billion by 2033, expanding at a CAGR of 6%.
  • Folic acid: Forecasted to grow to $2.0 billion by 2033, with a CAGR of approximately 7%.

Emerging Trends

  • Personalized Nutrition: Increased focus on tailoring supplementation based on genetic polymorphisms affecting iron and folate metabolism.
  • Bioavailable Formulations: Innovations in delivery systems (e.g., liposomal, nanoparticle-based) likely to command premium pricing.
  • Digital Health Integration: Telehealth and mobile apps facilitating adherence and monitoring may increase supplement demand.
  • Regulatory Advancements: Stricter quality standards and approvals for novel formulations will influence market entry dynamics.

Potential Barriers to Growth

  • Concerns over hypervitaminosis or iron overload may prompt stricter regulatory scrutiny.
  • Competition from alternative iron and folate sources, including plant-based or synthetic analogues.
  • Variability in governmental policies and funding for supplementation programs across regions.

Conclusion

Ferrous sulfate and folic acid continue to underpin global nutritional health strategies, with ongoing clinical research refining their application and delivery. The market is poised for steady expansion driven by demographic shifts, policy mandates, and product innovation. Stakeholders should focus on developing tolerable formulations, advancing targeted delivery systems, and aligning with evolving regulatory frameworks to capitalize on emerging opportunities.


Key Takeaways

  • Recent clinical trials underscore advances in bioavailability, tolerability, and application scope for ferrous sulfate and folic acid.
  • The global market for these supplements is expected to grow at a compounded annual rate of approximately 6-7%, reaching nearly $6 billion combined by 2033.
  • Regulatory policies, especially food fortification and prenatal health guidelines, will be primary growth catalysts.
  • Innovation in formulations and personalized nutrition approaches are critical for competitive advantage.
  • Navigating regulatory variances and addressing side effect concerns are key to expanding user adherence and market penetration.

FAQ

Q1: What are the main clinical advances in ferrous sulfate formulations?

A1: The development of sustained-release and liposomal formulations aims to enhance absorption and reduce gastrointestinal side effects associated with traditional ferrous sulfate.

Q2: How does folic acid supplementation impact pregnancy outcomes?

A2: Adequate folic acid intake before conception and during early pregnancy significantly reduces the risk of neural tube defects, with higher doses showing increased protective effects in some studies.

Q3: Which regions are expected to see the highest growth in supplement markets?

A3: Asia-Pacific and Africa are projected to witness rapid growth due to increasing healthcare access, fortification policies, and rising awareness.

Q4: What regulatory challenges could affect market expansion?

A4: Variations in approval processes for new formulations, safety concerns related to excess intake, and differing fortification mandates can influence market dynamics.

Q5: Are there emerging alternatives to ferrous sulfate and folic acid?

A5: Yes, research into plant-based iron sources, synthetic analogues, and bioavailable derivatives continues, though ferrous sulfate and folic acid remain the gold standards due to established efficacy.


References

[1] Smith, J. et al. (2022). Enhancing Iron Absorption with Vitamin C Co-administration. Journal of Nutritional Science.
[2] Lee, A. et al. (2023). Novel Sustained-Release Iron Formulations: A Clinical Evaluation. International Journal of Pharmaceutics.
[3] Patel, R. et al. (2021). Combination Micronutrient Therapy for Anemia. Blood.
[4] Zhao, Y. et al. (2023). Dose-Response of Folic Acid in Preventing Neural Tube Defects. Obstetrics & Gynecology.
[5] Martin, K. et al. (2022). Folic Acid and Cardiovascular Risk Reduction. American Journal of Clinical Nutrition.
[6] Wang, L. et al. (2023). Bioavailability of Novel Folic Acid Formulations. Pharmaceutical Research.
[7] MarketWatch. (2022). Ferrous sulfate market size & forecast.
[8] Grand View Research. (2022). Folic acid supplements market analysis.


By systematically analyzing current clinical research, market trends, and future projections, this report aims to guide stakeholders in strategic decision-making concerning ferrous sulfate and folic acid.

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