Ferric Carboxymaltose

How it works

The stable carbohydrate-iron complex is taken up by the reticuloendothelial system, where iron is released and incorporated into ferritin stores and haemoglobin synthesis, allowing delivery of a large iron dose with low free-iron toxicity.

Prescribing in practice

• Serious hypersensitivity and anaphylactic reactions can occur with intravenous iron, so administer only where resuscitation facilities are available and observe the patient during and after the infusion.
• Hypophosphataemia is a recognised effect, particularly with repeated courses, and serum phosphate should be checked in patients with risk factors or persistent symptoms.
• Extravasation causes persistent brown skin staining, so secure venous access and stop the infusion immediately if any leakage or local pain occurs.

Monitoring

Monitor for hypersensitivity during administration, reassess haemoglobin and iron indices several weeks after dosing, and check serum phosphate where repeated or high cumulative doses are given.

Counselling the patient

• Report any rash, breathlessness, swelling or feeling faint during or shortly after the infusion.
• Skin discolouration at the injection site is uncommon but can be long-lasting if the drug leaks under the skin.
• Iron stores are replaced over weeks; a blood test will be arranged to confirm the response.

Evidence & guidelines

MHRA guidance highlights the risk of serious hypersensitivity reactions with intravenous iron preparations, including in pregnancy, and the need for trained supervision.