Revocit (Ferric Citrate): An Oral Iron Preparation for CKD Patients

Revocit contains Ferric Citrate, an oral iron preparation indicated for specific conditions in adult patients with chronic kidney disease (CKD). It is used to control serum phosphorus levels in CKD patients on dialysis and to treat iron deficiency anemia in CKD patients not on dialysis. It belongs to the therapeutic class of Oral Iron preparations.

How Revocit Works (Pharmacology)

Ferric Citrate has a dual mechanism of action, primarily related to its ferric iron component:

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

Key Indications & Benefits

Revocit is indicated for:

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

Dosage & Administration

Revocit should be taken orally with meals. Dosage varies based on the indication and patient response. Always consult a registered physician for specific dosage instructions.

• Hyperphosphatemia in Chronic Kidney Disease on Dialysis:
  • Starting dose: 2 tablets orally 3 times per day with meals.
  • 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.
  • 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 and adolescents.

Important Considerations & Warnings

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

Contraindications:

• Patients with iron overload syndrome (Hemochromatosis).

Side Effects:

• Most common adverse reactions: Discolored feces, diarrhea, constipation, nausea, vomiting, cough, abdominal pain, and hyperkalemia (high potassium levels).

Pregnancy & Lactation:

• There are no available data on Ferric Citrate use in pregnant women and lactating mothers. Its use in these populations should be carefully considered by a healthcare professional based on individual risk-benefit assessment.

Precautions & Warnings:

• Iron Overload: Iron absorption from Revocit may lead to excessive elevations in iron stores. This can result in increased serum ferritin and transferrin saturation (TSAT) levels. Patients may require a reduction in dose or discontinuation of intravenous iron if co-administered.
• 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 Revocit out of reach of children. In case of accidental overdose, immediately call a doctor or poison control center at a hospital.

Drug Interactions:

• Oral drugs such as Doxycycline & Ciprofloxacin need to be separated from Revocit administration, as iron can impair their absorption. Specific separation intervals should be followed as advised by a healthcare professional.

Overdose Effects

• No specific data are available regarding overdose of Revocit in patients.
• In patients with Chronic Kidney Disease, the maximum dose studied was 2,520 mg ferric iron per day.
• General iron overdose symptoms can include abdominal pain, nausea, vomiting, diarrhea, followed by a latent period, and then potential for shock, metabolic acidosis, liver failure, and coma in severe cases. Management would typically involve supportive care and chelation therapy if indicated.

Storage Conditions

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