Phoscon (Ferric Citrate): A Phosphate Binder and Oral Iron Preparation

Phoscon contains Ferric Citrate, a compound used for two primary indications: controlling serum phosphorus levels in adult patients with chronic kidney disease (CKD) on dialysis, and treating iron deficiency anemia in adult CKD patients not on dialysis. It belongs to the therapeutic class of Oral Iron preparations.

How Phoscon Works (Pharmacology)

Ferric Citrate works through two distinct mechanisms:

• Phosphate Binding: In the gastrointestinal (GI) tract, ferric iron (the iron in Ferric Citrate) binds to dietary phosphate. This binding forms insoluble ferric phosphate, which is then excreted in the stool. By reducing phosphate absorption from the diet, ferric citrate effectively lowers serum phosphate concentrations.
• Iron Supplementation: Ferric iron is reduced to the ferrous form within the GI tract by ferric reductase. After absorption into the bloodstream via enterocytes, the oxidized ferric iron circulates bound to transferrin, a plasma protein. From there, it can be incorporated into hemoglobin, thus addressing iron deficiency.

Key Indications & Benefits

Phoscon is indicated for:

• Control of serum phosphorus levels in adult patients with chronic kidney disease on dialysis (managing hyperphosphatemia).
• Treatment of iron deficiency anemia in adult patients with chronic kidney disease not on dialysis.

Dosage & Administration

Phoscon should be taken orally with meals. Always consult a registered physician for medication use.

• Hyperphosphatemia in Chronic Kidney Disease on Dialysis:
  • Starting dose: 2 tablets orally 3 times per day with meals.
  • Dose adjustment: Adjust dose by 1 to 2 tablets as needed to maintain serum phosphorus at target levels, up to a maximum of 12 tablets daily. Doses can be titrated at 1-week or longer intervals.
• Iron Deficiency Anemia in Chronic Kidney Disease not on Dialysis:
  • Starting dose: 1 tablet orally 3 times per day with meals.
  • Dose adjustment: Adjust dose as needed to achieve and maintain hemoglobin goal, up to a maximum of 12 tablets daily or as directed by the physician.

Use in Children & Adolescents: The safety and efficacy of Ferric Citrate have not been established in Children & Adolescents.

Important Considerations & Warnings

It is crucial to discuss your full medical history with your doctor before taking Phoscon.

Contraindications:

• Patients with iron overload syndrome (Hemochromatosis).

Side Effects:

• Most common adverse reactions: Discolored feces, diarrhea, constipation, nausea, vomiting, cough, abdominal pain, and hyperkalemia.

Pregnancy & Lactation:

• There are no available data on Ferric Citrate use in pregnant women and lactating mothers.

Precautions & Warnings:

• Iron Overload: Iron absorption from Phoscon may lead to excessive elevations in iron stores. This may manifest as increases in serum ferritin and transferrin saturation (TSAT) levels. Patients may require a reduction in dose or discontinuation of intravenous iron if iron levels become too high.
• Accidental Overdose in Children: Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6 years of age. Keep Phoscon out of reach of children. In case of accidental overdose, immediately call a doctor or poison control center in a hospital.

Drug Interactions:

• Oral drugs such as Doxycycline & Ciprofloxacin need to be separated from Phoscon due to potential interactions affecting absorption.

Overdose Effects

• No data are available regarding overdose of Phoscon in patients.
• In patients with Chronic Kidney Disease, the maximum dose studied was 2,520 mg ferric iron per day.

Storage Conditions

Store below 30°C, away from light and in a dry place. Keep out of the reach of children.