Management of Iron Deficiency in Patients Taking Proton Pump Inhibitors

Understanding the Impact of Proton Pump Inhibitors on Iron Status

• The American Gastroenterological Association notes that proton pump inhibitors, such as pantoprazole, can reduce absorption of iron salts by decreasing gastric acidity, which is essential for converting dietary non-heme iron into its absorbable form 1, 2, 3

Diagnosing Iron Deficiency

• The American Journal of Hematology recommends that ferritin <30 ng/mL is diagnostic of iron deficiency in patients without inflammation, and ferritin <100 ng/mL indicates iron deficiency in patients with inflammation 4, 5

Choosing the Appropriate Iron Replacement Strategy

• The American Journal of Hematology suggests that intravenous iron is particularly effective in patients with functional iron deficiency (ferritin 30-800 ng/mL with transferrin saturation <20%) 4, 5, 7
• The American Journal of Kidney Diseases recommends that no test dose is required for iron gluconate; a 25 mg test dose is recommended for iron dextran in adults 6

Special Populations

• The National Comprehensive Cancer Network recommends maintaining ferritin ≥100 ng/mL and transferrin saturation ≥20% with IV iron as needed in CKD patients 6