ferric citrate

Action and Spectrum

Actions and Spectrum: 

ferric citrate is a form of iron supplement typically used to treat iron-deficiency anemia. It works by increasing the amount of iron in the body, which can help to boost the production of red blood cells and hemoglobin. 

Drug Interaction

Adverse Reaction

>10%: 

Diarrhea (21%) 

Discolored feces (22%) 

Nausea (10-11%) 

Constipation (8-18%) 

1-10%: 

Abdominal pain (5%) 

Hyperkalemia (5%) 

Cough (6%) 

Vomiting (7%) 

Black Box Warning

Black Box Warning: 

It is essential to carefully follow the dosage and administration instructions for ferric citrate

Contraindication / Caution

Contraindication/Caution: 

ferric citrate should not be used in people hypersensitive to the drug itself

Pregnancy / Lactation

Pregnancy consideration:  

There is no data available regarding the usage of the drug during pregnancy. 

Breastfeeding warnings:  

No data is available regarding the presence of drugs in human breast milk. 

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies do not show risk to the fetus in the first/later trimester.        
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women.        
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.       
• Category D: adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.        
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.        
• Category N: No data is available for the drug under this category

Pharmacology

Pharmacology 

The pharmacology of ferric citrate is related to its ability to provide iron to the body. Iron is an essential mineral required to produce hemoglobin; a protein found in red blood cells responsible for carrying oxygen throughout the body. Ferric citrate is used to treat iron-deficiency anemia, a condition in which the body doesn’t have enough iron to produce sufficient hemoglobin. 

Pharmacodynamics: 

When taken orally, ferric citrate binds to phosphate in the gastrointestinal tract and reduces the absorption of phosphate. The complex formed by the binding of ferric citrate to phosphate is not absorbed and is eliminated in the feces. By reducing the absorption of phosphate, ferric citrate helps to lower blood phosphate levels and improve mineral metabolism in patients with CKD. Additionally, ferric citrate also appears to have a beneficial effect on anemia by providing iron to support erythropoiesis. 

Pharmacokinetics: 

When ferric citrate is taken orally, it is broken down in the gut into its constituent parts: ferric ions (Fe3+) and citrate ions (C6H5O7-3). The body does not absorb the ferric ions, and they bind to phosphate ions (PO43-) in the gut, forming insoluble ferric phosphate, which is eliminated in the feces; this process is called chelation. 

Absorption 

The enterocytes absorb the citrate ions, the cells lining the gut, and transport them to the liver via the portal vein. The citrate ions can chelate (bind) with iron ions, forming soluble iron citrate. In turn, it gets absorbed and transported to the liver, where it is stored in ferritin or transported to the bone marrow, which is used to produce red blood cells. This process is called oral iron chelation. 

Distribution 

In the liver, the iron citrate is stored as ferritin, a protein that can store large amounts of iron. Ferritin can release iron as needed by the body. This stored iron is to produce red blood cells in the bone marrow. The liver also releases a protein called transferrin which carries iron through the bloodstream to the bone marrow, where it is used to produce red blood cells. 

Metabolism 

The body tightly regulates the distribution and metabolism of ferric citrate to ensure that iron levels are maintained at optimal levels to support the production of red blood cells and proper oxygenation of the body’s tissues. 

Elimination and excretion 

The liver is the leading site of storage for iron in the body; ferritin and hemosiderin are the two principal iron storage proteins in the liver and bone marrow. Iron is eliminated from the body primarily through the feces, with small amounts eliminated in the urine and sweat. The elimination half-life of iron from the body can vary depending on the form of iron and the individual’s iron status

Adminstartion

Administration: 

ferric citrate is administered through the oral route

Patient Information Leaflet

Patient information leaflet 

Generic Name: ferric citrate 

Pronounced: fer-rik sit-rayt  

Why do we use ferric citrate? 

ferric citrate helps to treat Hyperphosphatemia and Iron Deficiency Anemia