Drug General Information (ID: DDI1DG0M2I)
Drug Name			Pantoprazole		Drug Info		Ferrous fumarate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiulcer Agents				Iron Supplement
Structure

Mechanism of Pantoprazole-Ferrous fumarate Interaction (Severity Level: Moderate)
Altered gastric pH Click to Show/Hide Mechanism Graph
Drug Name		Pantoprazole				Ferrous fumarate
Mechanism		Gastric alkalinizer				Gastric pH sensitive
Key Mechanism Factor 1
		Factor Name		Gastric pH
		Factor Description		The normal pH range of gastric acid is between 1.5 and 3.5 and is highly acidic, consisting mainly of hydrochloric acid. Changes in the pH of the stomach can alter the absorption of drugs.
Mechanism Description		Decreased absorption of Ferrous fumarate due to altered gastric pH caused by Pantoprazole

Recommended Action
Management		Patients with iron deficiency may not respond adequately to oral iron replacement therapy during coadministration of proton pump inhibitors. If an interaction is suspected after ruling out other causes, it may be appropriate to discontinue the proton pump inhibitor or consider administering iron parenterally.

References
1	Hutchison C, Geissler CA, Powell JJ, Bomford A "Proton pump inhibitors suppress absorption of dietary non-haem iron in hereditary haemochromatosis." Gut 56 (2007): 1291-5. [PMID: 17344278]
2	Nand S, Tanvetyanon T "Proton pump inhibitors and iron deficiency: is the connection real?" South Med J 97 (2004): 799. [PMID: 15455957]
3	Product Information. Aciphex (rabeprazole) Janssen Pharmaceuticals, Titusville, NJ.
4	Product Information. Kapidex (dexlansoprazole). Takeda Pharmaceuticals America, Lincolnshire, IL.
5	Product Information. Nexium (esomeprazole) Astra-Zeneca Pharmaceuticals, Wilmington, DE.
6	Product Information. Prevacid (lansoprazole). TAP Pharmaceuticals Inc, Deerfield, IL.
7	Product Information. Prilosec (omeprazole). Merck & Co, Inc, West Point, PA.
8	Product Information. Protonix (pantoprazole) Wyeth-Ayerst Laboratories, Philadelphia, PA.
9	Sharma VR, Brannon MA, Carloss EA "Effect of omeprazole on oral iron replacement in patients with iron deficiency anemia." South Med J 97 (2004): 887-9. [PMID: 15455980]
10	Stewart CA, Termanini B, Sutliff VE, et al "Iron absorption in patients with Zollinger-Ellison syndrome treated with long-term gastric acid antisecretory therapy." Aliment Pharmacol Ther 12 (1998): 83-98. [PMID: 9692706]