ferric citrate (Rx)

Brand and Other Names:Auryxia
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 210mg ferric iron (equivalent to 1g ferric citrate)
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Hyperphosphatemia

Indicated for the control of serum phosphorus levels in patients with chronic kidney disease (CKD) on dialysis

Initial: 420 mg (2 tablets) PO TID with meals

Monitor serum phosphorus levels and adjust dose at ≥1-week intervals in decrements or increments of 1 to 2 tablets/day PRN to maintain serum phosphorus at target levels

Not to exceed 12 tablets/day

Iron Deficiency Anemia

Indicated for treatment of iron deficiency anemia in adults with CKD not on dialysis (CKD-NDD)

Initial: 210 mg (1 tablet) PO TID with meals

Titrate as needed to achieve and maintain hemoglobin at target levels

Not to exceed 12 tablets/day

In clinical trial, average dose was 5 tablets/day

Safety and efficacy not established

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Interactions

Interaction Checker

and ferric citrate

No Results

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Discolored feces (22%)

            Diarrhea (21%)

            Constipation (8-18%)

            Nausea (10-11%)

            1-10%

            Vomiting (7%)

            Cough (6%)

            Hyperkalemia (5%)

            Abdominal pain (5%)

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            Warnings

            Contraindications

            Iron overload syndromes (eg, hemochromatosis)

            Cautions

            Iron absorption from ferric citrate may lead to excessive elevations in iron stores; assess iron parameters (eg, 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 yr; keep out of the reach of children

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            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

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism 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

            Absorption

            Shown to increase serum iron parameters, including ferritin, iron, and TSAT

            In a 52-week clinical trial, mean ferritin levels rose from 593 ng/mL to 895 ng/mL, mean TSAT levels rose from 31% to 39%, and mean iron levels rose from 73 mcg/dL to 88 mcg/dL

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            Administration

            Oral Administration

            Take with meals

            Do not chew or crush tablets because tablets may cause discoloration of mouth and teeth

            Storage

            Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F)

            Protect from moisture

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • View the formulary and any restrictions for each plan.
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            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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