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    Iron

    Iron

    Uses

    What Are Star Ratings?

    Our proprietary ?Star-Rating? system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

    For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

    3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

    2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

    1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

    This supplement has been used in connection with the following health conditions:

    Used for Why
    3 Stars
    Anemia and Iron Deficiency
    If deficient: 100 mg daily for up to one year under medical supervision
    Taking iron may help prevent and treat anemia; ask your doctor if it?s right for you. Deficiencies of iron, vitamin B12, and folic acid are the most common nutritional causes of anemia.

    Deficiencies of iron , vitamin B12 , and folic acid are the most common nutritional causes of anemia.1 Although rare, severe deficiencies of several other vitamins and minerals, including vitamin A ,2 , 3 vitamin B2 ,4 vitamin B6 ,5 , 6 vitamin C ,7 and copper ,8 , 9 can also cause anemia by various mechanisms. Rare genetic disorders can cause anemias that may improve with large amounts of supplements such as vitamin B1 .10 , 11

    3 Stars
    Depression and Iron Deficiency
    See a doctor for evaluation
    A lack of iron can make depression worse; check with a doctor to find out if you are iron deficient.

    Iron deficiency is known to affect mood and can exacerbate depression, but it can only be diagnosed and treated by a doctor. While iron deficiency is easy to fix with iron supplements, people who have not been diagnosed with iron deficiency should not supplement iron.

    3 Stars
    Iron-Deficiency Anemia
    Consult a qualified healthcare practitioner
    Supplementing with iron is essential to treating iron deficiency.

    Caution: People should not supplement with iron unless diagnosed with iron deficiency, because taking iron when it isn?t needed has no benefit and may be harmful.

    Before iron deficiency can be treated, it must be diagnosed and the cause must be found by a doctor. In addition to addressing the cause (e.g., avoiding aspirin , treating a bleeding ulcer , etc.), supplementation with iron is the primary way to resolve iron-deficiency anemia.

    If a doctor diagnoses iron deficiency, iron supplementation is essential. Though some doctors use higher amounts, a common daily dose for adults is 100 mg per day. Even though symptoms of deficiency should disappear much sooner, iron deficient people usually need to keep supplementing with iron for six months to one year until the ferritin test is completely normal. Even after taking enough iron to overcome the deficiency, some people with recurrent iron deficiency?particularly some premenopausal women?need to continue to supplement with smaller levels of iron, such as the 18 mg present in most multivitamin-mineral supplements . This need for continual iron supplementation even after deficiency has been overcome should be determined by a doctor.

    3 Stars
    Menorrhagia and Iron Deficiency
    100 to 200 mg daily under medical supervision if deficient
    Supplementing with iron decreases excess menstrual blood loss in iron-deficient women who have no other underlying cause for their condition.

    Since blood is rich in iron , excessive blood loss can lead to iron depletion. Iron deficiency can be identified with simple blood tests. If an iron deficiency is diagnosed, many doctors recommend 100?200 mg of iron per day, although recommendations vary widely.

    The relationship between iron deficiency and menorrhagia is complicated. Not only can the condition lead to iron deficiency, but iron deficiency can lead to or aggravate menorrhagia by reducing the capacity of the uterus to stop the bleeding. Supplementing with iron decreases excess menstrual blood loss in iron-deficient women who have no other underlying cause for their condition.13 , 14 However, iron supplements should be taken only by people who have, or are at risk of developing, iron deficiency.

    2 Stars
    Athletic Performance and Iron Deficiency
    Consult a qualified healthcare practitioner
    Iron is a component of hemoglobin, which transports oxygen to muscle cells. In cases of iron deficiency, taking iron may restore levels and improve athletic performance.

    Iron is important for an athlete because it is a component of hemoglobin, which transports oxygen to muscle cells. Some athletes, especially women, do not get enough iron in their diet. In addition, for reasons that are unclear, endurance athletes, such as marathon runners, frequently have low body-iron levels.15 , 16 , 17 However, anemia in athletes is often not due to iron deficiency and may be a normal adaptation to the stress of exercise.18 Supplementing with iron is usually unwise unless a deficiency has been diagnosed. People who experience undue fatigue (an early warning sign of iron deficiency) should have their iron status evaluated by a doctor. Athletes who are found to be iron deficient by a physician are typically given 100 mg per day until blood tests indicate they are no longer deficient. Supplementing iron-deficient athletes with 100 to 200 mg per day of iron increased aerobic exercise performance in some,19 , 20 , 21 though not all,22 , 23 double-blind studies. A recent double-blind trial found that iron-deficient women who took 20 mg per day of iron for six weeks were able to perform knee strength exercises for a longer time without muscle fatigue compared with those taking a placebo.24

    2 Stars
    Attention Deficit?Hyperactivity Disorder and Iron Deficiency
    Consult a qualified healthcare practitioner
    In one study, iron levels were significantly lower in a group of children with ADHD than in healthy children. In the case of iron deficiency, supplementing with the mineral may improve behavior.

