Can You Take A Stool Softener With Oral Iron To Help With Constipation?

Answer

Hello, and thank you for reaching out.

Yes, you can certainly take a stool softener, such as docusate, to help relieve the constipation caused by your oral iron supplementation.

You're not alone in this. Oral iron, such as ferrous sulfate, is commonly used to treat anemia (low iron) and is generally effective. However, studies show that up to 70% of individuals report gastrointestinal side effects, especially with ferrous sulfate.

In the section below, I offer some strategies to improve the tolerability of oral iron. These suggestions may help reduce the severity of the constipation you are experiencing, but I recommend speaking with your doctor before making any changes to your medication regimen.

Strategies to Improve Tolerability

First and foremost, as mentioned above, if you are experiencing constipation, the use of a stool softener or bulk-forming laxative can be helpful.

Some other strategies include:

• Decreasing the dosing interval to every other day instead of every day (or twice a day as in your situation).
• Making dietary modifications (taking iron with food or milk), although this may reduce absorption.
• Switching to a formulation with a lower amount of elemental iron (the lower the iron, generally, the more tolerable it is).
• Switching from a tablet to a liquid can make it easier to titrate the dose and give your body time to adjust to the effects.

Dosing Schedule

I want to highlight the suggestion of altering your dosing schedule to help you deal with the side effects you are having (reiterating the disclaimer here to talk to your doctor before making medication regimen changes).

For starters, oral iron is often recommended to be dosed no more frequently than once daily (there are exceptions to this, but it would be uncommon to need twice daily dosing).

Additionally, several studies show that every-other-day dosing may be as effective, if not more so, than once-daily dosing, possibly due to the effects of hepcidin, a hormone involved in iron regulation.

Comparative Studies

Several studies have compared the efficacy and tolerability of different iron dosing schedules:

• A 2017 study compared daily oral iron (60 mg of ferrous sulfate) for 14 days versus once every other day for 28 days (same cumulative dose). The every-other-day dosing resulted in greater iron absorption (131 versus 175 mg total) for the 14 total doses. There was a trend towards decreased nausea in the every-other-day group that did not reach statistical significance; constipation was not assessed though.

• A 2015 study, involving 54 iron-deficient females found that administering multiple daily doses of oral iron could unexpectedly decrease iron absorption. These individuals, with depleted iron stores (ferritin ≤20 ng/mL) but without anemia, received varying doses of oral iron containing a traceable isotope to monitor absorption. The study found that iron absorption was most effective when dosing was limited to lower amounts and less frequent administration (40 to 80 mg of iron no more than once a day). Higher or more frequent doses of iron were associated with elevated levels of circulating hepcidin, a hormone that regulates iron metabolism. Increased hepcidin levels can reduce the absorption of iron in the body.

Conclusion

I know I provided some additional detail in this answer that you didn't necessarily ask for, but I thought it was important to provide some context to your question.

The short answer to your question is yes, taking a stool softener is perfectly fine to help relieve the constipation you are experiencing from your oral iron. Some other things may help as well though, such as decreasing how often you are taking it, and taking it at smaller doses.

I do want to point out that there certainly are times when oral iron supplementation doesn't improve iron levels enough in some individuals and IV iron may be needed.

For example, IV iron (as opposed to oral iron) may be more appropriate for individuals who cannot tolerate oral iron, who have severe bleeding, who have gastrointestinal disorders, who have severe anemia, and individuals who are anemic during pregnancy in the second or third trimester.

Be sure to speak with your doctor about how to best correct your anemia.

Thanks again for reaching out!