Don’t forget iron deficiency and thyroid function with gastric acid suppression

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Pharmacotherapy

Don’t forget iron deficiency and thyroid function with gastric acid suppression

31 March 2021

Leanne Te Karu

Wednesday 31 March 2021, 12:20 AM

Vegetarians are potentially more susceptible to iron deficiency in the context of gastric acid suppression

The absorption of medicines for iron deficiency anaemia and hypothyroidism is affected by long-term proton-pump inhibitor use. This case study describes these interactions and the effect the prescribing cascade can have on thyroid function

This article has been endorsed by the RNZCGP and has been approved for up to 0.25 CME credits for the General Practice Educational Programme and conti, Educate small, BACK panel - grey

Endocrinology

Gastroenterology

Medicines and Therapies

References

Schade SG, Cohen RJ, Conrad ME. Effect of hydrochloric acid on iron absorption. N Engl J Med 1968;279(13):672–74.
Centanni, M. Thyroxine treatment: absorption, malabsorption, and novel therapeutic approaches. Endocrine 2013;43(1):8–9.
Guzman-Prado Y, Vita R, Samson O. Concomitant use of levothyroxine and proton pump inhibitors in patients with primary hypothyroidism: a systematic review. J Gen Intern Med 2021; 19 January online.
Virili C, Antonelli A, Santaguida MG, et al. Gastrointestinal malabsorption of thyroxine. Endocr Rev 2019;40(1):118–36.
Irving SA, Vadiveloo T, Leese GP. Drugs that interact with levothyroxine: an observational study from the Thyroid Epidemiology, Audit and Research Study (TEARS). Clin Endocrinol 2015;82:136–41.

How to Treat

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Pharmacist prescribers Linda Bryant and Leanne Te Karu discuss positive polypharmacy for heart failure. Current evidence shows the intensive implementation of four medications offers the greatest benefit to most patients with heart failure, with significant reductions in cardiovascular mortality, heart failure hospitalisations and all-cause mortality

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