Ibuprofen and other NSAIDS (Naproxen, Aspirin) can cause internal bleeding. The risk is 1 in ~200 so it’s higher than most people think.

Other anti-clotting agents like Warfarin can also cause bleeding, albeit less often because of frequent monitoring while on these medications.

We suggest checking ferritin (not just hemoglobin) regularly while on medications that can cause internal bleeding.

The anti-depressants that are linked to lower hemoglobin.

SSRIs and SNRIs have been shown to be associated with lower hemoglobin levels.

While this isn’t a certainty, it is something to consider if you are taking antidepressants in these classes and struggle with your iron status.

The drugs that affect our guts

Metformin has inconsistently shown a negative effect on iron absorption. Some studies say yes, some say no. To be safe, when you start this medication, have your iron tested within the first few months.

Metformin has definitely been linked to reduced vitamin B12 absorption, which can lead to a type of anemia (vitamin B12 deficiency anemia) rather than iron deficiency anemia. However, prolonged B12 deficiency can sometimes mask or contribute to other types of anemia, including iron deficiency.

While metformin itself doesn’t directly cause iron deficiency, long-term use might impact overall red blood cell health if B12 levels drop significantly.

Proton Pump Inhibitors (PPIs), such as omeprazole and lansoprazole, are used to manage conditions like gastroesophageal reflux disease (GERD) and peptic ulcers. PPIs reduce stomach acid production, which can affect the absorption of non-heme iron (found in plant-based foods) and potentially lead to lower iron levels.

How worried should you be? Well, it depends on the person, the dosage, and how long the meds are taken. In other words, hard to say. So regardless, it’s a good idea to get your ferritin checked every so often.

When to take iron supplements around medications that reduce its absorption?

Tetracycline, antacids, proton pump inhibitors, H2 antagonists all reduce the absorption of iron salts. It is recommended that oral iron be taken 12 hours apart from these drugs.