Ferric Citrate
Indications
Ferric Citrate is used for:
Hyperphosphatemia, Iron Deficiency Anemia
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
Renal Dose
Administration
Take with meals
Do not chew or crush tablets because tablets may cause discoloration of mouth and teeth
Contra Indications
Contraindicated in patients with iron overload syndromes (e.g., hemochromatosis)
Precautions
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.
Pregnancy-Lactation
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
Interactions
Doxycycline and Ciprofloxacin has to be separated from drugs.
Side Effects
Side effects of Ferric Citrate :
>10%
Discolored feces (22%)
Diarrhea (21%)
Constipation (8-18%)
Nausea (10-11%)
1-10%
Vomiting (7%)
Cough (6%)
Hyperkalemia (5%)
Abdominal pain (5%)
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