    Iron status, as measured by the serum ferritin concentration, was significantly lower in a group of children with ADHD than in healthy children. Ferritin levels were below normal in 84% of the children with ADHD, compared with 18% of the healthy children.25 Since iron deficiency can adversely affect mood and cognitive function, iron status should be assessed in children with ADHD, and those who are deficient should receive an iron supplement. In a case report, a young boy with both ADHD and iron deficiency showed considerable improvement in behavior after receiving an iron supplement.26 Iron supplementation was also beneficial in a double-blind study of children with ADHD and iron deficiency.27

    2 Stars
    Breast-Feeding Support and Iron Deficiency
    Consult a qualified healthcare practitioner
    Iron may be required for infants with low iron stores or anemia.
    If a doctor diagnoses iron deficiency, iron supplementation is essential. Though some doctors use higher amounts, a common daily dose for adults is 100 mg per day. Even though symptoms of deficiency should disappear much sooner, iron deficient people usually need to keep supplementing with iron for six months to one year until the ferritin test is completely normal. Even after taking enough iron to overcome the deficiency, some people with recurrent iron deficiency?particularly some premenopausal women?need to continue to supplement with smaller levels of iron, such as the 18 mg present in most multivitamin-mineral supplements. This need for continual iron supplementation even after deficiency has been overcome should be determined by a doctor.
    2 Stars
    Canker Sores and Iron Deficiency
    Consult with your doctor
    Talk to your doctor to see if your recurrent canker sores might be related to iron deficiency.

    Several preliminary studies,28 , 29 , 30 , 31 though not all,32 have found a surprisingly high incidence of iron and B vitamin deficiency among people with recurrent canker sores. Treating these deficiencies has been reported in preliminary33 , 34 and controlled35 studies to reduce or eliminate canker sore recurrences in most cases. Supplementing daily with B vitamins?300 mg vitamin B1 , 20 mg vitamin B2 , and 150 mg vitamin B6 ?has been reported to provide some people with relief.36 Thiamine (B1) deficiency specifically has been linked to an increased risk of canker sores.37 The right supplemental level of iron requires diagnosis of an iron deficiency by a healthcare professional using lab tests.

    2 Stars
    Celiac Disease and Iron Deficiency
    Consult a qualified healthcare practitioner
    The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. Supplementing with iron may correct a deficiency.

    The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. The most common nutritional problems in people with celiac disease include deficiencies of essential fatty acids, iron , vitamin D , vitamin K , calcium , magnesium , and folic acid .38 Zinc malabsorption also occurs frequently in celiac disease39 and may result in zinc deficiency, even in people who are otherwise in remission.40 People with newly diagnosed celiac disease should be assessed for nutritional deficiencies by a doctor. Celiac patients who have not yet completely recovered should supplement with a high-potency multivitamin-mineral . Some patients may require even higher amounts of some of these vitamins and minerals?an issue that should be discussed with their healthcare practitioner. Evidence of a nutrient deficiency in a celiac patient is a clear indication for supplementation with that nutrient.

    After commencement of a gluten-free diet, overall nutritional status gradually improves. However, deficiencies of some nutrients may persist, even in people who are strictly avoiding gluten. For example, magnesium deficiency was found in 8 of 23 adults with celiac disease who had been following a gluten-free diet and were symptom-free. When these adults were supplemented with magnesium for two years, their bone mineral density increased significantly.41

    2 Stars
    Iron-Deficiency Anemia (Vitamin A)
    Consult a qualified healthcare practitioner
    Taking vitamin A and iron together has been reported to help overcome iron deficiency more effectively than iron supplements alone.

    Taking vitamin A and iron together has been reported to help overcome iron deficiency more effectively than iron supplements alone.42 Although the optimal amount of vitamin A needed to help people with iron deficiency has yet to be established, some doctors recommend 10,000 IU per day.

    2 Stars
    Night Blindness and Iron Deficiency
    30 mg of iron and 6 mg of riboflavin per day
    If a person has deficiencies of iron and riboflavin, supplementing with these nutrients may increase the benefits of vitamin A.

    In a study of women in Nepal, where there is a high prevalence of iron and riboflavin deficiencies, supplementation with 30 mg per day of iron and 6 mg per day of riboflavin for six weeks enhanced the effectiveness of vitamin A in the treatment of night blindness.43 It is not known whether these nutrients would be helpful for night blindness in people who are not deficient.

    2 Stars
    Pre- and Post-Surgery Health
    Consult a qualified healthcare practitioner
    Iron supplementation prior to surgery was found in one trial to reduce the need for postoperative blood transfusions.

    One preliminary study found iron levels to be reduced after both minor and major surgeries, and iron supplementation prior to surgery was not able to prevent this reduction.44 A controlled trial found that intravenous iron was more effective than oral iron for restoring normal iron levels after spinal surgery in children.45 One animal study reported that supplementation with fructo-oligosaccharides (FOS) improved the absorption of iron and prevented anemia after surgery,46 but no human trials have been done to confirm this finding. Some researchers speculate that iron deficiency after a trauma such as surgery is an important mechanism for avoiding infection, and they suggest that iron supplements should not be given after surgery.47

    Patients who have undergone major surgery frequently need blood transfusions to replace blood lost during the procedure. Studies have found that 18 to 21% of surgery patients were anemic prior to surgery,48 , 49 and these anemic patients required more blood after surgery than did non-anemic surgery patients. Supplementation with iron prior to surgery was found in a controlled trial to reduce the need for blood transfusions, whether or not iron deficiency was present.50 Iron supplements (99 mg per day) given before and for two months after joint surgery in another controlled trial improved blood values but did not change the length of hospitalization or the risk of post-operative fever.51 Pre-operative iron supplementation in combination with a medication that stimulates red blood cell production in the bone marrow is considered by some doctors to be an effective way to minimize the need for post-operative blood transfusions.52

    2 Stars
    Pregnancy and Postpartum Support
    Consult a qualified healthcare practitioner
    Iron requirements increase during pregnancy, making iron deficiency in pregnancy quite common. Supplementation may help prevent a deficiency.

