From the Research
Proton pump inhibitors (PPIs) significantly reduce oral iron absorption by decreasing stomach acid production, and patients taking PPIs who require iron supplementation should consider alternative approaches to enhance absorption, such as taking iron supplements on an empty stomach, separated from PPI doses, or using intravenous iron therapy in severe cases. PPIs like omeprazole, esomeprazole, pantoprazole, and lansoprazole raise gastric pH, which prevents the conversion of ferric iron (Fe3+) to the more absorbable ferrous form (Fe2+) 1. This acid-dependent conversion is essential for optimal iron absorption, particularly for non-heme iron found in plant foods and most supplements.
Some key points to consider:
- Patients taking PPIs who require iron supplementation should consider using ferrous sulfate, ferrous gluconate, or ferrous fumarate formulations, ideally taken on an empty stomach and separated from PPI doses by at least 2 hours 2.
- Vitamin C (approximately 250-500mg) taken with iron supplements can enhance absorption by creating an acidic microenvironment and helping with iron conversion.
- For patients with persistent iron deficiency despite oral supplementation while on PPIs, alternative approaches may include using liquid iron formulations, switching to H2 blockers (which have less impact on iron absorption), or considering intravenous iron therapy in severe cases 1.
- Patients should be monitored for iron deficiency if on long-term PPI therapy, especially those with other risk factors for iron deficiency 3, 4.
It is essential to prioritize the management of iron deficiency in patients taking PPIs, as iron deficiency anemia can have significant consequences on morbidity, mortality, and quality of life. The most recent and highest quality study 1 suggests that intravenous iron therapy can be an effective approach in correcting iron deficiency anemia in patients taking PPIs.