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Ferric Pyrophosphate Citrate


(FER ik pye roe FOS fate SIT rate)

Index Terms

  • Ferric Pyrophosphate
  • Soluble Ferric Pyrophosphate (SFP)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Hemodialysis:

Triferic: 27.2 mg/5 mL (50 mL)

Brand Names: U.S.

  • Triferic

Pharmacologic Category

  • Iron Salt


Iron in the form of ferric pyrophosphate citrate and added to hemodialysate solution is administered to patients by transfer across the dialyzer membrane. Iron delivered into the circulation binds to transferrin for transport to erythroid precursor cells to be incorporated into hemoglobin.


Vd: 0.765 to 0.859 L

Half-Life Elimination

~1.48 hours

Use: Labeled Indications

Iron replacement therapy in hemodialysis-dependent patients: Replacement of iron to maintain hemoglobin in adult patients with hemodialysis-dependent chronic kidney disease (HDD-CKD)

Limitations of use: Not intended for use in patients receiving peritoneal dialysis; has not been studied in patients receiving home hemodialysis


There are no contraindications listed in the manufacturer's labeling.

Dosing: Adult

Note: Triferic ampules contains 5.44 mg iron (III) per mL. Triferic powder contains 272 mg iron (III) per packet.

Iron replacement therapy in hemodialysis-dependent patients: Intradialytic: After admixture into bicarbonate concentrate dialysate (final concentration 2 micromolar [110 mcg/L]) use at each dialysis session. Therapy may be continued for as long as the patient is receiving maintenance hemodialysis for CKD.

Dosing: Renal Impairment

No dosage adjustment necessary.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.


Solution in ampules may appear slightly yellow-green in color. Add solution or powder to bicarbonate concentrate used for generation of hemodialysate (2 micromolar [110 mcg/L] iron [III] final concentration). Multiple single dose 5 mL ampules can be added to the master bicarbonate mix at each dialysis center at a ratio of one 5 mL ampule to each 9.46 L (2.5 gallons) of bicarbonate concentrate. Multiple 50 mL ampules or powder packets can be added to the master bicarbonate mix at each dialysis center at a ratio of one 50 mL ampule or 1 powder packet to each 94.6 L (25 gallons) of bicarbonate concentrate.


Intradialytic: Administer after admixed into bicarbonate concentrate dialysate at each dialysis session.


Do not add to acid hemodialysate concentrate mixtures.


Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Protect ampules from light. Use hemodialysate within 24 hours of preparation.

Drug Interactions

Dimercaprol: May enhance the nephrotoxic effect of Iron Salts. Avoid combination

Adverse Reactions

Note: Frequency not always defined.

>10%: Cardiovascular: Procedural hypotension (22%)

1% to 10%:

Cardiovascular: Peripheral edema (7%), clotted AV fistula (3%), dialysis access hemorrhage (3%)

Central nervous system: Headache (9%), fatigue (4%), dizziness

Dermatologic: Pruritus

Gastrointestinal: Constipation, nausea

Genitourinary: Urinary tract infection (5%)

Neuromuscular & skeletal: Muscle spasm (10%), limb pain (7%), back pain (5%), weakness (4%)

Respiratory: Dyspnea (6%)

Miscellaneous: Fever (5%)

<1% (Limited to important or life-threatening): Hypersensitivity


Concerns related to adverse effects:

• Hypersensitivity: Serious hypersensitivity reactions, including anaphylactic-type reactions (some fatal) have been reported in patients receiving parenteral iron products. Monitor for signs and symptoms of hypersensitivity (eg, shock, hypotension, loss of consciousness, collapse) during and after hemodialysis.

Other warnings/precautions:

• Iron status testing: Determine iron status on predialysis blood samples, as postdialysis serum iron parameters may overestimate serum iron and transferrin saturation.

Monitoring Parameters

Monitor for hypersensitivity reactions during and after the dialysis session. Determine iron status on predialysis blood samples, as postdialysis serum iron parameters may overestimate serum iron and transferrin saturation. Patients with CKD should have anemia indices (including hemoglobin, hematocrit, and iron studies) assessed as clinically indicated in routine care.

Pregnancy Considerations

Adverse events were observed in animal reproduction studies. Females of reproductive potential should use effective contraception during treatment and for at least 2 weeks following completion of therapy.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience painful extremities, headache, or muscle spasms. Have patient report immediately to prescriber dizziness, passing out, shortness of breath, swelling of arms or legs, or painful urination (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.