Ferric Citrate

What Is Ferric Citrate and How Does It Work?

• Ferric Citrate is a prescription medication used to control serum phosphorus levels in patients with chronic kidney disease on dialysis or for treating iron deficiency anemia.

Common side effects of Ferric Citrate include:

• diarrhea,
• nausea,
• constipation,
• vomiting,
• cough, and
• dark stools (related to the iron content).

Serious side effects of Ferric Citrate include:

• fatigue and weakness
• joint pain
• abdominal pain
• abdominal swelling
• darkened, discolored skin
• abnormal heart rhythms
• hyperkalemia (elevated potassium)

Rare side effects of Ferric Citrate include:

• none 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms such as fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheartedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

Adult dosage

Tablet

• 210 mg ferric iron (equivalent to 1 gram ferric Citrate)

Hyperphosphatemia

Adult dosage

• Initial: 420 mg (2 tablets) orally three times a day with meals
• Monitor serum phosphorus levels and adjust dose at above 1-week intervals in decrements or increments of 1 to 2 tablets per day or as needed to maintain serum phosphorus at target levels
• Not to exceed 12 tablets per day

Iron Deficiency Anemia

Adult dosage

• Initial: 210 mg (1 tablet) orally three times a day with meals
• Titrate as needed to achieve and maintain hemoglobin at target levels
• Not to exceed 12 tablets per day
• In a clinical trial, the average dose was 5 tablets per day

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Ferric Citrate has severe interactions with no other drugs.
• Ferric Citrate has serious interactions with the following drugs:
  • baloxavir marboxil
  • erdafitinib
• Ferric Citrate has moderate interactions with the following drugs:
  • ciprofloxacin
  • deferiprone
  • doxycycline
  • gemifloxacin
  • levofloxacin
  • moxifloxacin
  • ofloxacin
  • omadacycline
  • sarecycline
  • sodium sulfate/magnesium sulfate/potassium chloride
  • sodium sulfate/potassium sulfate/magnesium sulfate
  • vonoprazan
• Ferric Citrate has minor interactions with no other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Iron overload syndromes (e.g., hemochromatosis) 

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Ferric Citrate?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Ferric Citrate?”

Cautions

• Iron absorption from ferric Citrate may lead to excessive elevations in iron stores; assess iron parameters (e.g., serum ferritin, TSAT) before initiating drug and monitor parameters while on therapy; patients receiving IV iron may require a reduced dose or discontinuation
• Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children younger than 6 years; keep out of the reach of children

Pregnancy and Lactation

• There are no available data regarding use in pregnant women
• An overdose of iron in pregnant women may carry a risk of spontaneous abortion, gestational diabetes, and fetal malformation
• Effect of this drug on the absorption of vitamins and other nutrients not studied in pregnant women; requirements for vitamins and other nutrients are increased in pregnancy
• Lactation
  • There are no human data regarding the effect of 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