Is it safe to take iron supplements while taking Pepcid (famotidine)?

Taking Iron Supplements with Famotidine (Pepcid)

Yes, it is generally safe to take iron supplements while taking famotidine (Pepcid), and famotidine may actually be preferable to proton pump inhibitors for patients requiring both acid suppression and iron supplementation.

Famotidine and Iron Absorption

Unlike some medications that significantly impair iron absorption, famotidine (an H2 receptor antagonist) has minimal impact on iron absorption:

• Famotidine does not form chelates or complexes with iron supplements that would prevent absorption 1
• In contrast to proton pump inhibitors (PPIs), which can significantly reduce iron absorption by decreasing gastric acid production, H2 blockers like famotidine have less impact on gastric acid and iron absorption 2
• A case report demonstrated that switching from a PPI (rabeprazole) to famotidine actually resolved iron deficiency anemia in a patient 2

Recommendations for Taking Iron with Famotidine

To optimize iron absorption while on famotidine:

1. Separate administration times when possible:

   • Take iron supplements at least 2 hours before or 4 hours after famotidine
   • This timing minimizes any potential minor interactions

2. Consider the form of iron supplement:

   • Ferrous sulfate, ferrous gluconate, or ferrous fumarate are all acceptable options
   • If GI side effects occur, consider alternate-day dosing which may improve absorption and reduce side effects 3

3. Optimize absorption:

   • Take iron supplements with vitamin C (orange juice or vitamin C supplement) to enhance absorption
   • Avoid taking iron with calcium-containing foods, tea, coffee, or dairy products

Monitoring Recommendations

If you're taking both famotidine and iron supplements:

• Monitor for symptoms of iron deficiency (fatigue, weakness, pale skin)
• Have your healthcare provider check your hemoglobin and iron levels periodically
• Watch for common iron supplement side effects: constipation, nausea, abdominal discomfort

Special Considerations

• If you experience persistent GI side effects from iron supplements, discuss with your healthcare provider about:

  • Trying a different iron formulation
  • Reducing the dose
  • Switching to alternate-day dosing 3
  • Considering IV iron if oral supplementation is not tolerated or effective 4

• If you require long-term acid suppression therapy and iron supplementation, famotidine may be preferable to PPIs, as PPIs have been associated with decreased iron absorption and iron deficiency anemia with prolonged use 2

Potential Drug Interactions to Avoid

While famotidine and iron can be taken together, be aware that iron supplements can significantly reduce the absorption of several other medications, including:

• Tetracycline antibiotics
• Quinolone antibiotics (like ciprofloxacin)
• Levothyroxine
• Levodopa
• Methyldopa
• Penicillamine 5

If you take any of these medications, ensure you separate them from your iron supplements by at least 2-4 hours.