Citofer210 mg

Citofer 210 mg is a phosphate binder indicated for the control of serum phosphorus levels in adult patients with chronic kidney disease on dialysis. Citofer 210 mg is an iron replacement product indicated for the treatment of iron deficiency anemia in adult patients with chronic kidney disease not on dialysis.

Oral Iron preparations

Hyperphosphatemia in chronic kidney disease on dialysis: Ferric iron binds dietary phosphate in the GI tract and precipitates as ferric phosphate. This compound is insoluble and is excreted in the stool. By binding phosphate in the GI tract and decreasing absorption, Citofer 210 mg lowers the phosphate concentration in the serum.Iron deficiency anemia in chronic kidney disease not on dialysis: Ferric iron is reduced from the ferric to the ferrous form by ferric reductase in the GI tract. After transport through the enterocytes into the blood, oxidized ferric iron circulates bound to the plasma protein transferrin, and can be incorporated into hemoglobin.

Hyperphosphatemia in chronic kidney disease on dialysis: Starting dose is 2 tablets orally 3 times per day with meals. Adjust dose by 1 to 2 tablets as needed to maintain serumphosphorus at target levels, up to a maximum of 12 tablets daily. Dose can be titrated at 1-week or longer intervals. Iron deficiency anemia in chronic kidney disease not on dialysis: Starting dose is 1 tablet orally 3 times per day with meals. Adjust dose as needed to achieve and maintain hemoglobin goal, up to a maximum of 12 tablets daily.

Hyperphosphatemia in chronic kidney disease on dialysis: Starting dose is 2 tablets orally 3 times per day with meals. Adjust dose by 1 to 2 tablets as needed to maintain serumphosphorus at target levels, up to a maximum of 12 tablets daily. Dose can be titrated at 1-week or longer intervals. Iron deficiency anemia in chronic kidney disease not on dialysis: Starting dose is 1 tablet orally 3 times per day with meals. Adjust dose as needed to achieve and maintain hemoglobin goal, up to a maximum of 12 tablets daily.

When clinically significant drug interactions are expected, consider separation of the timing of administration. Consider monitoring clinical responses or blood levels of the concomitant medication.

Citofer 210 mg is contraindicated in patients with iron overload syndromes.

Most common adverse reactions (incidence ≥5%) are discolored feces, diarrhea, constipation, nausea, vomiting, cough, abdominal pain, and hyperkalemia.

There are no available data on Citofer 210 mg use in pregnant women to inform a drug-associated risk of major birth defects and miscarriage. There are no human data regarding the effect of Citofer 210 mg in human milk, the effects on the breastfed child, or the effects on milk production.

Iron absorption from Citofer 210 mg may lead to excessive elevations in iron stores. Increases in serum ferritin and transferrin saturation (TSAT) levels were observed in clinical trials. In a 56-week safety and efficacy trial evaluating the control of serum phosphate levels in patients with chronic kidney disease on dialysis in which concomitant use of intravenous iron was permitted, 55 (19%) of patients treated with Citofer 210 mg had a ferritin level >1500 ng/mL as compared with 13 (9%) of patients treated with active control. Assess iron parameters (e.g., serum ferritin and TSAT) prior to initiating Citofer 210 mg and monitor iron parameters while on therapy. Patients receiving intravenous iron may require a reduction in dose or discontinuation of intravenous iron therapy.

No data are available regarding overdose of Citofer 210 mg in patients. In patients with chronic kidney disease, the maximum dose studied was 2,520 mg ferric iron (12 tablets of Citofer 210 mg) per day. Iron absorption from Citofer 210 mg may lead to excessive elevations in iron stores, especially when concomitant intravenous iron is used.

Keep below 30°C temperature, away from light & moisture. Keep out of the reach of children.

Pediatric Use: The safety and efficacy of Citofer 210 mg have not been established in pediatric patients.Geriatric Use: Clinical studies of Citofer 210 mg included 292 subjects aged 65 years and older (104 subjects aged 75 years and older). Overall, the clinical study experience has not identified any obvious differences in responses between the elderly and younger patients in the tolerability or efficacy of Citofer 210 mg.

Oral Iron preparations

Hyperphosphatemia in chronic kidney disease on dialysis: Ferric iron binds dietary phosphate in the GI tract and precipitates as ferric phosphate. This compound is insoluble and is excreted in the stool. By binding phosphate in the GI tract and decreasing absorption, Citofer 210 mg lowers the phosphate concentration in the serum.Iron deficiency anemia in chronic kidney disease not on dialysis: Ferric iron is reduced from the ferric to the ferrous form by ferric reductase in the GI tract. After transport through the enterocytes into the blood, oxidized ferric iron circulates bound to the plasma protein transferrin, and can be incorporated into hemoglobin.

There are no available data on Citofer 210 mg use in pregnant women to inform a drug-associated risk of major birth defects and miscarriage. There are no human data regarding the effect of Citofer 210 mg in human milk, the effects on the breastfed child, or the effects on milk production.

Pediatric Use: The safety and efficacy of Citofer 210 mg have not been established in pediatric patients.Geriatric Use: Clinical studies of Citofer 210 mg included 292 subjects aged 65 years and older (104 subjects aged 75 years and older). Overall, the clinical study experience has not identified any obvious differences in responses between the elderly and younger patients in the tolerability or efficacy of Citofer 210 mg.