WARNING

Taking ferric citrate, like any medication, carries certain risks, particularly if not used appropriately or in specific medical conditions. Here are some key risks associated with ferric citrate:

• Gastrointestinal Side Effects: The most common side effects of ferric citrate include gastrointestinal symptoms such as diarrhea, constipation, nausea, vomiting, abdominal pain, and discolored stools. These symptoms can be bothersome and may affect quality of life.
• Hypophosphatemia: Ferric citrate can lower phosphate levels in the blood, leading to hypophosphatemia. Symptoms of hypophosphatemia may include weakness, fatigue, muscle pain or weakness, and confusion. Monitoring phosphate levels is crucial to prevent this complication.
• Iron Overload: Prolonged use of ferric citrate can potentially lead to iron overload, especially in patients with certain medical conditions like hemochromatosis or those receiving multiple iron-containing medications or supplements. Iron overload can cause organ damage and other serious complications.
• Allergic Reactions: Although rare, allergic reactions to ferric citrate can occur. Symptoms may include rash, itching, swelling of the face, lips, tongue, or throat, and difficulty breathing. Prompt medical attention is necessary if allergic reactions occur.
• Drug Interactions: Ferric citrate may interact with certain medications, including antibiotics, thyroid hormones, and medications that lower phosphate levels. It’s essential to inform your healthcare provider about all medications, supplements, or herbal products you are taking to avoid potential interactions.
• Black Stools: Ferric citrate can cause stools to appear black due to the iron component of the medication. While this is a harmless effect, it may be alarming to some individuals.
• Other Side Effects: Less common side effects of ferric citrate may include headache, dizziness, changes in taste, and other adverse reactions. Monitoring for side effects and reporting any concerns to a healthcare provider is essential.

It’s crucial to weigh the potential risks and benefits of ferric citrate therapy in consultation with a healthcare provider. Patients should follow their doctor’s instructions carefully, report any side effects promptly, and attend regular follow-up appointments for monitoring and adjustments to treatment as needed.

Why is this medication prescribed?

Ferric citrate is a medication primarily prescribed to treat hyperphosphatemia (high levels of phosphate in the blood) in patients with chronic kidney disease (CKD) who are on dialysis. Ferric citrate works by binding to phosphate in the food you eat, which helps to prevent its absorption into the bloodstream.

How should this medicine be used?

Here’s how ferric citrate is typically used:

• Dosage: The dosage of ferric citrate can vary depending on the individual’s condition and their doctor’s recommendations. It’s important to follow the prescribed dosage exactly as directed by your healthcare provider.
• Administration: Ferric citrate is usually taken orally, with or immediately after meals. This is because it needs to be taken with food to be most effective in binding to phosphate from the diet. Tablets should be swallowed whole and not crushed or chewed.
• Frequency: It is typically taken three times a day with meals, although the exact frequency may vary based on individual needs.
• Monitoring: Your doctor may regularly monitor your blood levels of phosphate and adjust your dosage of ferric citrate accordingly to achieve the desired level of phosphate control.
• Adherence: It’s essential to take ferric citrate exactly as prescribed by your doctor, even if you feel well. Skipping doses or taking more than prescribed can lead to ineffective treatment or unwanted side effects.
• Interactions: Be sure to inform your doctor about all medications, supplements, or herbal products you are taking before starting ferric citrate, as it may interact with certain medications.
• Side effects: While ferric citrate is generally well-tolerated, common side effects may include diarrhea, constipation, nausea, vomiting, abdominal pain, and discolored stools. If you experience severe or persistent side effects, contact your doctor.
• Storage: Store ferric citrate at room temperature, away from moisture and heat, and keep it out of reach of children.

Always consult your healthcare provider for personalized advice regarding the use of ferric citrate and any other medications.

Other uses for this medicine

Other uses for ferric citrate may include:

• Iron supplementation: Ferric citrate contains iron, so it can also be used to treat iron deficiency anemia in certain patients, particularly those with CKD who have both high phosphate levels and low iron levels.
• Food additive: Ferric citrate is sometimes used as a food additive, particularly in the food industry, where it can serve as a color stabilizer and fortifier.

What special precautions should I follow?

Here’s how ferric citrate is typically used:

• Dosage: The dosage of ferric citrate can vary depending on the individual’s condition and their doctor’s recommendations. It’s important to follow the prescribed dosage exactly as directed by your healthcare provider.
• Administration: Ferric citrate is usually taken orally, with or immediately after meals. This is because it needs to be taken with food to be most effective in binding to phosphate from the diet. Tablets or capsules should be swallowed whole and not crushed or chewed.
• Frequency: It is typically taken three times a day with meals, although the exact frequency may vary based on individual needs.
• Monitoring: Your doctor may regularly monitor your blood levels of phosphate and adjust your dosage of ferric citrate accordingly to achieve the desired level of phosphate control.
• Adherence: It’s essential to take ferric citrate exactly as prescribed by your doctor, even if you feel well. Skipping doses or taking more than prescribed can lead to ineffective treatment or unwanted side effects.
• Interactions: Be sure to inform your doctor about all medications, supplements, or herbal products you are taking before starting ferric citrate, as it may interact with certain medications.
• Side effects: While ferric citrate is generally well-tolerated, common side effects may include diarrhea, constipation, nausea, vomiting, abdominal pain, and discolored stools. If you experience severe or persistent side effects, contact your doctor.
• Storage: Store ferric citrate at room temperature, away from moisture and heat, and keep it out of reach of children.