    Iron requirements increase during pregnancy, making iron deficiency in pregnancy quite common.53 Iron supplement use in the United States is estimated at 85% during pregnancy, with most women taking supplements three or more times per week for three months.54 Pregnant women with a documented iron deficiency need doctor-supervised treatment. In one study, 65% of women who were not given extra iron developed iron deficiency during pregnancy, compared with none who received an iron supplement.55 However, there is a clear increase in reported side effects with increasing supplement amounts of iron, especially iron sulfate.56 , 57 Supplementation with large amounts of iron has also been shown to reduce blood levels of zinc.58 Although the significance of that finding is not clear, low blood levels of zinc have been associated with an increased risk of complications in both the mother and fetus.59

    Iron supplementation was associated in one study with an increased incidence of birth defects,60 possibly as a result of an iron-induced deficiency of zinc. Although additional research needs to be done, the evidence suggests that women who are supplementing with iron during pregnancy should also take a multivitamin-mineral formula that contains adequate amounts of zinc. To be on the safe side, pregnant women should discuss their supplement program with a doctor.

    2 Stars
    Restless Legs Syndrome and Iron Deficiency
    Consult a qualified healthcare practitioner
    When iron deficiency is the cause of restless leg syndrome, supplementing with iron may reduce the severity of the symptoms.

    Mild iron deficiency is common, even in people who are not anemic. When iron deficiency is the cause of RLS, supplementation with iron has been reported to reduce the severity of the symptoms. In one trial, 74 mg of iron taken three times a day for two months, reduced symptoms in people with RLS.61 In people who are not deficient in iron, iron supplementation has been reported to not help reduce symptoms of RLS.62 Most people are not iron deficient, and taking too much can lead to adverse effects. Therefore, iron supplements should only be taken by people who have a diagnosed deficiency.

    1 Star
    Alzheimer?s Disease (Coenzyme Q10, Vitamin B6)
    Refer to label instructions
    A combination of coenzyme Q10, iron (sodium ferrous citrate), and vitamin B6 may improve mental status in people with Alzheimer?s disease.

    In a preliminary report, two people with a hereditary form of Alzheimer?s disease received daily: coenzyme Q10 (60 mg), iron (150 mg of sodium ferrous citrate), and vitamin B6 (180 mg). Mental status improved in both patients, and one became almost normal after six months.63

    1 Star
    Cough (For iron deficiency)
    Refer to label instructions
    In a study of women with iron deficiency and a chronic unexplained cough, supplementation with iron for two months significantly improved symptoms.
    In a study of women with iron deficiency and a chronic unexplained cough, supplementation with iron for two months significantly improved symptoms.64 Since iron supplementation can be harmful for people who are not deficient, iron levels should be checked with a blood test before taking iron supplements.
    1 Star
    Dermatitis Herpetiformis and Iron Deficiency
    Refer to label instructions
    Talk to your doctor to see if supplementing with iron can counteract the nutrient deficiency that often occurs as a result of malabsorption.

    People with DH frequently have mild malabsorption (difficulty absorbing certain nutrients) associated with low stomach acid (hypochlorhydria) and inflammation of the stomach lining (atrophic gastritis).65 Mild malabsorption may result in anemia 66 and nutritional deficiencies of iron , folic acid ,67 , 68 vitamin B12 ,69 , 70 and zinc .71 , 72 , 73 More severe malabsorption may result in loss of bone mass.74 Additional subtle deficiencies of vitamins and minerals are possible, but have not been investigated. Therefore, some doctors recommend people with DH have their nutritional status checked regularly with laboratory studies. These doctors may also recommend multivitamin-mineral supplements and, to correct the low stomach acid, supplemental betaine HCl (a source of hydrochloric acid).

    1 Star
    Female Infertility and Iron Deficiency
    Refer to label instructions
    Even subtle iron deficiencies have been tentatively linked to infertility. Women who are infertile should consult a doctor to rule out the possibility of iron deficiency

    In preliminary research, even a subtle deficiency of iron has been tentatively linked to infertility.75 Women who are infertile should consult a doctor to rule out the possibility of iron deficiency.

    1 Star
    HIV and AIDS Support
    Refer to label instructions
    Iron deficiency is often present in HIV-positive children. Supplementing with it, under a doctor's supervision, may support immune function.

    Iron deficiency is often present in HIV-positive children.76 While iron is necessary for normal immune function , iron deficiency also appears to protect against certain bacterial infections .77 Iron supplementation could therefore increase the severity of bacterial infections in people with AIDS. For that reason, people with HIV infection or AIDS should consult a doctor before supplementing with iron.

