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Supplement · Grade A

Iron and medications.

Every documented pair, every citation. Below: 4 documented pairs grouped by mechanism.

Iron is in the Distil supplement database, evidence Grade A. The page below lists every medication we have explicitly assessed it against.

Below are the 4 documented pairs we have explicitly assessed for Iron: 4 amber. The pairs cluster around 2 mechanisms: Absorption interference and Mineral chelation (absorption). Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not listed here is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by medication, and the missing-item form at the bottom of the page routes any uncatalogued medication into our next curation pass.

Documented interactions

Absorption interference

Amber Omeprazole

Non-haem iron from supplements absorbs less well in a low-acid stomach, so chronic omeprazole use reduces iron uptake from a standard ferrous sulphate or ferrous fumarate tablet. Iron bisglycinate is less pH-dependent and a better choice on a long-term PPI. Always confirm ferritin is in the deficient range before supplementing iron.

BNF: Omeprazole · BNF: Ferrous-sulphate

Mineral chelation (absorption)

Iron binds to alendronic acid in the gut and blocks absorption in the same way calcium does. Take alendronic acid first thing on an empty stomach with plain water, stay upright for 30 minutes, then wait at least two hours before any iron supplement.

BNF: Alendronic acid

Iron can bind to levothyroxine in the gut and reduce how much you absorb. Separating doses by four hours usually solves it.

BNF: Levothyroxine

Iron binds to risedronate in the gut and blocks absorption. Take risedronate first thing on an empty stomach with plain water, stay upright for 30 minutes, then wait at least two hours before any iron supplement.

BNF: Risedronate

What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope. Use the checker below to surface any medication, and submit a missing item if you take something we have not catalogued.

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For adults over 18. This tool gives evidence-graded information, not medical advice. Always discuss changes with your GP, especially if you take any medication, are pregnant, breastfeeding, or have a serious health condition.
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How we decide

How we grade severity, choose what's in scope, and what we exclude.

Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.

Read the full methodology
Distil's interactions database is reviewed and updated every quarter. We grade evidence transparently and publish our methodology, including every database change, at /about/methodology. This tool is information, not a substitute for clinical judgement. If you take medication and supplements together, your GP or pharmacist can review your full regimen against your medical history. If you want a comprehensive personalised stack reasoned against this same database, the Distil report is the next step up.