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Effect of Omeprazole on Oral Iron Replacement in Patients with Iron Deficiency Anemia

Vivek R. Sharma, MD, Mark A. Brannon, BS, PA-C, Elizabeth A. Carloss, MD
Volume: 97 Issue: 9 September, 2004

Abstract:

Hypochlorhydric states such as atrophic gastritis and partial gastrectomy have long been known to cause iron deficiency anemia. However, studies to date have failed to show a similar association with omeprazole, a proton pump inhibitor that also produces achlorhydria. These studies, however, have primarily involved nonanemic, iron-replete individuals. The effect of the drug has not been studied in patients with established iron deficiency, and to our knowledge the patients presented here are the first of their kind to be reported. Our observations support the probability that the profound hypochlorhydria induced by omeprazole may indeed impair the optimal absorption of orally administered iron in iron-deficient individuals, precluding them from obtaining therapeutically adequate amounts to establish the positive balance necessary for the resolution of anemia and the replenishment of stores. The possible explanations for this phenomenon are also discussed.


Key Points


* Several achlorhydric states are known to be associated with iron deficiency.


* Although proton pump inhibitors can cause profound achlorhydria, studies in iron-replete individuals have not shown a higher incidence of iron deficiency anemia.


* The cases presented suggest that omeprazole-induced achlorhydria may impair the response to oral iron therapy in patients with preexisting iron deficiency.

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