    How It Works

    How to Use It

    If a doctor diagnoses iron deficiency , iron supplementation is essential. To treat iron deficiency, a common recommended amount for an adult is 100 mg per day; that amount is usually reduced after the deficiency is corrected. When iron deficiency is diagnosed, the doctor must also determine the cause. Usually it?s not serious (such as normal menstrual blood loss or blood donation). Occasionally, however, iron deficiency signals ulcers or even colon cancer .

    Some premenopausal women become marginally iron deficient unless they supplement with iron. However, the 18 mg of iron present in many multivitamin-mineral supplements is often adequate to prevent deficiency. A doctor should be consulted to determine the amount of iron that is needed.

    Where to Find It

    The most absorbable form of iron, called ?heme? iron, is found in oysters, meat and poultry, and fish. Non-heme iron is also found in these foods, as well as in dried fruit, molasses, leafy green vegetables, wine, and iron supplements. Acidic foods (such as tomato sauce) cooked in an iron pan can also be a source of dietary iron.

    Possible Deficiencies

    Vegetarians eat less iron than non-vegetarians, and the iron they eat is somewhat less absorbable. As a result, vegetarians are more likely to have reduced iron stores.78 However, iron deficiency is not usually caused by a lack of iron in the diet alone. An underlying cause, such as iron loss in menstrual blood, often exists.

    Pregnant women, marathon runners , people who take aspirin , and those who have parasitic infections, hemorrhoids , ulcers , ulcerative colitis , Crohn?s disease , gastrointestinal cancers, or other conditions that cause blood loss or malabsorption are likely to become deficient.

    Infants living in inner city areas may be at increased risk of iron-deficiency anemia 79 and suffer more often from developmental delays as a result.80 , 81 Supplementation of infant formula with iron up to 18 months of age in inner city infants has been shown to prevent iron-deficiency anemia and to reduce the decline in mental development seen in such infants in some,82 but not all,83 studies.

    Breath-holding spells are a common problem affecting about 27% of healthy children.84 These spells have been associated with iron-deficiency anemia,85 and several studies have reported improvement of breath-holding spells with iron supplementation.86 , 87 , 88 , 89

    People who fit into one of these groups, even pregnant women, shouldn?t automatically take iron supplements. Fatigue, the first symptom of iron deficiency, can be caused by many other things. A doctor should assess the need for iron supplements, since taking iron when it isn?t needed does no good and may do some harm.

    Best Form to Take

    All iron supplements are not the same. Ferrous iron (e.g. ferrous sulfate) is much better absorbed than ferric iron (e.g. ferric citrate).90 , 91 The most common form of iron supplement is ferrous sulfate, but it is known to produce intestinal side effects (such as constipation , nausea, and bloating ) in many users.92 Some forms of ferrous sulfate are enteric-coated to delay tablet dissolving and prevent some side effects,93 but enteric-coated iron may not absorb as well as iron from standard supplements.94 , 95 , 96 Other forms of iron supplements, such as ferrous fumarate,97 , 98 ferrous gluconate,99 heme iron concentrate,100 , 101 , 102 , 103 and iron glycine amino acid chelate104 , 105 are readily absorbed and less likely to cause intestinal side effects.

    Interactions

    Interactions with Supplements, Foods, & Other Compounds

    Many foods, beverages, and supplements have been shown to affect the absorption of iron.106

    Foods, beverages and supplements that interfere with iron absorption include

    • Green tea  (Camellia sinensis).107 , 108 , 109 , 110 This effect may be desirable for people with iron overload diseases, such as hemochromatosis. The inhibitory effect of green tea on iron absorption was 26% in one study.111

    • Coffee (Coffea arabica, C. robusta).112 , 113 , 114

    • Red wine, particularly the polyphenol component (also found in tea).115 , 116 Since wine is also a dietary source of iron, it is not clear whether drinking red wine would lead to a deficiency of iron.

    • Phytate (phytic acid), found in unleavened wheat products such as matzoh, pita, and some rye crackers; in wheat germ, oats , nuts, cacao powder, vanilla extract, beans, and many other foods, and in IP-6 supplements.117 , 118 , 119

    • Whole wheat bran, independent of its phytate content, has been shown to inhibit iron absorption.120

    • Calcium from food and supplements interferes with heme-iron absorption.121 , 122

    • Soy protein.123 , 124

    • Eggs.125 , 126

    Foods and supplements that increase iron absorption include

    • Meat, poultry, and fish.127 , 128 , 129 , 130 , 131

    Although vitamin C increases iron absorption,132 , 133 , 134 , 135 the effect is relatively minor.136

    Taking vitamin A with iron helps treat iron deficiency , since vitamin A improves the absorption and/or utilization of iron.137 , 138

    Although soy protein has been shown to decrease iron absorption (see above), certain soy-containing foods (e.g. tofu, miso, tempeh) have significantly improved iron absorption.139 Some soy sauces may also enhance iron absorption.140

    Alcohol, but not red wine, has been reported to increase the absorption of ferric, but not ferrous, iron.141 , 142

    Iron has been reported to potentially interfere with manganese absorption. In one trial, women with high iron status had relatively poor absorption of manganese.143 In another trial studying manganese/iron interactions in women, increased intake of ?non-heme iron??the kind of iron found in most supplements?decreased manganese status.144 These interactions suggest that taking multiminerals that include manganese may protect against manganese deficiencies that might otherwise be triggered by taking isolated iron supplements.

