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Ferrous Sulfate Does Not Interfere With Absorption Of Methotrexate In Patients With Rheumatoid Arthritis

Ferrous sulfate does not lessen the absorption of methotrexate (MTX) in patients with rheumatoid arthritis, reports a study from Canada.

Common treatment of rheumatoid arthritis (RA) with MTX and nonsteroidal anti-inflammatory drugs (NSAID) often causes gastrointestinal blood loss and iron deficiency that is often treated with iron supplements. However, these supplements can interfere with commonly prescribed drugs to treat RA.

To examine whether ingestion of ferrous sulfate would interfere with the absorption of oral MTX in patients with RA, Sean F. Hamilton, MD, FRCPC, Memorial University of Newfoundland, and colleagues conducted a randomised, double-blind, placebo-controlled crossover study of 10 patients with RA taking oral MTX (7.5 mg per week). During the first week of the study, patients were given either ferrous sulfate (300 mg) or placebo. During the second week, patients who had been given ferrous sulfate during the first week were then given placebo, and vice versa for the placebo group.

No statistically significant difference was found between the two groups, with average 24 hour urinary excretion of MTX of 8.44 umoles for the patients taking 300 mg ferrous sulfate twice daily for one week compared to 7.65 umoles for patients taking placebo (p=0.50).

The authors conclude that the hypothesis that ferrous sulfate interferes with the absorption of MTX in patients with RA is not substantiated by their data, which shows no significant interaction between these agents.

J Rheumatol 2003;30:1948-50. "The Effect of Ingestion of Ferrous Sulfate on the Absorption of Oral Methotrexate in Patients with Rheumatoid Arthritis"

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