From the Guidelines
Iron supplements should not be taken at the same time as carafate (sucralfate) because carafate can significantly reduce iron absorption. It's recommended to separate these medications by at least 2 hours, taking iron supplements either 2 hours before or 4 hours after taking carafate 1. This timing separation is important because carafate works by forming a protective coating on the stomach lining and ulcer surfaces, but this same mechanism causes it to bind to iron and other minerals, preventing their absorption in the digestive tract.
When considering iron supplementation, ferrous sulfate is preferred as the least expensive iron formulation, with no single formulation of oral iron having any advantages over any other 1. Many formulations of oral iron are available, without substantial evidence that any one product is better than another—either in effectiveness or tolerance 1.
Some key considerations for optimizing iron absorption include:
- Taking iron on an empty stomach between meals for optimal absorption
- Avoiding calcium-rich foods, tea, coffee, and antacids, which can decrease iron absorption 1
- Taking iron with vitamin C (such as orange juice) to enhance absorption, although evidence supporting vitamin C administration to improve iron absorption is mixed 1
- Considering taking carafate with meals and iron at a separate time to minimize interactions
Always follow your healthcare provider's specific instructions regarding your medication schedule, as they may have personalized recommendations based on your medical condition.
From the FDA Drug Label
Drug Interactions Some studies have shown that simultaneous sucralfate administration in healthy volunteers reduced the extent of absorption (bioavailability) of single doses of the following: ... The interaction between sucralfate and iron supplements is not explicitly mentioned in the provided drug label.
- The label does mention that sucralfate can bind to other agents in the gastrointestinal tract, potentially altering their absorption.
- However, without direct information on the interaction between sucralfate and iron, no conclusion can be drawn about the safety or efficacy of taking iron with sucralfate 2.
From the Research
Iron with Carafate
- The interaction between iron and carafate (sucralfate) has been studied in the context of oral iron supplementation and its effects on the bioavailability of other medications 3.
- Sucralfate is known to decrease the bioavailability of certain medications, including gemifloxacin, when taken together 3.
- However, the effect of sucralfate on iron absorption is not directly addressed in the provided studies.
- Studies on oral iron supplements, such as Sucrosomial® iron, have shown that they have high iron bioavailability and excellent gastrointestinal tolerance 4, 5.
- The absorption of iron from oral iron supplements can be affected by the dosing regimen, with alternate-day dosing and single morning doses resulting in higher iron absorption than consecutive-day dosing and twice-daily split dosing 6.
- Intravenous iron supplementation has also been studied as an alternative to oral iron supplements, particularly in patients with inflammatory bowel disease 7.
- While intravenous iron sucrose has been shown to be effective in treating iron deficiency anemia, its use may be limited by the need for venous access and infusion monitoring 7.