Low iron and connection to ACE inhibitors cough

[jobe1968]

I had repeat bloods recently and the only issue was slightly low iron resulting in low hemoglobin levels.

This can be a result of my meds although I think my mainly plant based diet also contributes. So before I rush o supplements I will be seeing which foods I can increase to increase my iron intake. I noted on same browsing session vege based diet should increase iron intake by 1.8 x as the availability of plant based iron is less.

Had a browse and noticed this thought it may interest those who experience a ramipril cough.

Snipped from healthline.com/health/10-re...

ACE inhibitors may even help prevent kidney disease in those with type 2 diabetes.

A dry cough is a common side effect of the medication. According to a study published in the Journal of the Renin-Angiotensin-Aldosterone System, people who took 200 milligrams of ferrous sulfate supplement daily, at least two hours after taking their ACE inhibitor, were less likely to have a cough.

Worth a read if you suffer from this side effect.

Regards

Mike

[Chappychap]

Very interesting, thanks for posting.

Although too much iron can be as much of a problem as too little, so I'd want to make sure I wasn't overdosing on iron in an attempt to suppress the Ramipril cough.

[MichaelJH Heart Star]

Post bypass my iron and haemoglobin levels were low. I had needed a blood transfusion and developed an electrolyte imbalance. Whilst things improved I need to keep an eye on my levels so try and eat foods rich in iron regularly. On your diet these would tend to be spinach, broccoli and fortified breakfast cereal. Eggs also contain iron but I imagine you would not eat them

After discussion it was agreed I could eat liver but only once every two or three weeks (it is a rich source of iron). The iron in iron tablets is not absorbed efficiently and they caused wicked constipation!

[Chappychap]

Bit of a digression, but on the cardio rehab course they asked how much iron a pint of Guinness contained? And the answer was not very much at all!

It seems the old advice to drink Guinness if you were low in iron was all just marketing nonsense!

[MichaelJH Heart Star in reply to Chappychap]

Pity! I actually had a bottle each night, instead of cocoa, to build me up when I was in hospital in the seventies. Lucky to get a cup of tea these days. As do a tonic wine fortified with iron but when I was badly anaemic I could not find a stockist and on line it was dearer than a decent Shiraz or Merlot!

[jobe1968]

The meds actually cause depleted levels. I have been advised spatone which is an iron rich water from north Wales is gentle on the stomach. Can be purchased in sachets at Boots the chemists 🧪

Been used since Roman times apparently!

[Moonflower76]

I had very bad anaemia the other day ( Hb down from 140- 58 ) and low iron levels. I had to have a blood transfusion. I also took liquid iron supplements which felt like it was burning a hole in my stomach but it did work to bring my iron levels back up. Spinach and beans and eggs contain iron and clams have about 5 times more iron than beef (but you need to eat a lot of them) mussels also quite good too.

[Motorman]

Sorry to revive this old post Jobe but I just found it! I am Veggie and take Ramipril and have done for many years ( high BP) I also have a ferritin level of 54, well below the suggested lower limit of 100. I still can't get iron infusion, so I think I will go private. Geoff

[Motorman]

I made a GP appointment and discussed ferritin levels. he agreed that mine are low. However he cannot do anything because the cardiologist has put in writing that I am not getting iron infusion! He has put me on ferrous sulphate 2x 200mcg a day and will do a ferritin level test in Jan ' 20. If the ferrous sulphate doesn't work I will go private.

[jobe1968 in reply to Motorman]

I don’t understand the comment regards the cardiologist? Does he have a clinical reason or is he making a cost/benefit decision on the behalf of the NHS. I have recently started reading up on my meds and the guidelines regards monitoring and testing bloods and titrations etc. I find to get the NICE advised testing schedule I need to inform GP of the recommendations???

If I didn’t do it ongoing care apart from writing repeat scripts would be non existent. As my gp practice seem to operate a revolving door system with doctors changing constantly there is not much in the way of relationship or patient knowledge.

Could you not write to the cardiologist and request a second opinion.

I was due a one year check up in Nov. However this was cancelled. Now February, most likely I will pay again for a private consultation just to ease my mind.

[Motorman]

I simply don't know why my cardiologist won't do it ( or get it done) I do know that the registrar, when asked about iron infusion, simply said " we don't do that here". There is also the question of the level at which patients are considered iron deficient, I have read that above 30 for ferritin level is "normal" but heart failure patients should be above 100. The problem is, doctors all have different ways of doing things, and opinions vary. My GP has told me if I get 3 different opinions I will get 3 differing diagnosis. I will give the ferrous sulphate a go, I took the first one today, and in a month I will have a test to see if it is working. If not I will go and see someone else privately. If I ever get a follow up appointment after my cardioversion I will ask some questions face to face.

[Motorman]

Thanks Jo, I had forgotten about that, I will bear it in mind after ferrous sulphide for a month. I guess that there will be placebo and treatment groups, I wouldn't want to be on a placebo , and I don't suppose I could choose

EDIT:- A bit of reading, it probably explains a lot! bmjopenquality.bmj.com/cont...