    Interactions with Medicines

    Certain medicines interact with this supplement.

    Types of interactions: Beneficial Adverse Check

    Replenish Depleted Nutrients

    • Aspirin

      Gastrointestinal (GI) bleeding is a common side effect of taking aspirin. A person with aspirin-induced GI bleeding may not always have symptoms (like stomach pain) or obvious signs of blood in their stool. Such bleeding causes loss of iron from the body. Long-term blood loss due to regular use of aspirin can lead to iron-deficiency anemia . Lost iron can be replaced with iron supplements. Iron supplementation should be used only in cases of iron deficiency verified with laboratory tests.

    • Cimetidine

      Stomach acid may facilitate iron absorption. H-2 blocker drugs reduce stomach acid and are associated with decreased dietary iron absorption.147 People with ulcers may also be iron deficient due to blood loss and benefit from iron supplementation. Iron levels in the blood can be checked with lab tests.

    • Dipyridamole

      Some studies suggest the taking of too much iron by individuals who are not iron deficient can result in tissue damage that may contribute to heart disease.148 Test tube studies have shown dipyridamole blocks platelet clumping caused by iron,149 which might reduce the damage caused by this mineral. Controlled human studies are needed to test this possibility.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Etodolac

      NSAIDs cause gastrointestinal (GI) irritation, bleeding, and iron loss.151 Iron supplements can cause GI irritation.152 However, iron supplementation is sometimes needed in people taking NSAIDs if those drugs have caused enough blood loss to lead to iron deficiency . If both iron and etodolac are prescribed, they should be taken with food to reduce GI irritation and bleeding risk.

    • Famotidine

      Stomach acid may increase absorption of iron from food. H-2 blocker drugs reduce stomach acid and are associated with decreased dietary iron absorption.153 The iron found in supplements is available to the body without the need for stomach acid. People with ulcers may be iron deficient due to blood loss. If iron deficiency is present, iron supplementation may be beneficial. Iron levels in the blood can be checked with lab tests.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Haloperidol

      Haloperidol may cause decreased blood levels of iron.155 The importance of this interaction remains unclear. Iron should not be supplemented unless a deficiency is diagnosed.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Hyoscyamine

      Absorption of ferrous citrate, an iron compound that is usually well absorbed, is reduced in individuals taking hyoscyamine;156 therefore, these two substances should not be taken at the same time.

    • Ibuprofen

      NSAIDs cause gastrointestinal (GI) irritation, bleeding, and iron loss.157 Iron supplements can cause GI irritation.158 However, iron supplementation is sometimes needed in people taking NSAIDs if those drugs have caused enough blood loss to lead to iron deficiency . If both iron and ibuprofen are prescribed, they should be taken with food to reduce GI irritation and bleeding risk.

    • Magnesium Hydroxide

      Antacids, including magnesium hydroxide, may reduce the absorption of dietary iron. Iron supplements do not require stomach acid for absorption and one human study found that a magnesium hydroxide/ aluminum hydroxide antacid did not decrease supplemental iron absorption.160

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Nabumetone

      NSAIDs cause gastrointestinal (GI) irritation, bleeding, and iron loss.162 Iron supplements can cause GI irritation.163 However, iron supplementation is sometimes needed in people taking NSAIDs if those drugs have caused enough blood loss to lead to iron deficiency . If both iron and nabumetone are prescribed, they should be taken with food to reduce GI irritation and bleeding risk.

    • Naproxen

      NSAIDs cause gastrointestinal (GI) irritation, bleeding, and iron loss.164 Iron supplements can cause GI irritation.165 However, iron supplementation is sometimes needed in people taking NSAIDs if those drugs have caused enough blood loss to lead to iron deficiency . If both iron and naproxen are prescribed, they should be taken with food to reduce GI irritation and bleeding risk.

    • Neomycin

      Neomycin can decrease absorption or increase elimination of many nutrients, including calcium , carbohydrates, beta-carotene , fats, folic acid , iron , magnesium , potassium , sodium, and vitamin A , vitamin B12 , vitamin D , and vitamin K .166 , 167 Surgery preparation with oral neomycin is unlikely to lead to deficiencies. It makes sense for people taking neomycin for more than a few days to also take a multivitamin-mineral supplement.

    • Nizatidine

      Stomach acid may increase absorption of iron from food. H-2 blocker drugs reduce stomach acid and are associated with decreased dietary iron absorption.168 The iron found in supplements is available to the body without the need for stomach acid. People with ulcers may be iron deficient due to blood loss. If iron deficiency is present, iron supplementation may be beneficial. Iron levels in the blood can be checked with lab tests.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Oxaprozin

      NSAIDs cause gastrointestinal (GI) irritation, bleeding, and iron loss.169 Iron supplements can cause GI irritation.170 However, iron supplementation is sometimes needed in people taking NSAIDs if those drugs have caused enough blood loss to lead to iron deficiency . If both iron and oxaprozin are prescribed, they should be taken with food to reduce GI irritation and bleeding risk.

    • Ranitidine

      Stomach acid may facilitate iron absorption. H-2 blocker drugs reduce stomach acid and are associated with decreased dietary iron absorption.174 People with ulcers may also be iron deficient due to blood loss and benefit from iron supplementation. Iron levels in the blood can be checked with lab tests.

