Quick answer

Ask your pharmacist or doctor before combining. Proton pump inhibitors lower stomach acid, and NIH says that can reduce how much iron the body absorbs. NIH adds that up to 10 years of use was not tied to iron depletion in people with normal iron stores, while people already low in iron may respond less well to iron supplements.^1,2

Key facts

NIH says stomach acid plays an important role in absorbing nonheme iron, and that proton pump inhibitors reduce the acidity of stomach contents.¹
NIH reports that treatment with proton pump inhibitors for up to 10 years was not associated with iron depletion or anemia in people with normal iron stores.¹
The same NIH sheet says patients with iron deficiency who take proton pump inhibitors can have suboptimal responses to iron supplementation.¹
The omeprazole label lists iron salts among the drugs whose absorption depends on stomach acidity.³
MedlinePlus lists iron supplements among nonprescription products that may interact with omeprazole.⁴

Your doctor may want to check on you

Proton pump inhibitors such as omeprazole and lansoprazole lower stomach acid, which can reduce how much nonheme iron is absorbed. Years of use did not deplete iron in people whose stores were normal, but people with low iron who take these medicines may respond less well to iron supplements.^1,2

Reported in studies

Do proton pump inhibitors affect iron absorption?

MedlinePlus describes omeprazole as a proton pump inhibitor that decreases the amount of acid made in the stomach, used for acid reflux and ulcers. NIH's iron fact sheets name omeprazole and lansoprazole as medicines that decrease stomach acid and might reduce how much nonheme iron the body absorbs.^2,4

Nonheme iron is the kind found in plant foods and iron-fortified foods. Meat, seafood and poultry contain both heme and nonheme iron. NIH's health professional sheet says gastric acid plays an important role in absorbing nonheme iron from the diet, so a medicine that reduces the acidity of stomach contents can reduce iron absorption.^1,2

The omeprazole label makes a related general point. It lists iron salts among the drugs whose absorption depends on stomach acidity, and says omeprazole can lower the absorption of such drugs because it reduces acidity in the stomach. Iron salts such as ferrous sulfate and ferrous gluconate are common forms in supplements.^2,3

Can proton pump inhibitors cause iron deficiency?

NIH points to evidence that long use did not by itself deplete iron: treatment with proton pump inhibitors for up to 10 years was not associated with iron depletion or anemia in people with normal iron stores. The picture changes when iron is already low. NIH says patients with iron deficiency who take these medicines can have suboptimal responses to iron supplementation.¹

NIH names groups more likely to run low on iron: teen girls and women with heavy periods, pregnant women, infants, frequent blood donors, and people with cancer, gastrointestinal disorders or heart failure. If you are in one of these groups and also take an acid reducer, your prescriber is the person to judge whether your iron needs checking.²

For medicines taken on a regular basis, NIH says people should discuss their iron status with their health care providers.¹

How well is this effect documented?

This pair is marked 'monitor' and 'studies'. The effect comes from the research NIH cites and from the general note on the omeprazole label about drugs that depend on stomach acidity. It is not a warning printed on an iron product, and neither NIH nor the label gives an amount of iron or a schedule to follow with an acid reducer. Those questions belong with your pharmacist.^1,3

Some proton pump inhibitors are sold without a prescription, so mention any acid reducer you buy yourself, including short courses.⁴

What to ask your pharmacist about iron and an acid reducer

Is my acid reducer a proton pump inhibitor, and how long have I taken it?
Has my iron level been checked since I started it, and does it need checking again?
If I take an iron product, should I expect it to work differently?
Do my multivitamin, prenatal vitamin or other products contain iron too?
Do I also take calcium, which NIH says might interfere with iron absorption?²

Bring the Supplement Facts panel of everything you take. NIH says iron is in many multivitamin and mineral supplements as well as in supplements that contain only iron.²

Questions people ask

Can you take iron with proton pump inhibitors?

NIH and the omeprazole label describe an effect on absorption, not a ban: the medicine lowers stomach acid, and that can reduce how much iron is absorbed. How that applies to you depends on your iron level, so ask your pharmacist.^1,3

Can proton pump inhibitors cause iron deficiency?

NIH says treatment for up to 10 years was not associated with iron depletion or anemia in people with normal iron stores. It also says people who already have iron deficiency can respond less well to iron supplements while taking these medicines.¹

Do proton pump inhibitors affect iron absorption from food and supplements?

NIH describes reduced absorption of nonheme iron from food. The omeprazole label lists iron salts, a common supplement form, among drugs that depend on stomach acidity to be absorbed.^2,3

What about iron deficiency anemia and proton pump inhibitors?

NIH says patients with iron deficiency who take proton pump inhibitors can have suboptimal responses to iron supplementation. How to manage low iron is a medical decision, so involve your doctor.¹

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This page is information, not medical advice. Talk to your doctor or pharmacist about your own situation.