Ferric Pyrophosphate Citrate
Medically reviewed on March 25, 2018
(FER ik pye roe FOS fate SIT rate)
- Ferric Pyrophosphate
- Soluble Ferric Pyrophosphate (SFP)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Triferic: 272 mg (1 ea, 100 ea)
Triferic: 27.2 mg/5 mL (50 mL [DSC])
Brand Names: U.S.
- 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
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.
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.
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.
Bictegravir: Iron Salts may decrease the serum concentration of Bictegravir. Management: Bictegravir, emtricitabine, and tenofovir alafenamide can be administered with iron salts under fed conditions, but coadministration with or 2 hours after an iron salt is not recommended under fasting conditions. Consider therapy modification
Dimercaprol: May enhance the nephrotoxic effect of Iron Salts. Avoid combination
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
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%, postmarketing, and/or case reports: Anaphylaxis, 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.
• Iron status testing: Determine iron status on predialysis blood samples, as postdialysis serum iron parameters may overestimate serum iron and transferrin saturation.
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.
Adverse events were observed in animal reproduction studies. The manufacturer recommends effective contraception during therapy and for 2 weeks after treatment is complete in women of reproductive potential.
• 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, loss of strength and energy, back pain, or muscle spasms. Have patient report immediately to prescriber signs of a urinary tract infection (hematuria, burning or painful urination, polyuria, fever, lower abdominal pain, or pelvic pain), dizziness, passing out, shortness of breath, or swelling of arms or legs (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 health care 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.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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Other brands: Triferic