    • Sodium Bicarbonate

      In a study of nine healthy people, sodium bicarbonate administered with 10 mg of iron led to lower iron levels compared to iron administered alone.175 This interaction may be avoided by taking sodium bicarbonate-containing products two hours before or after iron-containing supplements.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Stanozolol

      Stanozolol was associated with iron depletion in a group of 16 people.176 The results suggest that people taking this drug on a regular basis have their iron status monitored by the prescribing doctor. There is insufficient information to recommend routine iron supplementation during stanozolol treatment.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

    Reduce Side Effects

    • Amlodipine-Benazepril

      In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor, supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks reduced the severity of the cough by a statistically significant 45%, compared with a nonsignificant 8% improvement in the placebo group.145

    • Benazepril

      In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor, supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks reduced the severity of the cough by a statistically significant 45%, compared with a nonsignificant 8% improvement in the placebo group.146

    • Enalapril

      In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor, supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks reduced the severity of the cough by a statistically significant 45%, compared with a nonsignificant 8% improvement in the placebo group.150

    • Fosinopril

      In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor, supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks reduced the severity of the cough by a statistically significant 45%, compared with a nonsignificant 8% improvement in the placebo group.154

    • Lisinopril

      In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor, supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks reduced the severity of the cough by a statistically significant 45%, compared with a nonsignificant 8% improvement in the placebo group.159

    • Moexipril

      In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor, supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks reduced the severity of the cough by a statistically significant 45%, compared with a nonsignificant 8% improvement in the placebo group.161

    • Perindopril

      In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor, supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks reduced the severity of the cough by a statistically significant 45%, compared with a nonsignificant 8% improvement in the placebo group.171

    • Quinapril

      In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor, supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks reduced the severity of the cough by a statistically significant 45%, compared with a nonsignificant 8% improvement in the placebo group.172

    • Ramipril

      In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor, supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks reduced the severity of the cough by a statistically significant 45%, compared with a nonsignificant 8% improvement in the placebo group.173

    • Trandolapril

      In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor, supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks reduced the severity of the cough by a statistically significant 45%, compared with a nonsignificant 8% improvement in the placebo group.177

    Support Medicine

    • none

    Reduces Effectiveness

    • Carbidopa

      Iron supplements taken with carbidopa may interfere with the action of the drug.178

    • Carbidopa-Levodopa

      Iron supplements taken with carbidopa interfere with the action of the drug.179 People taking carbidopa should not supplement iron without consulting the prescribing physician.

    • Ciprofloxacin

      Minerals such as aluminum, calcium , copper , iron , magnesium , manganese , and zinc can bind to ciprofloxacin, greatly reducing the absorption of the drug.180 , 181 , 182 , 183 Because of the mineral content, people are advised to take ciprofloxacin two hours after consuming dairy products (milk, cheese, yogurt, ice cream, and others), antacids (Maalox®, Mylanta®, Tums®, Rolaids®, and others), and mineral-containing supplements.184

    • Demeclocycline

      Taking mineral supplements or antacids that contain aluminum, calcium , iron , magnesium , or zinc at the same time as tetracyclines inhibits the absorption of the drug.185 Therefore, individuals should take tetracyclines at least two hours before or after products containing minerals.

    • Doxycycline

      Many minerals can decrease the absorption and reduce effectiveness of doxycycline, including calcium , magnesium , iron , zinc , and others.186 To avoid these interactions, doxycycline should be taken two hours before or two hours after dairy products (high in calcium) and mineral-containing antacids or supplements.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Gemifloxacin

      A review of interactions involving quinolone antibiotics indicated that supplements containing iron, when taken at the same time as gemifloxacin, might reduce absorption of the drug up to 50%.187 Consequently, gemifloxacin and supplements containing iron should not be taken at the same time.

    • Levofloxacin

      Taking iron supplements concomitantly with levofloxacin can reduce the absorption?and thus the effectiveness?of the drug.188 Therefore, nutritional supplements containing iron, if used, should be taken two hours before or after taking levofloxacin.

    • Methyldopa

      Iron supplements have been found to decrease methyldopa absorption.189 , 190 Taking methyldopa two hours before or after iron-containing products can help avoid this interaction.

    • Ofloxacin

      Minerals including calcium , iron , magnesium , and zinc can bind to fluoroquinolones, including ofloxacin, greatly reducing drug absorption.191 Ofloxacin should be taken four hours before or two hours after consuming antacids (Maalox®, Mylanta®, Tumms®, Rolaids® and others) that may contain these minerals and mineral-containing supplements .192

    • Penicillamine

      Penicillamine binds iron. When taken with iron, penicillamine absorption and activity are reduced.193 Four cases of penicillamine-induced kidney damage were reported when concomitant iron therapy was stopped, which presumably led to the increased penicillamine absorption and toxicity.194

    • Risedronate

      Taking risedronate at the same time as iron , zinc , or magnesium may reduce the amount of drug absorbed.195 Therefore, people taking risedronate who wish to supplement with these minerals should take them an hour before or two hours after the drug.

