Ferric Citrate

Accidental overdose of products containing iron is a leading cause of fatal poisoning in children under the age of 6. Keep this product out of the reach of children. In case of an accidental overdose, call your doctor or a poison control center immediately.

Ferric citrate is used to control high blood levels of phosphorus in people with chronic kidney disease who are on dialysis (medical treatment to clean the blood when the kidneys are not working properly). Ferric citrate is also used to treat iron-deficiency anemia (a lower than normal number of red blood cells due to too little iron) in adults with chronic kidney disease (damage to the kidneys which may worsen over time and may cause the kidneys to stop working) who are not on dialysis. Ferric citrate is in a class of medications called phosphate binders and iron replacement products. It works to control high blood levels of phosphorus by binding phosphorus that you get from foods in your diet and prevents it from being absorbed into your blood stream. It works to treat iron-deficiency anemia by replenishing iron stores so that the body can make more red blood cells.

Ferric citrate comes as a tablet to take by mouth. It is usually taken with food 3 times a day. Take ferric citrate at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ferric citrate exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the tablets whole; do not split, chew, or crush them because discoloration of teeth and mouth may occur.

Your doctor will probably start you on a low dose of ferric citrate and gradually increase or decrease your dose, usually not more often than once a week. This depends on how well the medication works for you. Continue to take ferric citrate even if you feel well. Do not stop taking ferric citrate without talking to your doctor.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

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

Before taking ferric citrate,

• tell your doctor and pharmacist if you have previously had trouble tolerating iron supplements such as ferric citrate, ferrous sulfate, ferrous fumarate, or ferrous gluconate; or allergy to any other medications or any of the ingredients in ferric citrate tablets. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention if receiving any iron injections such as ferric carboxymaltose (Injectafer), ferumoxytol (Feraheme), iron dextran (Infed), or iron sucrose (Venofer). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with ferric citrate, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
• if you are taking ciprofloxacin, take it at least 2 hours before or 2 hours after ferric citrate. If you are taking doxycycline, take it at least 1 hour before ferric citrate.
• tell your doctor if you have an iron overload syndrome such as hemochromatosis (a disorder in which excess iron builds up in the body). Your doctor will probably tell you not to take ferric citrate.
• tell your doctor if you have or have ever had any medical condition.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking ferric citrate, call your doctor.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Ferric citrate may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• constipation
• stomach pain
• diarrhea
• nausea
• vomiting
• dark stools
• cough

Ferric citrate may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach. https://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to ferric citrate.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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