Ferric Pyrophosphate (injection)

Overview

Also known by its generic name, ferric pyrophosphate or iron pyrophosphate/iron (III) pyrophosphate, Triferic is a drug designed to replace iron, which enables patients ailing from hemodialysis-dependent chronic kidney disease (HD-CKD) to maintain normal levels of hemoglobin. Typically, the body gets its iron from the food one consumes. However, when one has chronic kidney disease (CKD), a lack of iron in the blood (anemia) is one of the disease's characteristic complications. Drugs like ferric pyrophosphate replace iron or act as a supplement to iron-rich foods when the body does not get enough iron from natural sources or is unable to absorb it properly through natural body processes

Anemia develops early in CKD and gets worse as the disease progresses. For a patient suffering the illness, it is crucial for both the doctor and the individual to ensure that the anemia does not exacerbate matters. Upon seeing signs and symptoms of iron deficiency, your doctor should prescribe Triferic, unless there are contraindications or you have a condition that would not work with the drug. It is only administered by a healthcare professional during hemodialysis and is added directly to the dialyzer fluid.

When the replacement iron from this drug is delivered into the bloodstream via the dialysis injection, it binds to a transporter compound known as transferrin. Then, it moves to blood-forming cells and is incorporated into the hemoglobin.

Conditions Treated

  • Iron replacement for hemodialysis-dependent chronic kidney disease (HDD-CKD)

Type Of Medicine

  • Iron replacement product

Side Effects

Side effects are the unwanted, undesirable effects that may be produced alongside the wanted effects or intended purpose. These effects may present individually, together or not at all, depending on the patient. Some side effects are more common than others and come about at a higher frequency, while others are rare.

The more frequent side effects associated with the use of iron III pyrophosphate include hypersensitivity and seemingly anaphylactic reactions, with symptoms such as hives, swollen face, neck, throat, limbs and extremities (peripheral edema), a tingling sensation in the legs and the hands, sweating and labored breathing. One should receive immediate medical attention upon signs of an allergic reaction. Other commonly occurring side effects are lightheadedness upon standing up or sitting up, confusion, muscle spasms and pain, dyspnea, sudden and unusual rapid gain in weight, procedural hypotension and blurred vision.

Let your doctor know if you suffer unusual bleeding around the dialysis vein access point, have a blue discoloration of the skin or bulging veins that appear purple. If you cough up blood, experience any swelling in the extremities, unusual bruising or bleeding, report it to a doctor with urgency. One may also suffer a urinary tract infection with complications such as bladder pain, difficulty in passing urine or experiencing a burning sensation, frequent urination, passing cloudy or bloody urine and experiencing lower back pain.

Other less frequent side effects include pain in the back, legs and arms, headaches and fever, fatigue and general body weakness, nauseous sensations, dizziness, constipation and shortness of breath. Some other unwanted complications that may accompany the use of Triferic, but whose frequency of incidence is unknown, include coughing, itchiness and reddened skin, tightness in the chest and difficulty in swallowing, among others. Some of these side effects may not necessarily require medical attention and may decrease or disappear as the body adjusts to the treatment. However, it is fundamental to let your clinician know so that you can work on reducing or preventing these effects. Consult the doctor if they persist and if you have any other side effects not reported above.

Dosage

Before prescribing a dose of Triferic, the physician ought to perform blood tests to ensure that it is safe to take the drug. It is given via dialysis injection and should not be self-administered. Only a qualified medical practitioner should perform this procedure.

The first step to administering this drug is preparation. Examine the ampules (powder packet) before use to ensure that it was not previously mixed with the bicarbonate concentrate and that there was no prior precipitation. It should have a slightly yellow-green color.

The iron III pyrophosphate is then added directly to only the bicarbonate concentrate of that which is used to prepare the hemodialysate. It is critical to note that the drug should not be added to acid concentrate mixtures.

Each ferric pyrophosphate ampule contains 27.2mg of the drug. That amount is added to 2.5 gallons of the bicarbonate concentrate at a ratio of one ampule per 2.5 gallons. This dose of 272mg per packet or 27.2mg/5ml ampule (5.44mg/ml) mixed into the hemodialysate concentrate is given at each dialysis procedure for the entire duration over which the patient receives treatment for the HDD-CKD. The doctor can add more than one ampule to the master mix of the bicarbonate concentrate, as long as it is in the same ratio of 1 ampule per every 2.5 gallons.

It is unlikely that you will miss or skip doses, since the drug is only given during hemodialysis and your doctor is in charge of that. However, in case of an overdose, you should get emergency medical attention. Get to or contact the nearest poison control center or use the poison helpline by calling 1-800-222-1222. The healthcare practitioner should also keep monitoring the blood post dialysis to ensure everything is going on well.

Major Drug Interactions:

If two drugs are taken at the same time, they may change each other's effect on the body as they interact. Such interactions may bring about a difference in the absorption, or delay, decrease or increase the effect of the drugs. Sometimes, interaction causes the development of new adverse effects. Therefore, one should be careful when using various drugs concurrently.

