1. Author(s), Institution
Purpose
This study aims to identify how often pharmacists verify
oral iron supplements and PPIs/H2RAs concurrently in
the inpatient setting.
The secondary endpoint examined the prevalence of
oral iron co-administration with acid suppression agents.
Results Conclusions
Achlorhydria is known to affect absorption of drugs, notably
oral iron because non-heme iron requires an acidic
environment in the gastrointestinal tract to facilitate oral iron
absorption.
Oral iron is administered in the non-heme form. Histamine 2
receptor antagonists block the effects of histamine on gastric
parietal cells decreasing the production of gastric acid. Proton
pump inhibitors inhibit the H+
/K+
ATPase pump in gastric
mucosal parietal cells and decrease gastric acid production.
There are few studies that document the effect of H2RAs on
absorption of iron. Several case reports have suggested an
association between PPI use and iron deficiency anemia.
 Study Design: Retrospective review of selected patient
data. The primary outcome was to determine the
prevalence of concurrent verification of oral iron and
acid lowering agents for inpatients at Ochsner Medical
Center--Jefferson Highway Campus
 Inclusion Criteria: Patients were included for analysis if
orders for PPI/H2RA and oral iron supplementation
were concurrently active at the time of administration.
The study time frame was from January 1st
, 2015 to
November 2nd,
2015.
 Statistical Analysis: Microsoft Excel tools
 The study protocol was IRB approved.
Nothing to disclose
Objectives
Methods
ReferencesReferences
 Heidelbaugh, J. “Proton Pump Inhibitors and Risk of
Vitamin and Mineral Deficiency: Evidence and Clinical
Implications.” Ther Adv in Drug Saf. 2013 Jun;4(3) 125-33
 Hutchinson C, Geissler C, Powell J, Bomford A. “Proton
pump inhibitors suppress absorption of dietary non-haem
iron in hereditary haemochromatosis.” Gut56 2007: 1291–
95
 Sarzynski, E, Chethan P, Yan X, et al. "Association Between
Proton Pump Inhibitor Use and Anemia: A Retrospective
Cohort Study." Dig Dis Sci 2011 Aug;56(8): 2349-53
 Sharma V, Brannon M, Carloss E, et al. “Effect of
omeprazole on oral iron replacement in patients with iron
deficiency anemia.” South Med J. 2004: Sep;97(9): 887–9
At Ochsner Medical Center, EPIC™ is the order entry
system and verification system used. There are built-in
drug interaction warnings for both prescribing and
verification, but presently there are no warnings for the
interaction of acid-lowering agents and oral iron
supplements.
 Acid suppression agents were co-verified over 90% of
the time with oral iron agents
Pantoprazole and famotidine were co-verified with oral
iron in 72% and 19% of cases, respectively.
Co-administration of oral iron within 2 hours and 4 hours
of acid lowering agents occurred at 73.8% and 78.6% of
the time respectively .
System-wide alerts or prompts may be necessary to
prevent the co-verification and co-administration of acid
suppression agents and oral iron supplements.
Further studies would be needed to assess whether co-
verification with subsequent co-administration
significantly impacts iron levels.
Evaluating the prevalence of concurrent verification of
acid-lowering agents and oral iron supplements
Jamal K. Pratt; Christian Bertot; Kyle Simmons, PharmD, BCPS;
Ashley L. Casey, PharmD BCPS