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ferric citrate (Oral route)

FER-ik SI-trate

Commonly used brand name(s)

In the U.S.

  • Auryxia

Available Dosage Forms:

  • Tablet

Therapeutic Class: Phosphate Binder

Uses For ferric citrate

Ferric citrate is used to control the phosphorus levels in the blood of patients with chronic kidney disease that are on dialysis.

ferric citrate is available only with your doctor's prescription.

Before Using ferric citrate

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For ferric citrate, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to ferric citrate or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of ferric citrate in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of ferric citrate in the elderly.

Pregnancy

Pregnancy Category Explanation
All Trimesters B Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking ferric citrate, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using ferric citrate with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Dimercaprol
  • Eltrombopag

Using ferric citrate with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Carbidopa
  • Cefdinir
  • Demeclocycline
  • Dolutegravir
  • Doxycycline
  • Gatifloxacin
  • Grepafloxacin
  • Levodopa
  • Levofloxacin
  • Levothyroxine
  • Lomefloxacin
  • Methyldopa
  • Minocycline
  • Moxifloxacin
  • Mycophenolic Acid
  • Norfloxacin
  • Ofloxacin
  • Omeprazole
  • Penicillamine
  • Temafloxacin
  • Tetracycline
  • Trovafloxacin Mesylate
  • Zinc

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using ferric citrate with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use ferric citrate, or give you special instructions about the use of food, alcohol, or tobacco.

  • Dairy Food
  • Phytic Acid Containing Food

Other Medical Problems

The presence of other medical problems may affect the use of ferric citrate. Make sure you tell your doctor if you have any other medical problems, especially:

  • Hemochromatosis (a genetic disorder which causes too much iron in the blood)—Should not be used in patients with this condition.
  • Inflammatory bowel disease or
  • Stomach or bowel problem (eg, bleeding)—ferric citrate has not been studied in patients with these conditions, but should be monitored for more serious side effects.

Proper Use of ferric citrate

Take ferric citrate exactly as directed by your doctor. Do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

Take ferric citrate with meals.

If you are taking doxycycline, take it at least 1 hour before you take ferric citrate.

Dosing

The dose of ferric citrate will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of ferric citrate. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For control of phosphorus levels in patients with chronic kidney disease on dialysis:
      • Adults—At first, 2 tablets three times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 12 tablets per day.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of ferric citrate, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using ferric citrate

It is very important that your doctor check your progress at regular visits to make sure that ferric citrate is working properly. Blood tests may be needed to check for unwanted effects.

Tell your doctor if you have severe or persistent diarrhea, constipation, nausea, or vomiting while using ferric citrate.

ferric citrate may cause dark-colored stools. This is normal when you take medicines containing iron and is nothing to worry about.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

ferric citrate Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Cough
  • diarrhea
  • difficulty having a bowel movement (stool)
  • nausea
  • vomiting
Incidence not known
  • Dark-colored stools

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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