What medications cause iron deficiency anemia?

From the Guidelines

Medications such as non-steroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), anticoagulants, certain antacids, chemotherapy drugs, H2 blockers, and certain antibiotics can cause or contribute to iron deficiency anemia by increasing blood loss, reducing iron absorption, or interfering with iron metabolism. These medications can lead to iron deficiency anemia through various mechanisms, including gastrointestinal bleeding, impaired iron absorption, and increased bleeding risk 1. Some of the specific medications that can cause iron deficiency anemia include:

• Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen, which can cause gastrointestinal bleeding, leading to iron loss over time 1
• Proton pump inhibitors (PPIs) such as omeprazole, esomeprazole, and pantoprazole, which reduce stomach acid and impair iron absorption from food 1
• Anticoagulants like warfarin, apixaban, and rivaroxaban, which increase bleeding risk and potentially cause chronic blood loss 1
• Certain antacids containing calcium, aluminum, or magnesium, which can bind to iron and prevent its absorption 1
• Chemotherapy drugs, which can damage the intestinal lining and reduce iron absorption 1
• H2 blockers like ranitidine and famotidine, which may reduce iron absorption by decreasing stomach acid 1
• Certain antibiotics like tetracyclines and quinolones, which can chelate iron and prevent its absorption when taken together 1 It is essential to monitor iron levels regularly in patients taking these medications long-term and consider iron supplementation or medication adjustments if anemia develops, as iron deficiency anemia can have significant morbidity and mortality implications if left untreated 1.

From the FDA Drug Label

NSAID medicines can cause ... (anemia) The naproxen drug label mentions that one of the possible side effects of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) is anemia 2.

• Naproxen may cause iron deficiency anemia due to gastrointestinal bleeding, a known side effect of NSAIDs.
• The exact mechanism of how naproxen causes anemia is not explicitly stated in the label, but it is likely related to the increased risk of ulcers and bleeding in the stomach and intestines.
• Patients taking naproxen should be monitored for signs of anemia, such as weakness, fatigue, and pale skin.

From the Research

Medications that Cause Iron Deficiency Anemia

• Proton pump inhibitors (PPIs) have been associated with iron deficiency anemia, as they reduce gastric acidity which is necessary for iron absorption 3, 4, 5, 6.
• Histamine-2 receptor antagonists may also contribute to iron deficiency anemia, although the evidence is limited 3.
• Calcium carbonate, an antacid, can inhibit iron absorption, potentially leading to iron deficiency anemia 3.
• The use of nonsteroidal anti-inflammatory drugs (NSAIDs) may also increase the risk of iron deficiency anemia, particularly in individuals with chronic inflammatory conditions 7.

Mechanism of Iron Deficiency Anemia

• Reduced gastric acidity due to PPIs and other acid-modifying medications can impair iron absorption, leading to iron deficiency anemia 3, 4, 5, 6.
• Impaired iron absorption can also occur in individuals with atrophic gastritis, celiac disease, and those who have undergone bariatric surgical procedures 7.

Treatment and Management

• Oral iron supplementation may not be effective in individuals taking PPIs or other acid-modifying medications, and intravenous iron therapy may be necessary 4, 5, 6.
• Identifying and treating the underlying cause of iron deficiency anemia is crucial, and oral iron therapy is typically the first-line treatment 7.