Usual Adult Dose for Hyperphosphatemia of Renal Failure

Each tablet contains ferric iron 210 mg equivalent to ferric citrate 1 g

Initial dose: 2 tablets orally 3 times a day with meals

• Adjust dose in increments/decrements of 1 to 2 tablets per day per week or longer intervals to maintain serum phosphorous at target levels

Average dose: 8 to 9 tablets per day
Maximum dose: 12 tablets per day

Comments:

• Monitor serum phosphorous and titrate dose accordingly.
• Tablets should not be chewed or crushed because it may cause discoloration of mouth and teeth.

Use: Control of serum phosphorous levels in patients with chronic kidney disease on dialysis.

Usual Adult Dose for Anemia Associated with Chronic Renal Failure

Each tablet contains ferric iron 210 mg equivalent to ferric citrate 1 g

Initial dose: 1 tablet orally 3 times a day with meals

• Adjust dose as needed to achieve and maintain target hemoglobin levels

Average dose: 5 tablets per day
Maximum dose: 12 tablets per day

Comments:

• Tablets should not be chewed or crushed because it may cause discoloration of mouth and teeth.

Use: Treatment of iron deficiency anemia in patients with chronic kidney disease not on dialysis.

Usual Adult Dose for Iron Deficiency Anemia

Each tablet contains ferric iron 210 mg equivalent to ferric citrate 1 g

Initial dose: 1 tablet orally 3 times a day with meals

• Adjust dose as needed to achieve and maintain target hemoglobin levels

Average dose: 5 tablets per day
Maximum dose: 12 tablets per day

Comments:

• Tablets should not be chewed or crushed because it may cause discoloration of mouth and teeth.

Use: Treatment of iron deficiency anemia in patients with chronic kidney disease not on dialysis.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

No adjustment recommended

Precautions

CONTRAINDICATIONS:

• Iron overload syndromes (e.g., hemochromatosis)

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

See Usual Adult Dosage for Treatment of Hyperphosphatemia in Chronic Kidney Disease on Dialysis

Other Comments

Administration advice:

• Take with meals
• Swallow whole; do not crush or chew tablets as it may discolor the mouth and teeth
• Instruct patient on medications that need to be taken apart from this drug

Storage requirements:

• Store at controlled room temperature
• Protect from moisture

Monitoring:

• Hyperphosphatemia in Chronic Kidney Disease on Dialysis: Assess iron parameters prior to therapy (e.g., serum ferritin and transferrin saturation) and continue monitoring iron parameters during therapy; monitor serum phosphorus levels
• Iron Deficiency Anemia in Chronic Kidney Disease Not on Dialysis: Monitor hemoglobin levels

Patient advice:

• Accidental ingestion of iron containing products is the leading cause of fatal poisoning in children under 6 years; keep out of reach of children.
• This drug may cause discolored/dark stools, which is normal in iron containing medications.
• Patients should report severe or persistent gastrointestinal symptoms to their physician.