Ferric Citrate

Ferric Citrate is a prescription medication used to control serum phosphorus levels in patients with chronic kidney disease (CKD) on dialysis. It is also used to treat iron deficiency anemia in patients with chronic kidney disease (CKD) not on dialysis.

Ferric Citrate a belongs to a group of drugs called ferric iron-based phosphate binders. These work by binding to phosphate in the body to pass it through the digestive system and eliminate the phosphate through the stool. In addition, ferric citrate can help replenish iron in the body necessary to make healthy red blood cells.  

This medication comes in tablet form and is taken typically 3 times a day, with meals.

Common side effects of Ferric Citrate include diarrhea, discolored (dark) stools, nausea, constipation, and vomiting.

Ferric citrate is a prescription medication used to:

• control serum phosphorous levels in patients with chronic kidney disease (CKD) on dialysis
• treat iron deficiency anemia in patients with chronic kidney disease (CKD) not on dialysis.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Ferric Citrate may be found in some form under the following brand names:

• Auryxia

Serious side effects have been reported with ferric citrate. See the “Ferric Citrate Precautions” section.

Common side effects of ferric citrate include the following:

• discolored feces 
• diarrhea
• constipation 
• nausea
• vomiting
• cough
• abdominal pain
• and hyperkalemia (high potassium levels in your blood)

This is not a complete list of ferric citrate side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effects that bother you or that do not go away.

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

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take antibiotic medications such as doxycycline or ciprofloxacin

This is not a complete list of ferric citrate drug interactions. Ask your doctor or pharmacist for more information.

There is a risk of overdosage in children due to accidental ingestion. Accidental ingestion and resulting overdose of iron-containing products is a leading cause of fatal poisoning in children under 6 years of age. Keep ferric citrate out of the reach of children.

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of ferric citrate, there are no specific foods that you must exclude from your diet when receiving this medication.

Before taking ferric citrate, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to ferric citrate or to any of its ingredients
• are pregnant or plan to become pregnant
• are breastfeeding or plan to breastfeed

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

No studies have been done in animals, and no well-controlled studies have been done in pregnant women. Ferric citrate should be given to a pregnant woman only if clearly needed.

Tell your doctor if you are breastfeeding or plan to breastfeed.

It is not known if ferric citrate crosses into human milk. Because many medications can cross into human milk and because of the possibility for serious adverse reactions in nursing infants with use of this medication, a choice should be made whether to stop nursing or stop the use of this medication. Your doctor and you will decide if the benefits outweigh the risk of using ferric citrate.

Take ferric citrate exactly as prescribed.

Ferric citrate comes in tablet form and is taken three times every day with meals. 

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of ferric citrate at the same time.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The dose your doctor recommends may be based on the following:

• the condition being treated
• other medical conditions you have
• other medications you are taking
• how you respond to this medication

The recommended starting dose of ferric citrate for control of serum phosphorus levels in patients with chronic kidney disease on dialysis is 2 tablets orally 3 times per day with meals. The dose can be adjusted by 1 to 2 tablets as needed to maintain serum phosphorus at target levels, up to a maximum of 12 tablets daily.

The recommended starting dose of ferric citrate for the treatment of iron deficiency anemia in patients with chronic kidney disease (CKD) not on dialysis is 1 tablet orally 3 times per day with meals. The dose can be adjusted as needed to achieve and maintain hemoglobin goal, up to a maximum of 12 tablets daily. 

If you take too much ferric citrate, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

• Store ferric citrate at room temperature (20 to 25°C (68 to 77°F). 
• Keep this and all medicines out of the reach of children.