For decades intravenous iron was considered dangerous. Newer formulations with carbohydrate cores binding elemental iron more tightly allow complete iron replacement within 15–60 min in one visit. Meta-analyses and prospective comparisons of different formulations support equivalent safety to placebo with less toxicity than oral iron. Of the available formulations, the preponderance of published evidence supports equal safety and efficacy. In this Viewpoint, we report evidence supporting repositioning of intravenous iron to the frontline in multiple disorders with iron deficiency, which include heart failure, chronic kidney disease, inflammatory bowel disease, patient blood management in the perioperative period, and obstetrics and gynaecology. We have also highlighted neonatal evidence supporting the inadequacy of oral iron in late pregnancy, a critical period of iron need for normal foetal brain development. Physicians should consider prioritising the use of intravenous iron rather than oral iron as a treatment for iron deficiency in some of these clinical scenarios.

几十年来，静脉注射铁被认为是危险的。较新的具有碳水化合物核心的配方可以更紧密地结合元素铁，一次就可以在15-60分钟内完全替代铁。荟萃分析和不同制剂的前瞻性比较支持与安慰剂同等的安全性，且毒性低于口服铁剂。在可用的制剂中，多数已发表的证据支持同等的安全性和有效性。在这一观点中，我们报告了支持在多种缺铁性疾病中将静脉内铁重新定位到一线的证据，这些疾病包括心力衰竭，慢性肾脏疾病，炎症性肠病，围手术期的患者血液管理以及妇产科。我们还强调了新生儿证据支持妊娠晚期口腔铁的不足，正常胎儿大脑发育需要铁的关键时期。在某些临床情况下，医师应考虑优先使用静脉铁剂而非口服铁剂治疗铁缺乏症。