Iron Deficiency and Proton Pump Inhibitors

Mechanism of Action

The American Gastroenterological Association notes that proton pump inhibitors, such as lansoprazole, reduce gastric acidity, which can decrease the absorption of non-heme iron due to decreased solubilization and reduction of ferric iron to ferrous iron 2

The British guidelines for the management of iron-deficiency anemia (2011) clearly indicate that proton pump inhibitors can contribute to the risk of iron deficiency 1
A case-control study from the Kaiser Permanente Northern California database demonstrated that proton pump inhibitor use for ≥2 years was strongly associated with iron deficiency, particularly at high doses (≥1.5 tablets/day) with an adjusted odds ratio of 2.49 (95% CI: 2.35-2.64) 2
Another case-control study from the British Clinical Practice Research Datalink database found dose-dependent associations between continuous proton pump inhibitor use and the risk of iron deficiency, but only after ≥1 year 2

Patients with conditions predisposing to iron deficiency (heavy menstrual bleeding, chronic gastrointestinal bleeding, etc.) are at increased risk 3

Iron-deficiency anemia with typical symptoms: fatigue, shortness of breath, pallor 3

For patients on lansoprazole with iron deficiency, consider reducing the dose or discontinuing proton pump inhibitor therapy if possible 3
Regularly monitor hematological parameters (hemoglobin, ferritin, transferrin saturation) in patients on long-term proton pump inhibitors 3

The duration and dose of proton pump inhibitor therapy seem to be important factors in the development of iron deficiency 2