Recently, I have gotten a number of people asking me this question and some variants of this question. Some of the other questions they ask include:
- Can I take blood tonic with malaria drugs?
- Can multivitamins be taken together with antimalarials
- Why did the doctor tell me not to take my malaria medicines with the iron preparations?
- What will happen if I take my antimalarials with a blood tonic?
In this article, I will be answering this question together with the variant forms mentioned and those that I couldn’t add to the list.
What actually is the problem with malaria medicines and iron preparations?
When it comes to the use of medications, a number of things should be of interest to anyone who takes them. Some of these things include:
- Side effects of the drugs
- Contraindications
- Interactions with other medicines, food and other therapies
- What could be over dosage or under dosage
So, which of these points actually relate to the use of iron preparations and antimalarials?
A number of theories have been proposed to explain what happens when one takes iron preparations with antimalarials. Before we look at some of these theories, let’s try and understand whether it is even necessary in the first place to be given iron preparations to someone who has malaria.
From this article, you will find out that one of the commonest symptoms of malaria is anaemia. Anaemia is basically the decrease in blood haemoglobin concentration. For those of you who do not know; hemoglobin is the substance that helps your blood to carry oxygen around the body for the use of your body tissues.
What it therefore means is that, when you get malaria, the parasites in your blood cause a breakdown of your red blood cells and therefore destroy this hemoglobin. This leads to a deprivation of your body cells or tissues from oxygen which presents a lot of other complications. You can find out more about this from here.
This same hemoglobin we are talking about is produced in the body from the use of iron. This implies that for your body to make enough hemoglobin in such situations, the body needs iron and that is why you may be given an iron preparation when you have malaria.
Why then can’t you take the iron preparations with your malaria medications?
So far, about three reasons have been established for why it is not recommended for patients treating malaria with antimalarials to take iron preparations concurrently.
First of these reasons was from the outcome of a study done in mice. The findings from this study published by the National Institutes of Health was that there will be the presence of extra iron in the red blood cells of a person suffering from malaria when given the iron preparations. This was found to interfere with the role of a protein called ferroportin which is supposed to prevent the excess build up of iron to toxic levels in the red blood cells.
The dysfunction of ferroportin in such instances leads to an excess build up of iron which ends up stressing the red blood cells and shortening their lifespan. This means that the excess iron will cause the red blood cells to die prematurely.
Another reason mentioned in the same study is the fact that the malaria parasites are able to feed on the excess iron available. If your antimalarial drugs are targeting at killing these parasites, why then would you want to be feeding them and making them stronger at the same time?
Finally, the other reason that has been identified has to do with the uptake of the iron into the body. There is a protein called hepcidin. The role of hepcidin in the body is to regulate the amount of iron that gets into the body at each point in time.
When the iron levels in the body are low, this hepcidin will ensure that more of it is taken up into the body. The body is able to achieve this by actually reducing the levels of hepcidin in the body. It means that when hepcidin levels are low, the body takes up more iron. The reverse too is true, where hepcidin levels go up, less iron will be absorbed in the body.
Another study published in an Oxford academic journal (The Journal of Nutrition) explains this better. It was noted that malaria results in some form of inflammation in the body. During such an inflammatory process, the protein hepcidin is upregulated as a protective mechanism by the body.
The body produces more hepcidin during inflammation to prevent excessive uptake of iron and therefore preventing feeding of the parasites with iron. Since hepcidin levels go up when you have malaria, it means taking your iron preparations during these periods of inflammation (while you still have the malaria) will result in only a small amount of the iron being taken up into the body. In other words, the iron will be practically wasted during such a period and may not yet have any good outcome.
It will therefore be important for you to wait and completely treat the malaria which usually takes just 3 days (for an uncomplicated malaria). These therefore explain why your doctor or pharmacist will ask you to hold on with the iron preparations during the 3 days that you are taking the malaria drugs.
Does this mean you can’t take vitamins or multivitamins when you have malaria?
According to a research published by ResearchGate, there is data that indicates that concurrent use of vitamins or multivitamins with malaria drugs may either accelerate potency of the drug or antagonize their effects. It is also mentioned in that article that deficiencies of some of these vitamins may protect, exacerbate or have both effects on the levels of the malaria parasites.
It is therefore safest to stay away from these vitamins or multivitamins during the treatment of malaria, especially ones that also contain any salt form of iron. The treatment is just for 3 days, so you can start taking your vitamins after the three days.
In conclusion, the 3 main reasons why you shouldn’t take an iron preparation whiles treating malaria or taking antimalarials are:
- Excess iron can reduce the lifespan of the red blood cells
- The malaria parasites can feed on the excess iron
- Absorption of iron is reduced due to malaria-induced inflammation
WRITTEN AND EDITED RESPECTIVELY BY:
Dr. Ehoneah Obed is a registered pharmacist and a member of the Pharmaceutical Society of Ghana. He has a Doctor of Pharmacy degree from Kwame Nkrumah University of Science and Technology and has experience working in a Tertiary hospital as well as various community pharmacies. He is also a software engineer interested in healthcare technologies.
His love for helping others motivates him to create content on an array of topics mostly relating to the health of people and also software engineering content.
He is knowledgeable in digital marketing, content marketing, and a host of other skills that make him versatile enough to uplift any team he joins.
MPSGH, MRPharmS, MPhil.
Isaiah Amoo is a practicing community pharmacist in good standing with the Pharmacy Council of Ghana who has meaningful experience in academia and industrial pharmacy. He is a member of the Royal Pharmaceutical Society, England, UK and currently pursuing his overseas pharmacy assessment programme (MSc) at Aston University, UK. He had his MPhil degree in Pharmaceutical Chemistry at Kwame Nkrumah University of Science and Technology. He has about 5 years’ experience as a community Pharmacist and has also taught in academic institutions like KNUST, Kumasi Technical University, Royal Ann College of Health, and G-Health Consult. He likes to spend time reading medical research articles and loves sharing his knowledge with others.
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