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Medication Considerrations

SUMMARY

  • There are certain medications that inhibit iron absorption.
  • Other medications are affected by iron.
  • Certain medications cause Mean Corpuscular Volume greater than 100fL.
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Which medications inhibit iron absorption?

Proton Pump Inhibitors

  • Omeprazole (Prilosec®)
  • Lansoprazole (Prevacid®)
  • Pantoprazole (Protonix®)
  • Esomeprazole (Nexium®)
  • Rabeprazole (Aciphex®)

Histamine-2 receptor antagonists (H2RAs) [H2 blockers]

  • Famotidine (Pepcid®)
  • Cimetidine (Tagamet®)
  • Nizatidine (Axid®, Tazac®)
  • Ranitidine (Zantac®)

Calcium carbonate

Calcium antacids

Anti-inflammatory drugs

  • Upadacitinib (Rinvoq®)
  • Turmeric/Curcumin

Antibiotics

  • Tetracycline
  • Doxycycline
  • Ciprofloxacin

Which medications are affected by iron?

Decreased absorption

  • Tetracyclines
  • Quinolones
  • Angiotensin-converting enzyme (ACE) inhibitors

Reduced effectiveness

  • Levothyroxine
  • Levodopa
  • Carbidopa

Which medications cause Mean Corpuscular Volume (MCV) greater than 100fL?

Directly or indirectly interfere with Vitamin B12 or Folate absorption

Anticonvulsants

  • Phenytoin
  • Primidone
  • Topiramate
  • Valproic acid

Anti-hyperglycemic agents

  • Metformin

Anti-inflammatory drugs

  • Sulfasalazine

Antimicrobials

  • Pyrimethamine
  • Sulfamethoxazole
  • Trimethoprim

Antiretrovirals

  • Zidovudine
  • Stavudine

Antivirals

  • Valacyclovir

Chemotherapeutics

  • Cyclophosphamide
  • Hydroxyurea
  • Methotrexate
  • Azathioprine
  • Mercaptopurine
  • Cladribine
  • Cytosine arabinoside (Cytarabine®)
  • 5-Fluorouracil (5-FU®)

Diuretics

  • Triamterene

Bone Health (Parathyroid hormone analog)

  • Teriparatide (Forteo®)

References

  1. Cancelo-Hidalgo, M. J., et al. (2013). Tolerability of different oral iron supplements: A systematic review. Current Medical Research and Opinion, 29(4), 291–303.
  2. Houston, B. L., et al. (2018). Efficacy of iron supplementation in patients with non-anemic iron deficiency: A systematic review and meta-analysis. Blood Advances, 2(13), 1330–1340.
  3. Klip, I. T., et al. (2013). Iron deficiency in chronic heart failure: An international pooled analysis. European Journal of Heart Failure, 15(3), 304–312.
  4. Zoller, H., et al. (2023). Comparative efficacy of ferric carboxymaltose and ferric derisomaltose in PHOSPHARE-IBD. Journal of Crohn’s and Colitis. https://doi.org/10.1093/ecco-jcc/jjad004
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