NutriStack
Esomeprazole and Iron, a caution.
Esomeprazole reduces absorption of oral iron, particularly non-heme iron salts like ferrous sulfate that require gastric acid for solubilization. In a large Kaiser case-control study, two or more years of PPI use raised iron deficiency risk roughly 2.5-fold. Patients with menstrual losses, GI bleeding, or vegan diets are most affected.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Esomeprazole and Iron
- Pair type
- Caution
- Evidence (highest tier)
- Strong
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Strong evidence
Caution
What is happening. Esomeprazole reduces absorption of oral iron, particularly non-heme iron salts like ferrous sulfate that require gastric acid for solubilization. In a large Kaiser case-control study, two or more years of PPI use raised iron deficiency risk roughly 2.5-fold. Patients with menstrual losses, GI bleeding, or vegan diets are most affected.
Mechanism. Gastric acid converts dietary ferric iron (Fe3+) to absorbable ferrous iron (Fe2+) and solubilizes iron salts for duodenal uptake by DMT1. Esomeprazole also up-regulates hepcidin via an aryl hydrocarbon receptor pathway, further suppressing intestinal iron transfer.
Recommendation. Take iron supplements at least 4 hours apart from esomeprazole. Consider iron bisglycinate or a heme-iron product, which are less acid-dependent. Recheck ferritin and CBC 3 months after starting iron, and let your prescriber know if hemoglobin does not respond.
Minimum separation. 240
Sources (2)
- Lam JR, Schneider JL, Quesenberry CP, Corley DA. Proton Pump Inhibitor and Histamine-2 Receptor Antagonist Use and Iron Deficiency. Gastroenterology. 2017;152(4):821-9. PMID 27890768
- Hamano H, Niimura T, Horinouchi Y, et al. Proton pump inhibitors block iron absorption through direct regulation of hepcidin via the aryl hydrocarbon receptor-mediated pathway. Toxicol Lett. 2020;318:86-91. PMID 31669099
Stack Score
How this pair moves the number.
Effect on the composite score
If both Esomeprazole and Iron are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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