ferric citrate


fe-rik si-trate

Trade Name(s)

  • Auryxia

Ther. Class.
electrolyte modifiers

Pharm. Class.
phosphate binders


Control of serum phosphorous in chronic renal failure patients on dialysis.


Binds phosphorous and precipitates it as ferric phosphate.

Therapeutic Effect(s):

Maintenance of normal phosphorous levels.


Absorption: Some absorption follows oral administration and may lead to iron overload.

Distribution: Unknown.

Metabolism and Excretion: Following binding, precipitated ferric phosphate is excreted in stool.

Half-life: Unknown.

TIME/ACTION PROFILE (lowering of serum phosphorous)

POwithin 1 wkunknownunknown


Contraindicated in:

  • Iron overload syndromes including hemochromatosis.

Use Cautiously in:

  • GI bleeding/inflammation;
  • OB: Use cautiously during pregnancy (consider effects on vitamins/nutrient and potential iron overload);
  • Lactation: Consider possible iron transport into milk;
  • Pedi: Safety and effectiveness not established.

Adverse Reactions/Side Effects

GI: diarrhea, discolored feces, nausea, constipation, vomiting

Misc: iron overload

* CAPITALS indicate life-threatening.
Underline indicate most frequent.



  • Binds and ↓ absorption of doxycycline (should be given ≥1 hr prior to ferric citrate).
  • Binds and ↓ absorption of ciprofloxacin (should be given ≥2 hr prior to or after ferric citrate).


PO (Adults) 2 tablets (2 g ferric citrate) 3 times daily. Adjust by 1–2 tablets/day at weekly (or longer) intervals to attain target phosphorous levels.

Availability (generic available)

Tablets: 1 g (contains 210 mg ferric iron)


  • Monitor clinical responses or blood levels of concurrent medications; may decrease bioavailability of medications administered concurrently.

Lab Test Considerations: Monitor serum phosphorous prior to starting and periodically during therapy to keep serum phosphorous at target levels.

  • Assess iron parameters (serum ferritin and transferritin saturation TSAT) prior to starting and periodically during therapy. May cause ↑ serum ferritin and TSAT requiring reduced dose or discontinuation of IV iron therapy.

Potential Diagnoses


  • PO Administer 3 times daily with meals.

Patient/Family Teaching

  • Instruct patient to take ferric citrate as directed and to continue with prescribed diet.
  • Advise patient that ferric citrate may cause dark stools; this is normal for medications containing iron.
  • Inform patient that ferric citrate may cause diarrhea, nausea, constipation, and vomiting. Notify health care professional if GI symptoms become severe or persistent.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications. Medications may need to be taken separately from ferric citrate.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

Normal serum phosphorous levels.

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