Generic Name

Ferric Citrate

Precaution

Iron overload: Monitor ferritin and TSAT. Patients may require a reduction in dose or discontinuation of intravenous iron Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6 years of age. Keep this product out of reach of children.

Indication

Hyperphosphatemia, Iron Deficiency Anemia

Contra Indication

Contraindicated in patients with iron overload syndromes (e.g., hemochromatosis)

Dose

N/A

Side Effect

>10% Discolored feces (22%) Diarrhea (21%) Constipation (8-18%) Nausea (10-11%) 1-10% Vomiting (7%) Cough (6%) Hyperkalemia (5%) Abdominal pain (5%)

Pregnancy Category

Mode of Action

Hyperphosphatemia in CKD on dialysis Phosphate binder; ferric iron binds dietary phosphate in the GI tract and precipitates as ferric phosphate, which is insoluble and is excreted in the feces By binding phosphate in the GI tract and decreasing absorption, ferric citrate lowers the phosphate concentration in the serum Iron deficiency anemia in CKD not on dialysis Ferric iron is reduced from the ferric to the ferrous form by ferric reductase in the GI tract After transport through the enterocytes into the blood, oxidized ferric iron circulates bound to the plasma protein transferrin, and can be incorporated into hemoglobin

Interaction

Doxycycline and Ciprofloxacin has to be separated from drugs.

Pregnancy Category Note

Pregnancy There are no available data regarding use in pregnant women An overdose of iron in pregnant women may carry a risk for spontaneous abortion, gestational diabetes, and fetal malformation Lactation There are no human data regarding the effect in human milk, the effects on the breastfed child, or the effects on milk production Data from rat studies have shown the transfer of iron into milk by divalent metal transporter-1 (DMT-1) and ferroportin-1 (FPN-1); therefore, there is a possibility of infant exposure The development and health benefits of breastfeeding should be considered along with the mother’s clinical need for the drug and any potential adverse effects on the breastfed child or from the underlying maternal condition

Adult Dose

Hyperphosphatemia in Chronic Kidney Disease on Dialysis The recommended starting dose is 2 tablets orally 3 times per day with meals. Monitor serum phosphorus levels and titrate the dose in decrements or increments of 1 to 2 tablets per day as needed to maintain serum phosphorus at target levels, up to a maximum dose of 12 tablets daily. Iron Deficiency Anemia in Chronic Kidney Disease Not on Dialysis The recommended starting dose is 1 tablet orally 3 times per day with meals. Titrate the dose of as needed to achieve and maintain hemoglobin at target levels, up to a maximum dose of 12 tablets daily. For Iron Deficiency Anemia: 120-240mg elemental Fe3+ iron per day immediately after meal for 7 weeks

Child Dose

N/A

Renal Dose

N/A

Administration

Take with meals Do not chew or crush tablets because tablets may cause discoloration of mouth and teeth