    • Sulfasalazine

      Iron can bind with sulfasalazine, decreasing sulfasalazine absorption and possibly decreasing iron absorption.196 This interaction can be minimized by taking iron-containing products two hours before or after sulfasalazine.

    • Tetracycline

      Many minerals can decrease the absorption of tetracycline, thus reducing its effectiveness. These minerals include aluminum (in antacids), calcium (in antacids, dairy products, and supplements), magnesium (in antacids and supplements), iron (in food and supplements), zinc (in food and supplements), and others.

    • Warfarin

      Iron , magnesium , and zinc may bind with warfarin, potentially decreasing their absorption and activity.197 People on warfarin therapy should take warfarin and iron/magnesium/zinc-containing products at least two hours apart.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

    Potential Negative Interaction

    • Deferoxamine

      People treated with deferoxamine for dangerously high levels of iron should not take iron supplements, because iron exacerbates their condition, further increasing the need for the deferoxamine. They should read all labels carefully for iron content. All people treated with deferoxamine should consult their prescribing doctor before using any iron-containing products.

    Explanation Required

    • Captopril

      Iron may interfere with captopril absorption. They should not be taken within two hours of each other.198

      In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor, supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks reduced the severity of the cough by a statistically significant 45%, compared with a nonsignificant 8% improvement in the placebo group.199

    • Desogestrel-Ethinyl Estradiol

      Menstrual blood loss is typically reduced with use of oral contraceptives. This can lead to increased iron stores and, presumably, a decreased need for iron in premenopausal women.200 Premenopausal women taking oral contraceptives should have their iron levels monitored and talk with their prescribing doctor before using iron-containing supplements.

    • Dessicated Thyroid

      Iron deficiency has been reported to impair the body?s ability to make its own thyroid hormones,201 which could increase the need for thyroid medication. In a preliminary trial, iron supplementation given to iron-deficient women with low blood levels of thyroid hormones, partially normalized these levels.202 Diagnosing iron deficiency requires the help of a doctor. The body?s ability to make its own thyroid hormones is also reduced during low-calorie dieting. Iron supplementation (27 mg per day) was reported in a controlled study to help maintain normal thyroid hormone levels in obese patients despite a very low-calorie diet.203

      However, iron supplements may decrease absorption of thyroid hormone medications.204 , 205 People taking thyroid hormone medications should talk with their doctor before taking iron-containing products. If advised to supplement, iron and the drug should not be taken within less than four hours of each other.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Ethinyl Estradiol and Levonorgestrel

      Menstrual blood loss is typically reduced with use of oral contraceptives. This can lead to increased iron stores and, presumably, a decreased need for iron in premenopausal women.206 Premenopausal women taking oral contraceptives should have their iron levels monitored and talk with their prescribing doctor before using iron-containing supplements.

    • Ethinyl Estradiol and Norethindrone

      Menstrual blood loss is typically reduced with use of OCs. This can lead to increased iron stores and, presumably, a decreased need for iron in premenopausal women.207 Premenopausal women taking OCs should have their iron levels monitored and talk with their prescribing doctor before using iron-containing supplements.

    • Ethinyl Estradiol and Norgestimate

      Menstrual blood loss is typically reduced with use of OCs. This can lead to increased iron stores and, presumably, a decreased need for iron in premenopausal women.208 Premenopausal women taking OCs should have their iron levels monitored and talk with their prescribing doctor before using iron-containing supplements.

    • Ethinyl Estradiol and Norgestrel

      Menstrual blood loss is typically reduced with use of oral contraceptives. This can lead to increased iron stores and, presumably, a decreased need for iron in premenopausal women.209 Premenopausal women taking oral contraceptives should have their iron levels monitored and talk with their prescribing doctor before using iron-containing supplements.

    • Indomethacin

      Iron supplements can cause stomach irritation. Use of iron supplements with indomethacin increases the risk of stomach irritation and bleeding.210 However, stomach bleeding causes iron loss. If both iron and indomethacin are prescribed, they should be taken with food to reduce stomach irritation and bleeding risk.

    • Levonorgestrel

      Menstrual blood loss is typically reduced with use of oral contraceptives. This can lead to increased iron stores and, presumably, a decreased need for iron in premenopausal women.211 Premenopausal women taking oral contraceptives should have their iron levels monitored and talk with their prescribing doctor before using iron-containing supplements.

    • Levonorgestrel-Ethinyl Estrad

      Menstrual blood loss is typically reduced with use of oral contraceptives. This can lead to increased iron stores and, presumably, a decreased need for iron in premenopausal women.212 Premenopausal women taking oral contraceptives should have their iron levels monitored and talk with their prescribing doctor before using iron-containing supplements.

    • Levothyroxine

      Iron deficiency has been reported to impair the body?s ability to make its own thyroid hormones,213 which could increase the need for thyroid medication. In a preliminary trial, iron supplementation given to iron-deficient women with low blood levels of thyroid hormones, partially normalized these levels.214 Diagnosing iron deficiency requires the help of a doctor. The body?s ability to make its own thyroid hormones is also reduced during low-calorie dieting. Iron supplementation (27 mg per day) was reported in a controlled study to help maintain normal thyroid hormone levels in obese patients despite a very low-calorie diet.215

      However, iron supplements may decrease absorption of thyroid hormone medications.216 , 217 People taking thyroid hormone medications should talk with their doctor before taking iron-containing products.  If advised to supplement, iron and the drug should not be taken within less than four hours of each other.

