What is Ferric Citrate: Uses, Dosage, Side Effects and More

Ferric citrate is an iron-based medication that helps manage two important health conditions at once. It works as both an iron supplement for people with iron deficiency and as a phosphate binder for those with chronic kidney disease.

This dual-action medication offers a unique approach to treatment, especially for people dealing with kidney problems who often struggle with both low iron levels and high phosphate in their blood. Understanding how ferric citrate works can help you feel more confident about your treatment plan.

What is Ferric Citrate?

Ferric citrate is a prescription medication that contains iron in a special form that your body can absorb and use effectively. Unlike regular iron supplements you might find at the pharmacy, this medication is specifically designed to do two jobs simultaneously.

The medication comes as oral tablets that dissolve in your stomach. When it breaks down, it releases iron that your body can absorb while also binding to phosphate in your digestive system. This makes it particularly valuable for people with chronic kidney disease who need both iron supplementation and phosphate control.

What is Ferric Citrate Used For?

Ferric citrate treats iron deficiency anemia in adults with chronic kidney disease who are not on dialysis. It also helps control phosphate levels in people with chronic kidney disease who are on dialysis.

Your kidneys normally help regulate phosphate levels in your blood, but when they're not working well, phosphate can build up to dangerous levels. At the same time, chronic kidney disease often leads to iron deficiency because your body has trouble making enough healthy red blood cells.

This medication addresses both problems by providing the iron your body needs while preventing excess phosphate from being absorbed into your bloodstream. This dual benefit makes it an efficient treatment option for people managing kidney disease.

How Does Ferric Citrate Work?

Ferric citrate works through a clever two-step process in your digestive system. First, it binds to phosphate in your stomach and intestines, preventing this mineral from entering your bloodstream where it could cause problems.

Second, as the medication breaks down, it releases iron that your body can absorb and use to make healthy red blood cells. This iron is in a form that's generally well-tolerated and effective for people with kidney disease.

The medication is considered moderately strong and effective for its intended uses. It's not as harsh as some iron supplements, but it's more targeted than basic over-the-counter iron pills. Your doctor chose this specific medication because it addresses your particular health needs efficiently.

How Should I Take Ferric Citrate?

Take ferric citrate exactly as your doctor prescribed, usually with meals to help your body absorb it better and reduce stomach upset. The tablets should be taken with food, not on an empty stomach.

You can take the medication with water, juice, or milk. Having some food in your stomach helps the medication work properly and makes it gentler on your digestive system. Try to take it at the same times each day to maintain steady levels in your body.

Avoid taking ferric citrate with antacids, calcium supplements, or other medications that might interfere with absorption. If you need to take other medications, space them out by at least two hours from your ferric citrate dose when possible.

How Long Should I Take Ferric Citrate For?

The length of treatment with ferric citrate depends on your specific condition and how well you respond to the medication. For iron deficiency anemia, you'll typically need to take it until your iron levels improve and stabilize.

If you're using it to control phosphate levels due to kidney disease, you may need to take it long-term as part of your ongoing treatment plan. Your doctor will monitor your blood levels regularly to determine how long you need to continue the medication.

Never stop taking ferric citrate suddenly without talking to your doctor first. Your healthcare provider will want to check your iron and phosphate levels before making any changes to ensure your treatment remains effective.

What Are the Side Effects of Ferric Citrate?

Like most medications, ferric citrate can cause side effects, though many people tolerate it well. The most common side effects are related to your digestive system and are usually mild to moderate.

Here are the side effects you might experience, starting with the most common ones:

• Diarrhea or loose stools
• Discolored stools (dark or black)
• Constipation
• Nausea
• Stomach pain or cramping
• Vomiting

The dark-colored stools are actually normal and expected when taking iron-containing medications. This happens because your body doesn't absorb all the iron, and the excess passes through your digestive system.

Less common but more serious side effects can include severe stomach pain, persistent vomiting, or signs of allergic reactions like rash, swelling, or difficulty breathing. Contact your doctor right away if you experience any of these more concerning symptoms.

Who Should Not Take Ferric Citrate?

Ferric citrate isn't suitable for everyone, and your doctor will carefully review your medical history before prescribing it. Some people should avoid this medication due to safety concerns.

You should not take ferric citrate if you have iron overload disorders like hemochromatosis or hemosiderosis. These conditions cause your body to store too much iron, and adding more iron could be dangerous.

People with certain types of anemia that aren't caused by iron deficiency should also avoid this medication. If you have allergies to iron preparations or any ingredients in ferric citrate, you'll need a different treatment option.

Your doctor will also be cautious about prescribing ferric citrate if you have active peptic ulcers, inflammatory bowel disease, or other serious digestive conditions that could be worsened by iron supplementation.

Ferric Citrate Brand Names

The main brand name for ferric citrate is Auryxia, which is manufactured by Akebia Therapeutics. This is the most commonly prescribed version of the medication in the United States.

Your pharmacy might also carry generic versions of ferric citrate, which contain the same active ingredient but may be less expensive. Both brand name and generic versions are equally effective when taken as prescribed.

Ferric Citrate Alternatives

If ferric citrate doesn't work well for you or causes troublesome side effects, your doctor has several alternative treatments to consider. The choice depends on whether you primarily need iron supplementation, phosphate control, or both.

For iron deficiency, alternatives include ferrous sulfate, ferrous gluconate, or iron dextran injections. For phosphate control, options include calcium carbonate, sevelamer, or lanthanum carbonate.

Some people might benefit from separate medications to address iron deficiency and phosphate control individually, rather than using a combination medication like ferric citrate. Your doctor will help determine the best approach based on your specific needs and how you respond to treatment.

Is Ferric Citrate Better Than Ferrous Sulfate?

Ferric citrate and ferrous sulfate both provide iron, but they work differently and are used for different situations. Ferrous sulfate is a more traditional iron supplement that's primarily used to treat iron deficiency anemia.

Ferric citrate has the advantage of also controlling phosphate levels, making it particularly useful for people with chronic kidney disease. It may also cause fewer digestive side effects than ferrous sulfate in some people.

However, ferrous sulfate is often less expensive and more widely available. Your doctor will choose between these medications based on your specific condition, kidney function, and whether you need phosphate control in addition to iron supplementation.