Ferric Carboxymaltose (intravenous)

Ferric carboxymaltose is a powerful iron injection solution capable of reversing severe medical problems brought on by lack of iron.

Overview

Anemia is a condition where there is not enough blood in the body. This can be caused by a handful of factors, including severe chronic iron deficiency. Injections of ferric carboxymaltose are a way to reverse the iron deficiency, prompting the body to begin producing its own new blood to make up for the deficiency. In some situations, injections of ferric carboxymaltose may be used in place of a blood transfusion to enable the body to quickly produce its own new blood.

Ferric carboxymaltose was approved by the FDA in 2013. Solutions of ferric carboxymaltose are manufactured by the company Luitpold Pharmaceuticals under the brand name Injectafer.

Conditions Treated

  • Anemia (lack of blood)

Type Of Medicine

  • Iron product

Side Effects

Ferric carboxymaltose can cause a wide variety of different side effects in patients who take ferric carboxymaltose. The severity of these side effects can range from so dangerous as to require medical attention to not dangerous at all. Patients who begin to experience any of the following side effects after beginning to take ferric carboxymaltose should contact their doctor immediately as medical attention may be necessary:

  • Blurry vision
  • Sudden confusion
  • Dizziness
  • Lightheadedness, faintness, or dizziness when rising from a seated or prone position
  • Sensations of warmth
  • Headaches
  • Pounding in the ears
  • Nervousness
  • Reddened skin on the arms, neck, face, and upper chest

The following side effects have been reported by patients taking ferric carboxymaltose, but the precise incidence of the following side effects are unknown. Nevertheless, patients who begin to experience any of the following side effects after starting to take ferric carboxymaltose should contact their doctor immediately. Medical attention may be necessary.

  • Discomfort in the chest
  • Sudden chills
  • Coughing
  • Labored or difficult breathing
  • Difficult or pained swallowing
  • Fainting
  • Fast, pounding, or otherwise irregular heartbeat
  • Fever
  • Hives
  • Itching
  • Large, hive like swelling on the face, eyelids, mouth, or genitals
  • Swelling or puffiness of the face, tongue, throat, lips, or eyelids
  • Rash on the skin
  • A feeling of tightness in the chest

Not all side effects of ferric carboxymaltose necessarily require medical attention. Some of the side effects caused by ferric carboxymaltose are simply the product of the body adapting to the sudden influx of new medicine. Many side effects are only as serious as the discomfort they cause to the patient. Patients who begin to experience any of the following side effects after taking ferric carboxymaltose should contact their doctor to find out how they can diminish any of their most unpleasant side effects.

  • Nausea
  • Altered sense of taste
  • Loss of taste
  • Discoloration at the injection site
  • Pain at the injection site
  • Irritation at the injection site
  • Vomiting
  • Stomach pain or cramping
  • Abdominal pain
  • Burning, crawling, itching, prickling, numbness, or rogue 'œpins and needles' sensations
  • Diarrhea
  • Constipation
  • Sneezing

The following side effects have been reported by patients taking ferric carboxymaltose, however the precise incidence of the following side effects is unknown. Nevertheless, patients who begin to experience any of the following side effects should consult with their doctor to find out how they can diminish the most unpleasant side effects.

  • Rogue back pains
  • Difficult or labored movement
  • Hives or welts
  • Muscle pain
  • Muscle stiffness
  • Pain in the joints
  • Reddened skin

This is not necessarily a comprehensive list of side effects. Patients who begin to experience new or worsening symptoms after beginning to take ferric carboxymaltose should contact their doctor immediately. Patients can report new side effects to the FDA (Food and Drug Administration) by calling 1(800) FDA-1088 or on the web by going to www.fda.gov/medwatch.

Dosage

The following dosage directions are for treating iron deficiency anemia. Ferric carboxymaltose may be prescribed to treat other conditions. When using ferric carboxymaltose to treat other conditions. Patients should follow their doctor's instructions.

Patients who weigh more than 50 kilograms (roughly 110 pounds) typically receive two doses of 750 mg of ferric carboxymaltose delivered via a slow push IV. In most cases it is necessary to wait at least a week between the two doses.

Patients who weigh less than 50 kilograms (again roughly 110 pounds) typically require a smaller dose than their heavier counterparts. Patients who weigh less than 50 kilograms typically receive two doses of 15 milligrams of ferric carboxymaltose per kilogram of bodyweight. As with patients over 50 kilograms, patients under 50 kilograms usually need to wait at least 7 days between the two doses.

The maximum dose of ferric carboxymaltose is usually thought to be 1500 milligrams (1.5 grams) of ferric carboxymaltose per treatment cycle (which consists of two doses).

Ferric carboxymaltose injections typically take 15 minutes or more.

Ferric carboxymaltose injections are typically the second line of defense against iron deficiency anemia. Patients are usually directed to take iron tablets orally to treat their iron deficiency anemia. Ferric carboxymaltose are typically only resorted to if iron tablets prove ineffective.

Patients who miss a dose of ferric carboxymaltose (for example, by missing their injection appointment) should receive the dose as soon as they are able. The medical professionals administering the ferric carboxymaltose injection will decide if any dose adjustments will be necessary.

