Ferric carboxymaltose (FCM) injection contains iron in ferric state and it forms a complex with carbohydrate polymer.

This complex releases iron which utilizes for iron transport and storage proteins in the body (ferritin and transferrin). It can be given in a single high dose in a short time which rapidly refills the iron stores than orally administered comparators.(15)

Indication

Ferric carboxymaltose (FCM) is a new intravenous iron form which is approved for patients of iron deficiency having inadequate response to oral iron therapy, intolerance to oral iron, or non-dialysis dependent chronic kidney disease.

Dosage and administration

  • FCM injection should be administered under the supervision of trained staff who can evaluate and manage the anaphylactic reaction.
  • Each 10 ml vial contains 500 mg of iron and 20 ml vial contains 1000 mg of iron as ferric carboxymaltose.

Calculation of cumulative dose

It is based on the patient’s body weight and hemoglobin level and should not be exceeded.

Calculation of cumulative dose

  • FCM must only be administered by intravenous route either by injection or by infusion.
  • It should not be administered by subcutaneous or intramuscular route.
  • Should not administer 1000 mg of iron (20ml) more than once a week.
  • Hb level should be assessed after 4 weeks of post-final FCM administration.

Pediatric population

The use of FCM injection has not been evaluated in children so it is not recommended in children under 14 years.

Contraindications

Hypersensitivity to FCM is the main contraindication.

Warnings and precautions

Hypersensitivity reactions

Patients may present with shock, hypotension, loss of consciousness, and/or collapse. Signs and symptoms of hypersensitivity should be observed during and after administration for at least 30 minutes. More risk is for patients with known allergies including drug allergies, patients with a history of severe asthma, eczema or another atopic allergy.

Adverse reactions

The most common adverse reactions are nausea followed by headache, hypertension, flushing, hypophosphatemia, and dizziness. FCM is well tolerated than oral ferrous sulfate, having a low risk of hypersensitivity reactions and gastrointestinal adverse effects. (15)

FCM in Post-partum anemia (12)

This can be defined as haemoglobin (Hb) of < 10 gm% during the postpartum period due to loss of blood during delivery.  FCM is efficiently used in this condition. FCM is front line therapy because it can be administered 1000mg doses in one setting as well as has a fewer adverse reaction and better compliance.