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Oral iron can interact with various medications and foods. It is important that clinicians ensure their patients are aware of these possible interactions, which have been summarised in the following table.
| Oral Iron Therapy Interactions and Management |
|
|
Interaction |
How to manage the interaction |
| Iron absorption may be increased by: | |
|
chloramphenicol |
systemic chloramphenicol increases serum iron concentration due to chloramphenicol-induced bone marrow toxicity; if myelosuppression occurs, monitor iron stores and decrease iron dose as needed; consider stopping chloramphenicol, seek specialist advice |
| Iron absorption may be decreased by: | |
| antacids | separate dosage times by as long as possible |
| calcium (eg, in dairy products such as milk) | separate dosage times by several hours |
| Iron may decrease the absorption of: | |
|
oral bisphosphonates (eg, alendronate, clodronate, etidronate, ibandronic acid, risedronate, tiludronate) |
do not take iron within 2 hours of taking an oral bisphosphonate |
| levodopa, carbidopa | separate dosage times by as long as possible |
| methyldopa | separate dosage times by 2 hours; monitor BP and adjust methyldopa dose if necessary |
| penicillamine | give iron at least 2 hours before penicilammine |
| thyroid hormones (eg, liothyronine, thyroxine) | separate dosage times by 4–5 hours |
| Iron absorption is decreased by and iron decreases the absorption of: | |
| oral quinolones (eg, ciprofloxacin, moxifloxacin, norfloxacin) | take quinolone at least 2 hours before iron |
| tetracyclines (eg, doxycycline, minocycline) | separate dosage times by as long as possible (at least 2 hours) |
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