The dosing information given above describe the typical dose or best practices for ferric carboxymaltose administration, and do not necessarily apply to every patient. Patients rely on their doctor to determine the proper dosage regimen for them.

Interactions

Patients who are taking dimercaprol (a medicine used to treat heavy metal poisoning, such as poisoning from arsenic, gold or mercury) should not receive ferric carboxymaltose injections. Dimercaprol can bind with some metals (including iron) to form complexes which are toxic to the kidneys. Receiving injections of ferric carboxymaltose while taking dimercaprol will cause these complexes to form en masse, which can cause tremendous damage to the offending patient's kidneys. Patients should let at least 24 hours pass after taking their last dose of dimercaprol before receiving a ferric carboxymaltose injection.

The list of drugs known to interact negatively with ferric carboxymaltose is not a long one (less than 50 drugs), but the interactions which can occur do so no less frequently and no less severely than for interactions with other drugs. Patients who are taking any of the following drugs should exercise extreme caution when considering receiving a ferric carboxymaltose injection. Patients taking any of the following drugs who want to receive ferric carboxymaltose injections should consult with their doctor to find out how they can do so safely (if possible).

  • Benazepril
  • Captopril
  • Carbonyl iron
  • Chloramphenicol
  • Ferrous fumarate
  • Ferrous gluconate
  • Ferrous sulfate
  • Fosinopril
  • Gallium citrate ga-67
  • Heme iron polypeptide
  • Iron polysaccharide
  • Iron protein succinylate
  • Lisinopril
  • Moexipril
  • Multivitamin with iron
  • Multivitamin with iron and fluoride
  • Prenatal multivitamin
  • Perindopril
  • Quinapril
  • Ramipril
  • Trandolapril
  • Vitamin e

Patients who are receiving ferric carboxymaltose injections should not take oral iron supplements, including vitamin supplements which have been fortified with iron (such as prenatal vitamins). By doing so patients put themselves at risk of having too much iron in their blood, and all of the health problems which may be associated with that. To ensure medical safety, patients should wait for at least 6 days after receiving their final ferric carboxymaltose injection before they begin taking oral iron supplements.

This is not necessarily a comprehensive list of potential interactions between ferric carboxymaltose and other drugs. Patients who are planning to receive ferric carboxymaltose injections should rely on their doctor to identify any potential interactions between ferric carboxymaltose and any drugs, supplements, or medications they are currently taking. In order to support their doctor in this, patients should disclose a complete list of any and all drugs, medications, and supplements they are taking to their doctor prior to deciding to receive ferric carboxymaltose injections.

Warnings

Neither the safety nor the efficacy of ferric carboxymaltose injections have been established in patients younger than 18 years old. For that reason, patients 17 years old and under should exercise caution when considering receiving ferric carboxymaltose injections. Patients who are younger than 18 should consult with their doctor to find out if ferric carboxymaltose injections will be an effective treatment for their condition.

Ferric carboxymaltose has been known to cause serious allergic reactions in some patients. Patients who have previously had an allergic reaction to ferric carboxymaltose should not use ferric carboxymaltose. Patients who are receiving ferric carboxymaltose injections should remain vigilant for signs of an allergic reaction, which may include hives, rashes, swelling of the throat and neck, or even anaphylaxis.

It may be unwise for some patients with specific medical conditions to receive ferric carboxymaltose injections. Patients who suffer from:

  • Iron overload disorder
  • Liver disease
  • Anemia (not caused by iron deficiency)
  • High blood pressure

May not be able to safely receive ferric carboxymaltose injections. Patients with any of the aforementioned medical conditions should consult with their doctor to find out if they will safely be able to receive ferric carboxymaltose injections.

Ferric carboxymaltose is a class C drug in terms of pregnancy. This means that there is insufficient data to determine whether or not ferric carboxymaltose is safe for pregnant humans. In animal studies, damage to fetuses may have been observed following ferric carboxymaltose administration.

Ferric carboxymaltose is known to pass into human breast milk and has been known to cause harm to fetuses. Patients who are pregnant should not receive injections of ferric carboxymaltose.

Patients who overdose on ferric carboxymaltose should contact their doctor immediately or call poison control by dialing 1(800) 222-1222. Symptoms of ferric carboxymaltose overdose can include weakness, joint pain/problems, and pain/difficulty while walking.

Storage

The ferric carboxymaltose used for injections should be stored by the doctor or other medical professional in charge of administering the injection. Patients should never have to store ferric carboxymaltose in their home.

If for some reason, patients find themselves in a position which requires them to store ferric carboxymaltose, they should consult with their doctor to find out the proper storage method for ferric carboxymaltose.

Summary

Ferric carboxymaltose is a potent tool for warding off iron deficiency anemia. For such a powerful injected drug the list of potential interactions and possible side effects is comparably small. Nevertheless, the potential interactions remain serious, and some side effects of ferric carboxymaltose can be dangerous. On top of that, ferric carboxymaltose is delivered via injection, which always carries a risk of infection and can throw off a patient's cardiovascular system. However, when used under the supervision of medical professionals by a well-informed patient, there is no reason that a patient should not be able to safely and effectively treat their iron deficiency anemia with injections of ferric carboxymaltose.