Triferic (Ferric pyrophosphate citrate) is an iron-ligand complex that is used in the treatment and prevention of anemia in adult patients on hemodialysis. It bypasses the reticuloendothelial system and directly donates iron to transferrin avoiding iron sequestration.

Triferic (Ferric pyrophosphate citrate) Uses:

• Iron replacement therapy in hemodialysis-dependent patients:

  • It is indicated for the maintenance treatment/ prevention of anemia in adult patients who are on hemodialysis for chronic kidney disease.
• Limitations of use:
  • It is not for use in patients on peritoneal dialysis and those receiving home hemodialysis.

Triferic (Ferric pyrophosphate citrate) Dose in Adults

Note: One ampule of the drug contains 5.44 mg iron (III). The powder contains 272 mg of iron (III) per packet.

Triferic (Ferric pyrophosphate citrate) Dose in the Iron replacement therapy in hemodialysis-dependent patients:

• Intradialytic:
  • The admixture is added to bicarbonate concentrate dialysate (final concentration 2 micromolar or 110 mcg/L) and used at each dialysis session.
  • The treatment may be continued until the patient is on maintenance hemodialysis.

Use in Children:

Not studied.

Ferric pyrophosphate citrate pregnancy risk category: C

• Animal reproduction studies have shown adverse outcomes for fetuses.
• Despite the fact that iron requirements are increasing during pregnancy, the fetal iron content remains constant, despite mild to moderate maternal deficiencies.
• For females in reproductive age groups, the manufacturer suggests effective contraception for at least two consecutive weeks.

Use of ferric pyrophosphate citrate during breastfeeding

• Breastmilk contains iron.
• The data are not available on whether or not maternal exposure to the drug alters the iron content of breastmilk in any significant way.
• Manufacturers recommend that you weigh the risks and benefits of drug exposure for the mother and infant.

Dose in Kidney Disease:

No dosage adjustments are necessary in patients with kidney disease.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Common Side Effects of Triferic (Ferric pyrophosphate citrate):

• Cardiovascular:

  • Procedural hypotension

Less Common Side Effects of Triferic (Ferric pyrophosphate citrate):

• Cardiovascular:

  • Peripheral Edema
  • Clotted AV Fistula
  • Dialysis Access Hemorrhage

• Central Nervous System:

  • Headache
  • Fatigue
  • Dizziness

• Dermatologic:

  • Pruritus

• Gastrointestinal:

  • Constipation
  • Nausea

• Genitourinary:

  • Urinary Tract Infection

• Neuromuscular & Skeletal:

  • Muscle Spasm
  • Limb Pain
  • Back Pain
  • Weakness

• Respiratory:

  • Dyspnea

• Miscellaneous:

  • Fever

Contraindications to Triferic (Ferric pyrophosphate citrate):

The manufacturer's labeling does not list any contraindications.

Warnings and precautions

• Hypersensitivity

  • It is possible to have serious allergic reactions after or during infusions of parenteral iron products.
  • Anaphylactic reactions can be severe and even fatal.
  • Monitor patients for signs and symptoms of allergic reactions such as hypotension, shock, or loss of consciousness after hemodialysis.

Ferric pyrophosphate citrate: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• Monitor for allergic reactions to the drug during the dialysis session.
• The iron status should be determined before dialysis.
• Post-dialysis iron estimation may be falsely high and may overestimate serum iron and transferrin saturation.
• Patients with CKD should have hematologic parameters including hemoglobin, hematocrit, and iron studies assessed at regular intervals and as clinically indicated in routine care.

How to administer Triferic (Ferric pyrophosphate citrate)?

Intradialytic:

• It is administered at each dialysis session after admixed into bicarbonate concentrate dialysate.

Mechanism of action of Triferic (Ferric pyrophosphate citrate):

• The drug is added to hemodialysate and administered by transdermal transfer to patients.
• The iron is then introduced into the circulation and binds with the transferrin.
• It is then transported to the erythroid precursor cells, where it is then incorporated into hemoglobin.

Half-life elimination:

• About 1.48 hours

International Brand Names of Ferric pyrophosphate citrate:

• Triferic
• Rinofer Chewable

Ferric pyrophosphate citrate Brand Names in Pakistan:

No Brands Available in Pakistan.