ferric citrate

Therapeutic Classification: electrolyte modifiers

Pharmacologic Classification: phosphate binders

Indications ⬆ ⬇

REMS

Treatment of hyperphosphatemia in patients with chronic kidney disease on dialysis.
Treatment of iron deficiency anemia in patients with chronic kidney disease not on dialysis.

Action ⬆ ⬇

Binds phosphorous and precipitates it as ferric phosphate.
After being transported through enterocytes into the blood, oxidized ferric iron circulates bound to transferrin where it is incorporated into hemoglobin.

Therapeutic effects:

Maintenance of normal phosphorous levels.
Resolution of iron deficiency anemia.

Pharmacokinetics ⬆ ⬇

Absorption: Some absorption follows oral administration and may lead to iron overload.

Distribution: Unknown.

Metabolism/Excretion: Following binding, precipitated ferric phosphate is excreted in stool.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(lowering of serum phosphorous)

ROUTE	ONSET	PEAK	DURATION
PO	within 1 wk	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Iron overload syndromes including hemochromatosis.

Use Cautiously in:

GI bleeding/inflammation;
OB: Use cautiously during pregnancy (consider effects on vitamins/nutrient and potential iron overload);
Lactation: Consider possible iron transport into milk;
Pedi: Safety and effectiveness not established.

Adv. Reactions/Side Effects ⬆ ⬇

GI: diarrhea, discolored feces, nausea, constipation, vomiting

Hemat: iron overload

Interactions ⬆ ⬇

Drug-drug:

Binds and ↓ absorption of doxycycline (should be given ≥1 hr prior to ferric citrate).
Binds and ↓ absorption of ciprofloxacin (should be given ≥2 hr prior to or after ferric citrate).

Route/Dosage ⬆ ⬇

Hyperphosphatemia

PO (Adults ): 2 tablets (2 g ferric citrate) 3 times daily. Adjust by 1–2 tablets/day at weekly (or longer) intervals to attain and maintain target phosphorous levels (max = 12 tablets/day).

Iron Deficiency Anemia

PO (Adults ): 1 tablet (1 g ferric citrate) 3 times daily. Adjust dose as needed to attain and maintain target hemoglobin levels (max = 12 tablets/day).

Availability ⬆ ⬇

(Generic available)

Tablets: 1 g (contains 210 mg ferric iron)

Assessment ⬆ ⬇

Monitor clinical responses or blood levels of concurrent medications; may decrease bioavailability of medications administered concurrently.

Lab Test Considerations:

Monitor serum phosphorous prior to starting and periodically during therapy to keep serum phosphorous at target levels.
- Assess iron parameters (serum ferritin and transferritin saturation TSAT) prior to starting and periodically during therapy. May cause ↑ serum ferritin and TSAT requiring reduced dose or discontinuation of IV iron therapy.

Implementation ⬆ ⬇

PO: Administer 3 times daily with meals. Swallow tablets whole; do not crush or chew; may cause discoloration of mouth and teeth. Titrate doses no less than weekly.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take ferric citrate as directed and to continue with prescribed diet.
Advise patient that ferric citrate may cause dark stools; this is normal for medications containing iron.
Inform patient that ferric citrate may cause diarrhea, nausea, constipation, and vomiting. Notify health care professional if GI symptoms become severe or persistent.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications. Medications may need to be taken separately from ferric citrate.
Advise patient to store ferric citrate out of the reach of children; if accidentally ingested by a child seek immediate medical attention.
Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

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Pronunciation ⬇

Classifications ⬆ ⬇