Adult Dosing

Management of hyperphosphatemia in CKD patients on dialysis

• Initial Dose: 2 tablets PO TID with meals
• Monitor serum phosphorus levels and titrate the dose in increments or decrements of 1 or 2 tablets per day to maintain serum phosphorus at target levels
• Dose can be titrated at 1 week or longer intervals
• Maximum dose: 12 tablets/day

Note:

• An average of 8 to 9 tablets per day were required to control the serum phosphorus levels in a clinical trial conducted in the United States

Oral drugs that have to be separated from ferric citrate and meals

• Doxycyline: Take at least 1 hour before ferric citrate
• Ciprofloxacin: Take at least 2 hours before or after ferric citrate

Pediatric Dosing

• Safety and efficacy in pediatric patient have not been established

[Outline]

• Adult Dosing
• Pediatric Dosing

• Control of serum phosphorus levels in patients with chronic kidney disease (CKD) on dialysis

• Hypersensitivity to any of the ingredients of the product|Patients with iron overload syndromes (e.g. hemochromatosis)

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Iron overload: Iron absorption from ferric citrate leads to excessive elevation in iron stores. Assess iron parameters (e.g. serum ferritin and transferrin saturation (TSAT)) prior to initiating the therapy and while on therapy
• Accidental overdose of iron: Can cause fatal poisoning in children under 6 years of age. Hence, keep tablets out of the reach of children. Call a doctor or poison control center immediately, in case of accidental poisoning

Pregnancy Category:B

• An overdose of iron in pregnant women may carry a risk of spontaneous abortion, gestational diabetes, and fetal malformation

Breastfeeding: Safety Unknown.

• Data from rat studies have shown the transfer of iron into milk. Hence, infant exposure is possible if ferric citrate is administered to nursing women

• GI: Diarrhea, nausea, constipation, vomiting
• RESP: Cough

• Phosphate binder; ferric iron binds dietary phosphate in the GI tract and precipitates as insoluble ferric phosphate, which is excreted in the feces, lowering the phosphate concentration in the serum
• Metabolism: Unknown
• Excretion: Unknown
• Half life: Unknown

US Trade Name(s)

• Auryxia

US Availability

Auryxia

• TABS: 210 mg ferric iron (eq. to 1 g ferric citrate)

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

[Outline]

Endocrine/Metabolic

Phosphate Binders