Sustainable practice: Sustainable prescribing of iron replacement therapy
BMJ 2023; 383 doi: https://doi.org/10.1136/bmj-2023-075741 (Published 06 November 2023) Cite this as: BMJ 2023;383:e075741Linked Editorial
Sustainable practice: what can I do?
- Myles Sergeant, assistant clinical professor, director of postgraduate medical education for sustainable healthcare1,
- Jennifer Do, pharmacist2,
- Ana Hategan
, clinical professor, geriatric psychiatrist3
- 1Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- 2Medication Information, Quality, and Safety (MedIQS), Pharmacy Department, Sunnybrook HSC, Toronto, Ontario, Canada
- 3Division of Geriatric Psychiatry, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Correspondence to M Sergeant sergean{at}hhsc.ca
- This article is part of a series that offers practical actions clinicians can take to support reaching net zero. Browse all the articles at https://sandpit.bmj.com/graphics/2023/tangibleActions-v8/. To pitch your idea for an article go to https://bit.ly/46Etl9i
What you need to know
When oral iron is indicated for iron deficiency and iron deficiency anaemia, consider prescribing one pill either daily or on alternate days instead of multiple pills daily
Consider dietary and drug interactions, eg, proton pump inhibitors, as a cause of iron deficiency; optimising iron absorption per pill can lead to a reduction in dosing as well as the associated carbon footprint of medications
Avoid checking ferritin levels if there is no clear indication
Treatment of iron deficiency (with or without anaemia) is an area where clinicians can implement updated recommendations on dose and frequency of iron supplementation that can have a clinical benefit for patients and also help mitigate environmental harms from healthcare practices.
Why change is needed
Production and use of medications represent 12-25% of the greenhouse gas emissions from healthcare, the largest item in the supply chain with respect to carbon footprint.12 An accessible entry point for clinicians to reduce their environmental impact is to focus on optimising prescribing.
Iron deficiency is a continuum that starts with iron depletion from the body’s stores, which can progress to anaemia. Iron deficiency affects an estimated 2 billion people and is one of the leading risk factors for disability and death worldwide.3 The British Society of Gastroenterology recently updated its guidelines for management of iron deficiency anaemia.4 Recommendations now include dosing iron once daily or on alternate days instead of two to three times daily.4 These changes provide an opportunity for clinicians to reassess how they prescribe iron supplements and to include environmental considerations in their thought process. Few systematic analyses are available that consider the environmental impact of the medication life cycle, but clinicians can treat patients and reduce their carbon footprint by prescribing fewer medications along with ordering fewer …