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Heart Failure

Ferric Carboxymaltose

Brand names: Ferinject

Used in: Anaemia

Ferric carboxymaltose is an intravenous iron preparation used to treat iron deficiency, including in heart failure and where oral iron is not tolerated, is ineffective, or rapid replacement is needed.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

For patients weighing 50 kg or more, the recommended dosage is Injectafer 750 mg intravenously in two doses separated by at least 7 days for a total cumulative dose of 1,500 mg of iron per course. For adult patients weighing 50 kg or more, an alternative dose of Injectafer 15 mg/kg body weight up to a maximum of 1,000 mg intravenously may be administered as a single-dose per course. ( 2.1 ) For patients weighing less than 50 kg, the recommended dosage is Injectafer 15 mg/kg body weight intravenously in two doses separated by at least 7 days per course. ( 2.1 ) See Section 2.1, Table 1 for dosage in patients with iron deficiency and heart failure. ( 2.1 ) Injectafer treatment may be repeated …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-01-01. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It delivers iron within a carbohydrate complex that is taken up by the reticuloendothelial system and released for incorporation into haemoglobin and replenishment of iron stores, bypassing the limitations of gastrointestinal absorption.

Prescribing in practice

  • Serious hypersensitivity reactions, including anaphylaxis, can occur — administer only where resuscitation facilities are immediately available and observe the patient during and after the infusion.
  • Hypophosphataemia can occur and may be significant or prolonged, particularly with repeated dosing — monitor serum phosphate and correct if needed.
  • Extravasation can cause persistent brown skin staining, so ensure secure venous access; avoid intravenous iron during active infection and use with caution in hepatic impairment.

Monitoring

Observe the patient during and after administration for hypersensitivity. Monitor haematological response (haemoglobin and iron indices) and serum phosphate, especially with repeated courses, and inspect the infusion site for extravasation.

Counselling the patient

  • Tell us immediately during the infusion if you feel unwell, dizzy, breathless, or develop a rash or swelling.
  • Report any pain, swelling or skin discolouration at the drip site, as leakage can cause long-lasting brown staining.
  • Some people feel tired or notice muscle symptoms afterwards; seek advice if these are marked or persistent.

Evidence & guidelines

Intravenous iron is recommended for iron deficiency where oral iron is unsuitable, and is used in selected patients with heart failure (NICE NG106; MHRA guidance on intravenous iron).

Reference: AFFIRM-AHF Lancet 2020; 396(10266):1895-1904; IRONMAN Lancet 2022; 400(10353):2199-2209; ESC HF Guidelines 2021; MHRA 2023 DSU; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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