Always consult your healthcare provider for personalized advice regarding the use of ferric citrate and any other medications.

What special dietary instructions should I follow?

Special Dietary Instructions:

• Timing: Take ferric citrate with or immediately after meals. This is because it needs to be taken with food to be most effective in binding to phosphate from the diet.
• Phosphate-Rich Foods: Limit intake of foods high in phosphate, such as dairy products, certain meats, and processed foods. Your doctor or dietitian may provide specific dietary recommendations to help manage phosphate levels effectively.

What should I do if I forget a dose?

If you forget to take a dose of ferric citrate, take it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not double up on doses to make up for a missed one.

What side effects can this medication cause?

Ferric citrate, like any medication, can cause side effects, although not everyone experiences them. Common side effects of ferric citrate may include:

• Gastrointestinal Symptoms: These are the most commonly reported side effects and may include diarrhea, constipation, nausea, vomiting, abdominal pain, and discolored stools.
• Black Stools: Ferric citrate can cause stools to appear black, which is a harmless effect of the iron component of the medication. This discoloration is expected and not a cause for concern.
• Hypophosphatemia: In some cases, ferric citrate may lead to low levels of phosphate in the blood, especially if doses are too high or if it is taken without meals. Symptoms of hypophosphatemia may include weakness, fatigue, muscle pain or weakness, and confusion.
• Allergic Reactions: Although rare, allergic reactions to ferric citrate can occur. Symptoms may include rash, itching, swelling of the face, lips, tongue, or throat, and difficulty breathing.
• Iron Overload: Prolonged use of ferric citrate can potentially lead to iron overload, especially in patients with certain medical conditions like hemochromatosis or those receiving multiple iron-containing medications or supplements.
• Other Side Effects: Less common side effects may include headache, dizziness, and changes in taste.

It’s essential to report any unusual or severe side effects to your healthcare provider promptly. Additionally, if you experience any signs of an allergic reaction, such as difficulty breathing or swelling of the face, seek immediate medical attention.

Your doctor will monitor you for side effects during treatment with ferric citrate and may adjust your dosage or provide additional guidance to help manage any adverse effects. Always follow your doctor’s instructions and do not hesitate to discuss any concerns you may have about side effects or the overall management of your condition.

What should I know about storage and disposal of this medication?

Storage and disposal of ferric citrate:

Storage:

• Room Temperature: Store ferric citrate at room temperature, away from moisture and heat.
• Keep Away from Children: Ensure that ferric citrate is stored out of reach of children and pets.
• Original Container: Keep ferric citrate in its original container, tightly closed, to protect it from moisture and air exposure.

Disposal:

• Follow Instructions: Dispose of unused or expired ferric citrate according to local regulations and guidelines.
• Medication Take-Back Programs: Some pharmacies or community centers offer medication take-back programs, allowing safe disposal of medications.
• Do Not Flush: Do not flush ferric citrate down the toilet unless instructed to do so by local regulations.

In case of emergency/overdose

• Seek Medical Assistance: In case of overdose or emergency, contact your local poison control center or seek emergency medical attention immediately.
• Symptoms of Overdose: Symptoms of ferric citrate overdose may include gastrointestinal symptoms (e.g., severe diarrhea, vomiting), hypophosphatemia (low phosphate levels), and symptoms related to iron toxicity (e.g., abdominal pain, lethargy, weakness).

What other information should I know?

• Regular Monitoring: Your doctor may periodically monitor your blood levels of iron, phosphate, and other relevant parameters while you are taking ferric citrate to ensure its effectiveness and safety.
• Follow Doctor’s Instructions: Take ferric citrate exactly as prescribed by your healthcare provider. Do not change your dosage or stop taking the medication without consulting your doctor.
• Medical Alerts: Inform healthcare providers, including dentists and pharmacists, about your use of ferric citrate before undergoing any medical procedures or taking any new medications.
• Lab Tests: Your doctor may order blood tests to monitor your response to ferric citrate and to check for any adverse effects on your blood levels of iron, phosphate, or other parameters.
• Dietary Advice: Follow any dietary recommendations provided by your doctor or dietitian to help manage your condition effectively, including limiting phosphate-rich foods and taking ferric citrate with meals.
• Keep Appointments: Attend all scheduled appointments with your healthcare provider for regular check-ups and monitoring of your condition.
• Adherence: It’s essential to take ferric citrate exactly as prescribed, even if you feel well. Skipping doses or taking more than prescribed can lead to ineffective treatment or unwanted side effects.

Always consult your healthcare provider for personalized advice and guidance regarding the use of ferric citrate and any other medications. If you have any questions or concerns about storage, disposal, emergency procedures, or other aspects of ferric citrate therapy, don’t hesitate to discuss them with your healthcare provider.