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Medication Considerations

SUMMARY

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

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