View Full Version : Low Iron? could it be from Methotrexate?

11-23-2006, 08:33 PM
I just found out that I have very low iron. I take 8mg pred, 10mg Methotrexate, colchicine, folic acid. My doc wants me to take ferrous sulfate 3 times a day..... I just wonder if it could be from the methotrexate. I have been on it for about 10months. Havent had any iron problems before.....
Will see my dr. on Tues.
Thanks for any feedback!

11-24-2006, 10:00 AM
Methotrexate is more likely to cause folate deficiency, because it interferes with the body's absorption of folate, which can lead to folate deficiency anemia. This is part of the reason folic acid supplements are needed with methotrexate.

Iron deficiency is the most common nutrient deficiency in the world, and women who still have menstrual cycles are especially vulnerable, because of monthly blood loss, especially if you have heavy or prolonged periods. Vegetarians may also be iron-deficient because the form of iron derived from plants (non-heme iron) is less easily absorbed by the body than the iron from meats and fish (heme iron). Drugs that do interfere with iron absorption include quinolone antibiotics like Floxin and Cipro, drugs prescribed for Parkinson's disease, thyroid hormone, ACE inhibitors, soy supplements, calcium supplements, and mulivitamin/mineral supplements. H2 blockers and proton pump inhihbitors (drugs prescribed for reflux and ulcers) can also interfere with iron absorption. So there are a lot of factors that can vcause low iron - it isn't necessarily related to methotrexate.

Oysters, meat, poultry and fish are all high in heme iron. The main sources of nonheme iron are dried fruits, molasses, whole grains, legumes, leafy green vegetables, nuts, seeds, and kelp. Many breads and cereals are also fortified with iron. Acidic foods like tomatoes are a good source of iron when they've been cooked in iron or stainless steel cookware (some of the iron leaches into the food). Vitamin C also helps your body absorb iron better.

You mentioned low iron - did your doctor say whether or not you have iron deficency anemia? And do you know if the test was for for serum iron (amount actually in the blood) or ferritin (which correlates to stored iron). Ferritin levels are usually a more accurate picture of your iron levels, because serum iron levels can be affected by many different things. So be sure to ask your doctor exactly what he meant by low iron. Low iron levels can lead to iron defiency anemia, which can cause extreme fatigue, shortness of breath, dizziness, and other symptoms. But iron defiency is usually severe before anemia develops, so hopefully the supplements will correct the problem early.

Once your iron levels are back up, your doctor will probably reduce the amount of iron you are taking, to the lowest amount needed to maintain a good iron balance. You should ask your pharmacist about the best time to take your supplements, because the iron can interact with other medicines and affect the absorption of both. So you may need to take the iron at a separate time. Iron can cause a lot of stomach upset, so also ask about whether to take it with food. Calcium can interfere with iron absorption, so you shouldn't take the supplements with milk or calcium fortified juice. If your iron levels don't come within two weeks, this may indicate a problem with iron absorrption, or a possible problem with GI bleeding, and other tests may be necessary. But most times they will come back up with no problems. Just remember that iron supplements can be very toxic to children, so be sure to keep them out of reach if you have children in your home.

Hope this helps!

11-29-2006, 09:41 PM
Low iron was what helped me get my Lupus diagnosis (helped the docs take things seriously when my hematocrit was 25 - while taking iron supplements).

Anyway, it seems my chronic low iron has been a combo of bleeding from kidneys, Lupus in general, and maybe from Cellcept (but I don't thiknmuch from the Cellcept). Supplements hadn't helped, but ProCrit has - it has helped my energy level a lot, too.

Good luck!!!