Ferric has a long list of other medications that may affect its action. Among these are vitamins and supplements, prescription drugs and alternative therapies, such as herbs, and over the counter medication. To afford you with as much information as possible, the following is a compiled list of most of them:

  • Almasilate
  • Aloglutamol
  • Aluminium
  • Aluminium acetoacetate
  • Aluminium glycinate
  • Aluminium hydroxide
  • Asenapine
  • Sodium phosphate
  • Sodium glycerophosphate
  • Sodium bicarbonate
  • Bismuth Subnitrate
  • Bismuth Subcitrate
  • Calcium carbonate
  • Calcium silicate
  • Tromethamine
  • Trovafloxacin
  • Temafloxacin
  • Sparfloxacin
  • Sitafloxacin
  • Rufloxacin
  • Rosoxacin
  • Ranitidine
  • Rabeprazole
  • Roxatidine acetate
  • Prulifloxacin
  • Piromidic acid
  • Pipemidic Acid
  • Penicillamine
  • Pazufloxacin
  • Pantoprazole
  • Pancrelipase
  • Oxolinic Acid
  • Omeprazole
  • Olanzapine
  • Norfloxacin
  • Nizatidine
  • Nemonoxacin
  • Nalidixic Acid
  • Minocycline
  • Metiamide
  • Methyldopa
  • Methantheline
  • Magnesium Trisilicate
  • Magnesium silicate
  • Magnesium peroxide
  • Magnesium oxide
  • Magnesium hydroxide
  • Magaldrate
  • Lipoic Acid
  • Levothyroxine
  • Levofloxacin
  • Levodopa
  • Lansoprazole
  • Hydrotalcite
  • Grepafloxacin
  • Gemifloxacin
  • Gatifloxacin
  • Garenoxacin
  • Flumequine
  • Fleroxacin
  • Famotidine
  • Esomeprazole
  • Epinastine
  • Enoxacin
  • Eltrombopag
  • Doxycycline
  • Doxepin
  • Dolutegravir
  • Dipotassium phosphate
  • Dimercaprol
  • Dexrabeprazole
  • Dexlansoprazole
  • Demeclocycline
  • Deferiprone
  • Cinoxacin
  • Cimetidine
  • Chlortetracycline
  • Cefdinir

Note that a doctor ought to have all the information on any drugs that the patient is currently using or uses habitually, together with their start and stop dates, even if the drugs are not in the above list.

Warnings

Ferric pyrophosphate should never be prescribed to or used by anyone with a history of severe hypersensitivity reactions to injected iron products. Individuals suffering liver disease or hypertension (high blood pressure) should only take this medicine under the advisement of a doctor.

Women should also inform their doctor if they are pregnant, since using ferric while you're pregnant can cause harm to your unborn baby. Use birth control to prevent pregnancy during the entire duration of your treatment and for a period of at least two weeks after your final dose. Lactating mothers should not use the drug either, because it is known to pass through the milk and could be a danger to a breastfeeding baby.

The drug also has some dose limitations. One of them is that it is only your medical practitioner who can perform this procedure. Due to limited study, it is not recommended for use in patients whose hemodialysis is performed from home. It should also not be used on those receiving peritoneal dialysis.

Be careful to follow the physician's instructions on any restrictions on food, drink and activities that can be done while taking this drug.

Heath care practitioners should be careful to determine a patient's iron status by carrying out the necessary blood work before use. Inhaling the Triferic dust may cause respiratory tract and GIT irritation. Iron salts are also considered as skin irritants.

Storage

The manufacturer recommends that an ampule of Ferric pyrophosphate should remain unopened and retained in its original compartment (the aluminum pouch) until when it is needed for use. It should be kept away from direct light and humidity and stored in controlled room temperature recommended to be between 20 degrees to 25 degrees Celsius. Acceptable deviations are 15 degrees Celsius at a minimum and 30 degrees at maximum.

Upon preparation and admixture into hemodialysis solutions, one should use it within 24 hours.

Summary

Iron is an essential component of the body because it helps in the formation of hemoglobin, which transports oxygen in the body. When there is an insufficiency of this mineral and the body presents anemic symptoms, as is common in hemodialysis-dependent chronic kidney disease, a patient needs an iron replacement product such as Triferic.

Studies show that the parenteral route of administering iron works at a higher efficiency than oral iron and the hemoglobin levels increase significantly with the former route than the latter. The drug is administered during dialysis. It is among the most recommended and preferred drug for patients with HDD-CKD anemia.

It does cause side effects, but these can be addressed by a doctor. Only a qualified medical practitioner should administer it and take all the necessary precautions while doing so. Proper storage, prior and continuous monitoring of serum iron and other blood work, careful preparation and dosing and taking caution with the drug and disease interactions, contraindications and side effects are crucial parts of using this medication.