Low iron and PPIs

[Cavlover]

My Hb and ferritin levels have been decreasing over the past 18 months and despite my pointing it out to various medical people it has only just been decided to try and find out why. I am wondering if it might be from taking Lansoprazole as I was taking ranitidine until the middle of last year and it was withdrawn so was given the PPI instead. Has anyone else had any problems?

[Hidden]

With the caveat that I’m not medically qualified. My understanding is that PPI use can be associated with anaemia (including low ferritin) in some people. Why some are effected by deficiencies like this and not others is not yet understood: I’ve personally been taking a PPI daily for the last decade without any issues with iron, b vitamins or anything else. It might just be me being pedantic with the numbers, but the only question mark I do have is the timeline you state: you said your ferritin has been decreasing for 18 months, but you’ve only been taking the lansoprazole since last summer? If there is a direct correlation between switching to the PPI and the start of the downward trend, then it’s possible it’s the cause, but if the slide started whilst on ranitidine, it could be coincidence or an exacerbating factor rather than the reason. There is a suggestion in studies that H2 antagonists like ranitidine can also be associated with iron deficiency.

Although ranitidine has been withdrawn, there are other drugs in the same family that are still available on the NHS, such as famotidine.

[Cavlover in reply to Hidden]

Thank you for this helpful answer and apologies that I put 18 months - meant to say 15. I have checked and the downward trend started at the same time as I started the PPI so I think they may well be related. Once I have had the tests, I will be in a better position to point this out to my GP, but just wanted to see if anyone else had had the same experience.

[Hidden in reply to Cavlover]

Bottom line is we know PPIs can definitely cause low iron anaemia, so if the timeline fits, it’s a solid shout. We also know from a number of studies that anaemia as a result of PPI use doesn’t always respond to oral replacement therapy: if you can get the medics to agree, switching to famotidine and seeing what happens might be worth a go in the first instance. Glad to be of help, though 👍

[Cavlover in reply to Hidden]

Thank you. I will make sure I advise the GP of my concerns at some point. Thank you again.

[Gnarli]

I don't take a PPI but still have low ferritin and Hb. Just lucky perhaps but well worth checking with your GP?

[hatshepsut]

I have longstanding problems with low ferritin and haemoglobin. It has been diagnosed by haematology as "anaemia of chronic disease" In other words, it's RD that is the cause. I have had red blood cells infused, and an iron infusion. I am just awaiting the results of yet another blood test to confirm low levels again, and it's possible I may need to have another infusion.

I do feel that rheumatologist and G Ps should be more watchful for these anaemias. It is well known that RD can cause anaemia, which can be extremely debilitating, and should be monitored carefully.