Ferric carboxymaltose

How it works

It is a stable iron-carbohydrate complex that delivers iron to the reticuloendothelial system, from where it is incorporated into ferritin stores and used for haemoglobin synthesis.

Prescribing in practice

• Serious hypersensitivity and anaphylaxis can occur, so it must be given where resuscitation facilities are available, with observation after administration, and it should generally be avoided in the first trimester of pregnancy.
• It can cause clinically significant and sometimes persistent hypophosphataemia, particularly with repeated dosing, so phosphate should be checked in at-risk or repeatedly treated patients.
• Extravasation can cause long-lasting brown skin staining, so careful intravenous administration is essential and it should not be given during active infection.

Monitoring

Monitor for hypersensitivity during and after infusion, reassess haemoglobin and iron indices after a suitable interval, and check serum phosphate with repeated or high-dose courses.

Counselling the patient

• Report any rash, wheeze, swelling or dizziness during or shortly after the infusion at once.
• Tell the nurse immediately if you feel burning or see swelling at the drip site, as leakage can stain the skin.
• Report persistent tiredness, bone pain or muscle weakness after treatment, which can signal low phosphate.

Evidence & guidelines

Intravenous iron such as ferric carboxymaltose is supported by NICE guidance for iron-deficiency anaemia, with MHRA advice on hypersensitivity precautions and the risk of hypophosphataemia.