Drug Guide
Ferric Citrate
Classification
Therapeutic: Hematologic agent, Iron supplement
Pharmacological: Iron salt
FDA Approved Indications
- Treatment of iron deficiency anemia in patients with chronic kidney disease on dialysis
- Control of serum phosphorus levels in patients with chronic kidney disease on dialysis
Mechanism of Action
Ferric citrate acts as a source of bioavailable iron for incorporation into hemoglobin and other iron-containing enzymes; it also binds dietary phosphorus in the gastrointestinal tract, reducing serum phosphorus levels.
Dosage and Administration
Adult: Typically 1 g three times daily with meals, adjusted based on iron studies and serum phosphorus levels.
Pediatric: Not approved for pediatric use; data is limited.
Geriatric: No specific dose adjustment, but monitor for iron overload and other adverse effects.
Renal Impairment: Adjustments depend on indication; for CKD patients, dosing should be individualized based on serum phosphorus and iron parameters.
Hepatic Impairment: Use caution; no specific adjustments established.
Pharmacokinetics
Absorption: Absorbed in the gastrointestinal tract, with systemic iron absorption contributing to iron stores.
Distribution: Bind to plasma proteins; distributed throughout body tissues.
Metabolism: Metabolized in the liver, as with other iron salts.
Excretion: Excreted mainly via the gastrointestinal tract; small amounts may be excreted in urine.
Half Life: Approximately 4-6 hours, but varies with iron status.
Contraindications
- Hypersensitivity to ferric citrate or other iron preparations.
- Hemochromatosis or hemosiderosis.
Precautions
- Use with caution in patients with iron overload conditions, infections, or gastrointestinal disease. Monitor iron status regularly; overdose can lead to iron toxicity.
Adverse Reactions - Common
- Gastrointestinal upset (constipation, nausea, diarrhea) (Common)
- Dark stools (Common)
Adverse Reactions - Serious
- Iron overload leading to hemosiderosis (Rare)
- Allergic reactions including rash, itching, swelling (Rare)
Drug-Drug Interactions
- May affect absorption of other medications (e.g., levothyroxine, quinolones, tetracyclines).
Drug-Food Interactions
- Concurrent intake of calcium-rich foods may impair iron absorption.
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor hemoglobin, hematocrit, serum ferritin, transferrin saturation, and serum phosphorus regularly.
Diagnoses:
- Altered serum iron levels
- Risk for electrolyte imbalance
Implementation: Administer with meals to reduce gastrointestinal discomfort. Monitor for signs of iron overload.
Evaluation: Assess for improvement in anemia and control of phosphorus levels.
Patient/Family Teaching
- Take medication with meals to decrease gastrointestinal side effects.
- Report symptoms of overdose (e.g., fatigue, abdominal pain, dizziness).
- Maintain regular lab testing as scheduled.
- Limit intake of foods high in calcium around dosing times, if advised.
Special Considerations
Black Box Warnings:
- Iron overdose can be fatal; keep out of reach of children.
Genetic Factors: No specific genetic considerations.
Lab Test Interference: Can interfere with some assays measuring serum iron, ferritin, and transferrin saturation.
Overdose Management
Signs/Symptoms: Nausea, vomiting, diarrhea, abdominal pain, hypotension, shock, iron toxicity symptoms.
Treatment: Discontinue iron, provide supportive care, and chelation therapy if indicated (deferoxamine). Consider gastric lavage or activated charcoal. Monitor vital signs and laboratory parameters.
Storage and Handling
Storage: Store at room temperature, away from moisture and heat.
Stability: Stable for the duration specified on the packaging.