Ferric citrate
AURYXIA
What it isIron-based phosphate binder that also delivers absorbable iron; hyperphosphatemia in CKD.
Why this oneIt lowers phosphate and raises iron stores at once, reducing ESA and IV iron requirements.
What limits itIron overload is possible, so ferritin must be monitored. Diarrhea and discolored stools.
FDA-approved for
- hyperphosphatemia in dialysis (2014)
- iron deficiency anemia in CKD (2017)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hyperphosphatemia in CKD on dialysis | adult | 2 tablets TID with meals | 12 tablets/day | |
| Iron deficiency anemia in CKD not on dialysis | adult | 1 tablet TID with meals | 12 tablets/day |
Titration Adjust by 1–2 tablets at ≥1-week intervals.
Renal Undefined
Hepatic Undefined
Instructions
- Swallow tablets whole with meals; do not chew or crush (may discolor mouth and teeth).
Contraindications
- Iron overload syndromes (e.g., hemochromatosis)
Cautions
- Iron overload — monitor ferritin and TSAT; may need to reduce/stop IV iron
- Risk of accidental iron overdose in children (leading cause of fatal poisoning under age 6)
Adverse reactions
- Discolored feces
- Diarrhea
- Constipation
- Nausea
- Vomiting
- Cough
- Abdominal pain
- Hyperkalemia
Pregnancy No data; iron overdose in pregnancy may carry risks of miscarriage, gestational diabetes, and fetal malformation.
Lactation No human data; iron may transfer into milk.
NO BOXED WARNINGS
Principal riskIron overload; monitor ferritin
Cost, est. cash$20–$300/month
Generic entry2030 est.
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityGI toxicity is common; overdose can cause shock, hepatic failure and delayed gastrointestinal injury.
Mechanism of action: Ferric citrate ballicule
