Ferric Citrate

Ferric Citrate is indicated for the control of serum phosphorus levels in adult patients with chronic kidney disease on dialysis and the treatment of iron deficiency anemia in adult patients with chronic kidney disease not on dialysis.

Ferric iron binds dietary phosphate in the GI tract and precipitates as ferric phosphate. This compound is insoluble and is excreted in the stool. By binding phosphate in the GI tract and decreasing absorption, ferric iron lowers the phosphate concentration in the serum.

• Hyperphosphatemia in CKD on Dialysis: Used for control of serum phosphorus levels in adult CKD patients on dialysis.
• Iron Deficiency Anemia in CKD not on Dialysis: Used for treatment of IDA in adult CKD patients not on dialysis.

Oral Iron preparations

Phosphate Binder + Iron Replacement

Ferric iron binds dietary phosphate in the GI tract and precipitates as ferric phosphate. This compound is insoluble and is excreted in the stool. By binding phosphate in the GI tract and decreasing absorption, ferric iron lowers the phosphate concentration in the serum. 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.

Ferric Citrate binds dietary phosphate to reduce phosphorus absorption and replenishes iron stores to treat anemia.

Adult Dose (Oral):

• Hyperphosphatemia in CKD on Dialysis: Starting dose: 2 tablets orally 3 times per day with meals; adjust by 1-2 tablets as needed; max 12 tablets daily; titrate at 1-week or longer intervals.
• IDA in CKD not on Dialysis: Starting dose: 1 tablet orally 3 times per day with meals; adjust as needed to achieve hemoglobin goal; max 12 tablets daily.

Take orally with meals. Swallow the tablet whole. Do not chew, crush or break it.

If you miss a dose of Ferric Citrate, take it as soon as possible; however, if it is almost time for your next dose, skip the missed dose.

Common Side Effects:

• Discolored feces
• Diarrhea
• Constipation
• Nausea
• Vomiting
• Cough
• Abdominal pain
• Hyperkalemia

Precautions:

• Iron absorption may lead to excessive elevations in iron stores; monitor serum ferritin and TSAT; may require reduction in dose or discontinuation of IV iron.
• Oral drugs such as Doxycycline and Ciprofloxacin have to be separated from Ferric Citrate.
• Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6 years; keep out of reach of children.

Contraindications: Iron overload syndrome (Hemochromatosis).

Drug Interactions:

• Doxycycline, Ciprofloxacin: Have to be separated from Ferric Citrate.

Food Interactions: Should be taken with meals.

Use in Pregnancy: No data available on use in pregnant women.

Use in Lactation: No data available on use in lactating mothers.

Pediatric Use: Safety and efficacy not established in children and adolescents.

Geriatric Use: No specific dosage adjustment is necessary for elderly patients.

Renal Impairment: Indicated for CKD patients (on dialysis and not on dialysis).

Hepatic Impairment: No specific precautions necessary.

Overdose: No data available regarding overdose; maximum dose studied in CKD patients was 2,520 mg ferric iron per day.

Storage: Store below 30 degree C, away from light and in a dry place. Keep out of reach of children.

Ferric Citrate