Indications

Citofer is indicated in-
. The control of serum phosphorus levels in adult patients with chronic kidney disease on dialysis.
. The treatment of iron deficiency anemia in adult patients with chronic kidney disease not on dialysis.

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Pharmacology

Ferric iron binds dietary phosphate in the GI tract and precipitates as ferric phosphate. This compound is insoluble and is excreted in the stool. By binding phosphate in the GI tract and decreasing
absorption, ferric iron lowers the phosphate concentration in the serum. Ferric iron is reduced from the ferric to the ferrous form by ferric reductase in the GI tract. After transport through the
enterocytes into the blood, oxidized ferric iron circulates bound to the plasma protein transferrin, and can be incorporated into hemoglobin.

Dosage & Administration

Hyperphosphatemia in Chronic Kidney Disease on Dialysis:
. Starting dose is 2 tablets orally 3 times per day with meals
. Adjust dose by 1 to 2 tablets as needed to maintain serum phosphorus at target levels, up to a maximum of 12 tablets daily. Dose can be titrated at 1-week or longer intervals.
Iron Deficiency Anemia in Chronic Kidney Disease not on Dialysis:
. Starting dose is 1 tablet orally 3 times per day with meals
. Adjust dose as needed to achieve and maintain hemoglobin goal, up to a maximum of 12 tablets daily or as directed by the physician.
Use in Children & Adolescents: The safety and efficacy of Ferric Citrate have not been established in Children & Adolescents.

Interaction

Oral drugs such as Doxycycline & Ciprofloxacin have to be separated from Citofer.

Contraindications

Ferric Citrate is contraindicated in patients with iron overload syndrome (Hemochromatosis).

Side Effects

Most common adverse reactions are discolored feces, diarrhoea, constipation, nausea, vomiting, cough, abdominal pain and hyperkalemia.

Pregnancy & Lactation

There are no available data on Ferric Citrate use in pregnant women & Lactating mother.