    • Liothyronine

      Iron deficiency has been reported to impair the body?s ability to make its own thyroid hormones,218 which could increase the need for thyroid medication. In a preliminary trial, iron supplementation given to iron-deficient women with low blood levels of thyroid hormones, partially normalized these levels.219 Diagnosing iron deficiency requires the help of a doctor. The body?s ability to make its own thyroid hormones is also reduced during low-calorie dieting. Iron supplementation (27 mg per day) was reported in a controlled study to help maintain normal thyroid hormone levels in obese patients despite a very low-calorie diet.220

      However, iron supplements may decrease absorption of thyroid hormone medications.221 , 222 People taking thyroid hormone medications should talk with their doctor before taking iron-containing products. If advised to supplement, iron and the drug should not be taken within less than four hours of each other.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Liotrix

      Iron deficiency has been reported to impair the body?s ability to make its own thyroid hormones,223 which could increase the need for thyroid medication. In a preliminary trial, iron supplementation given to iron-deficient women with low blood levels of thyroid hormones, partially normalized these levels.224 Diagnosing iron deficiency requires the help of a doctor. The body?s ability to make its own thyroid hormones is also reduced during low-calorie dieting. Iron supplementation (27 mg per day) was reported in a controlled study to help maintain normal thyroid hormone levels in obese patients despite a very low-calorie diet.225

      However, iron supplements may decrease absorption of thyroid hormone medications.226 , 227 People taking thyroid hormone medications should talk with their doctor before taking iron-containing products. If advised to supplement, iron and the drug should not be taken within less than four hours of each other.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Mestranol and Norethindrone

      Menstrual blood loss is typically reduced with use of oral contraceptives. This can lead to increased iron stores and, presumably, a decreased need for iron in premenopausal women.228 Premenopausal women taking oral contraceptives should have their iron levels monitored and talk with their prescribing doctor before using iron-containing supplements.

    • Minocycline

      Taking calcium, iron, magnesium, or zinc at the same time as minocycline can decrease the absorption of both the drug229 , 230 and the mineral. Therefore, calcium, iron, magnesium, or zinc supplements, if used, should be taken an hour before or after the drug.

    • Norgestimate-Ethinyl Estradiol

      Menstrual blood loss is typically reduced with use of OCs. This can lead to increased iron stores and, presumably, a decreased need for iron in premenopausal women.231 Premenopausal women taking OCs should have their iron levels monitored and talk with their prescribing doctor before using iron-containing supplements.

    The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers? package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.

    Side Effects

    Side Effects

    Caution: Iron (ferrous sulfate) is the leading cause of accidental poisonings in children.232 , 233 , 234 The incidence of iron poisonings in young children increased dramatically in 1986. Many of these children obtained the iron from a child-resistant container opened by themselves or another child, or left open or improperly closed by an adult.235 Deaths in children have occurred from ingesting as little as 200 mg to as much as 5.85 grams of iron.236 Keep iron-containing supplements out of a child?s reach.

    Hemochromatosis, hemosiderosis, polycythemia, and iron-loading anemias (such as thalassemia and sickle cell anemia ) are conditions involving excessive storage of iron. Supplementing iron can be quite dangerous for people with these diseases.

    Supplemental amounts required to overcome iron deficiency can cause constipation . Sometimes switching the form of iron (see ?Which forms of supplemental iron are best?? above), getting more exercise, or treating the constipation with fiber and fluids is helpful, though fiber can reduce iron absorption (see below). Sometimes the amount of iron must be reduced if constipation occurs.

    Some researchers have linked excess iron levels to diabetes ,237cancer,238 increased risk of infection ,239 systemic lupus erythematosus (SLE),240 exacerbation of rheumatoid arthritis ,241 and Huntington?s disease.242 The greatest concern has surrounded the possibility that excess storage of iron in the body increases the risk of heart disease .243 , 244 , 245 Two analyses of published studies came to different conclusions about whether iron could increase heart disease risk.246 , 247 One trial has suggested that such a link may exist, but only in some people (possibly smokers or those with elevated cholesterol levels).248 The link between excess iron and any of the diseases mentioned earlier in this paragraph has not been definitively proven. Nonetheless, too much iron causes free radical damage , which can, in theory, promote or exacerbate most of these diseases. People who are not iron deficient should generally not take iron supplements.

    Patients on kidney dialysis who are given injections of iron frequently experience ?oxidative stress?. This is because iron is a pro-oxidant, meaning that it interacts with oxygen molecules in ways that can damage tissues. These adverse effects of iron therapy may be counteracted by supplementation with vitamin E .249

    Supplementation with iron, or iron and zinc, has been found to improve vitamin A status among children at high risk for deficiency of the three nutrients. 250

    People with hepatitis C who have failed to respond to interferon therapy have been found to have higher amounts of iron within the liver. Moreover, reduction of iron levels by drawing blood has been shown to decrease liver injury caused by hepatitis C.251 Therefore, people with hepatitis C should avoid iron supplements.

    In some people, particularly those with diabetes , insulin resistance syndrome , or liver disease, a genetic susceptibility to iron overload has been reported.252

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