Taking iron with other meds

[50568789]

have T2 diabetes, hypertension, atrial fibrillation and occasional RLS. Diabetes is managed with twice daily insulin injections, AF is currently dormant after ablation and cardioversion this year, RLS comes and goes, episodes usually controlled using a Therapulse. My question is about adding in ferrous bisglycinate into my medication regime. I had been diagnosed with anaemia (which can also be a stress trigger for AF) and was prescribed ferrous fumarate which between November 2023 and August 2024 increased my ferritin from 12 to 51. GP then decided my iron tests were within reference levels so anaemia had gone away and withdrew the iron prescription. I'm not convinced about that, and question the effects on RLS, but it's such a pain getting to see a doctor (who understands) that I've yet to have that conversation. I am considering just taking iron supplement again anyway, but am aware of possible absorption issues with other meds, both ways. For info, my evening regime is a dose of insulin about 17.30 followed by dinner then atenolol (betablocker), rivaroxaban (anticoagulant), Atorvastatin, and ramipril (blood pressure) about 18.30. Unless I have acid reflux at 22.30ish when I would take Gaviscon Advance, no more meds until before breakfast next morning , insulin, bendroflumethiazide (blood pressure) and Lansoprazole (acid reflux). I don't normally drink orange juice as it affects blood sugar levels and acid reflux. Can anybody advise on fitting iron in with this lot?

[SueJohnson]

The two that you need to take 4 hours before iron or at least 2 hours after are Lansoprazole and Gaviscon. Others can be taken at the same time. Iron supplements can potentially interact with rivaroxaban, increasing the risk of bleeding.

Your ferritin is still very low. I would ask for an iron infusion to quickly bring it up. Since your doctor won't prescribe it you can also get one privately by paying for it, but it costs around £800.

I gave you this before:

Since you take a blood thinner, iron binds with blood thinners, potentially reducing the effectiveness of the blood thinners and of the iron so check with your doctor.

Otherwise take two tablets of 325 mg of ferrous sulfate or 75 mg to 100 mg of iron bisglycinate with 100 mg of vitamin C or some orange juice since that helps its absorption although you say you can't take it. Ferrous sulfate is fine for most people, but if you have problems with constipation, iron bisglycinate is better. Also take Lactobacillus plantarum 299v as it also helps its absorption.

Take it every other day as more is absorbed that way preferably at night at least 1 hour before a meal or coffee or tea and at least 2 hours after a meal or coffee or tea since iron is absorbed better on an empty stomach and the tannins in coffee and tea limit absorption.

If you take magnesium (or magnesium rich foods), calcium (or calcium rich foods) or zinc even in a multivitamin, take them at least 2 hours apart since they interfere with the absorption of iron. Also antacids as I mentioned above interfere with its absorption so should be taken at least 4 hours before the iron or at least 2 hours after. Don't take your iron tablets before or after exercise since inflammation peaks after a workout. Don't take turmeric as it can interfere with the absorption of iron. It takes several months for the iron tablets or iron infusion to slowly raise your ferritin. Ask for a new blood test after 3 months if you are taking iron tablets or after 8 weeks if you have an iron infusion. Stop taking any iron supplements including in a multivitamin 48 hours before the test, avoid a heavy meat meal the night before and fast after midnight and have your test in the morning before 9 am if possible.

[50568789 in reply to SueJohnson]

Many thanks Sue for this information. I can't see me going for an iron infusion in the near future, but I will get an updated blood test for iron to see what's been happening , check with GP about absorbtion / anticoagulant and then if appropriate start iron supplement as part of my meds regime.