Using Ferric Citrate is simple, but it must be used correctly:

• Take it exactly as your doctor prescribes. Do not take more or less than the amount recommended.
  
  
• Take with meals. This helps the medicine work better and also makes it easier on your stomach.
  
  
• Swallow the tablets whole. Do not chew or crush them.
  
  
• Drink plenty of water. Staying hydrated helps your kidneys and digestion.
  
  

If you miss a dose, take it as soon as you remember. But if it’s almost time for your next dose, skip the missed one. Do not take two doses at once.

Ferric Citrate works in two ways:

1. Lowers phosphate levels: When you eat food, it contains phosphorus (a mineral found in meat, dairy, and other foods). Ferric Citrate binds to phosphorus in your stomach and intestines. This keeps phosphorus from being absorbed into the blood. Instead, it passes out of the body through stool.
   
   
2. Adds iron to the body: Ferric Citrate contains a type of iron that the body can absorb. This iron goes into the bloodstream and helps the body make hemoglobin, the part of red blood cells that carries oxygen. This helps treat anemia in people with kidney disease.
   
   

Because it helps with both high phosphate and low iron, Ferric Citrate is a useful medicine for many patients with kidney problems.

As with all medicines, Ferric Citrate can cause side effects, though not everyone will have them. Most side effects are mild and go away as your body adjusts.

Common side effects include:

• Diarrhea
  
  
• Nausea
  
  
• Stomach pain
  
  
• Gas or bloating
  
  
• Constipation (less common)
  
  
• Discolored stool (dark or black, which is normal with iron)
  
  

Serious side effects are rare but may include:

• High iron levels (iron overload)
  
  
• Allergic reactions like rash, itching, or swelling
  
  
• Liver problems (very rare)
  
  

If you have symptoms like chest pain, trouble breathing, or swelling of your face or throat, seek medical help right away. Regular blood tests will help your doctor check for any problems.

Before using Ferric Citrate, talk to your doctor if you:

• Have too much iron in your body (conditions like hemochromatosis)
  
  
• Have stomach or bowel problems
  
  
• Are pregnant or planning to become pregnant
  
  
• Are breastfeeding
  
  
• Have liver disease
  
  

It’s important to follow your doctor’s instructions and go for regular check-ups. Your doctor may test your blood often to check your iron levels, phosphate levels, and how your kidneys are working.

Do not give this medicine to children unless a doctor recommends it. Keep it out of reach of children, as too much iron can be dangerous, especially for young kids.

• Other iron supplements: Taking extra iron can cause too much iron in the body.
  
  
• Antacids or calcium: These can make Ferric Citrate less effective.
  
  
• Certain antibiotics: Iron can block the absorption of some antibiotics like ciprofloxacin or doxycycline.
  
  

Always tell your doctor about all the medicines and vitamins you are taking. Do not stop or start any medicine without your doctor’s advice.

The dose of Ferric Citrate will depend on:

• Your phosphate levels
  
  
• Your iron levels
  
  
• Whether or not you are on dialysis
  
  
• How you respond to treatment
  
  

Usually, you’ll start with one or two tablets per meal, taken three times a day. Your doctor may increase or reduce the number of tablets depending on how well your body responds.

Always take the tablets with food, and drink plenty of water throughout the day. Do not take more than your doctor prescribes, even if you feel okay.

Even if you feel better, continue taking the medicine unless your doctor tells you to stop.

Ferric Citrate is a prescription-only medicine. You need a doctor’s prescription to get it from the pharmacy. This is because your doctor must check your blood tests to decide whether Ferric Citrate is the right treatment for you.

Before prescribing Ferric Citrate, your doctor will:

• Check your phosphate and iron levels
  
  
• Make sure you don’t already have too much iron
  
  
• Review your other medications
  
  

Check your overall kidney function

• What is Ferric Citrate used for?
  It is prescribed to:

  • Control serum phosphorus levels in patients with chronic kidney disease (CKD) on dialysis.

  • Treat iron deficiency anemia (IDA) in adults with CKD not on dialysis.

• What are the brand names?
  Auryxia® (U.S.) and Riona® (international).

• What is the active ingredient?
  Ferric citrate, an iron-based compound that binds dietary phosphate in the gut and provides bioavailable iron.

• How does Ferric Citrate work?

  • In the gut, it binds with phosphate from food to form insoluble ferric phosphate, which is excreted in stool — thereby lowering phosphate levels.

  • At the same time, some iron is absorbed, helping to increase hemoglobin and iron stores in patients with iron deficiency.

• What type of medication is it?
  A phosphate binder and iron replacement therapy.

• How is Ferric Citrate taken?

  • Orally, as a tablet, usually with meals.

  • The dose is individualized and adjusted based on serum phosphorus and iron levels.

• What are the available strengths?

  • Auryxia®: 1 gram tablet containing 210 mg ferric iron (Fe³⁺).

• How often is it taken?
  Typically 3–4 times daily with meals, as prescribed.

• What are the common side effects?

  • Diarrhea

  • Nausea or vomiting

  • Constipation

  • Stomach upset

  • Dark-colored stools (harmless effect of iron)

• Are there serious side effects?
  Rare but possible:

  • Iron overload (especially with long-term use)

  • Allergic reactions (rash, swelling, difficulty breathing)

  • Liver enzyme elevation (rare)

• Who should not take Ferric Citrate?

  • Patients with iron overload disorders (e.g., hemochromatosis)

  • Those with known hypersensitivity to ferric citrate or its components

• Can Ferric Citrate cause constipation or diarrhea?
  Yes — mild GI disturbances are common, but manageable with dose adjustments or dietary changes.

• Can Ferric Citrate be used in pregnancy?
  Yes, if clearly needed — but always under medical supervision, as excess iron may pose risks.

• Can I take Ferric Citrate while breastfeeding?
  Yes — generally considered safe, with minimal transfer of iron into breast milk.

• Does Ferric Citrate interact with other medications?
  Yes — it can reduce absorption of certain oral drugs. Separate by at least 1 hour before or 2 hours after taking:

  • Levothyroxine

  • Doxycycline or ciprofloxacin

  • Antacids or phosphate supplements

• Does Ferric Citrate affect iron levels in the body?
  Yes — it increases serum ferritin and transferrin saturation (TSAT); periodic iron monitoring is recommended.

• Can Ferric Citrate cause iron overload?
  Rarely, but possible with long-term use — particularly in patients receiving IV iron or erythropoiesis-stimulating agents (ESAs).

• Can Ferric Citrate replace other phosphate binders?
  Yes — it’s an alternative to calcium-based binders (like calcium acetate) and non-calcium binders (like sevelamer), with the added benefit of improving iron stores.

• How long does it take to work?

  • Phosphorus reduction: within 1–2 weeks.

  • Hemoglobin improvement (in anemia): within 4–8 weeks.

• Can I take Ferric Citrate on an empty stomach?
  No — it should be taken with meals to bind dietary phosphate effectively.

• Does Ferric Citrate cause black stools?
  Yes — this is harmless and expected due to the iron content.

• Can I take it with other iron supplements?
  Usually not necessary — doing so may increase the risk of iron overload.

• What should I do if I miss a dose?
  Take it with your next meal — don’t double up doses.

• How should I store Ferric Citrate?
  Store at room temperature (20°C–25°C / 68°F–77°F), away from moisture and heat.

• Is there a generic version available?
  Yes — generic ferric citrate tablets are available.

• Where can I get Ferric Citrate?
  Available by prescription only at pharmacies.