Medication and food interactions

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.

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
Antacids
Separate dosage times by as long as possible
Calcium (eg, in dairy products such as milk)
Separate dosage times by several hours
Phytates (eg, whole grain cereals)
Separate dosage times by several hours
Tea and coffee
Separate dosage times by several hours

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
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)
 
References
  1. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2016.
  2. National Prescribing Service. NPS News 70: Iron deficiency anaemia. Published 1 October 2010.

 

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