Note: Triferic ampules (intradialytic formulation) contains 5.44 mg iron (III) per mL. Triferic powder (intradialytic formulation) contains 272 mg iron (III) per packet. Triferic AVNU (IV formulation) contains 1.5 mg iron (III) per mL.
Iron replacement therapy in hemodialysis-dependent patients:
Intradialytic: After admixture into bicarbonate concentrate dialysate (final concentration 2 micromolar [110 mcg/L]) use at each dialysis session. Therapy may be continued for as long as the patient is receiving maintenance hemodialysis for chronic kidney disease (CKD).
IV: 6.75 mg with each dialysis session. Therapy may be continued for as long as the patient is receiving maintenance hemodialysis for CKD.
No dosage adjustment necessary.
There are no dosage adjustments provided in the manufacturer's labeling.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Packet, Hemodialysis:
Triferic: 272 mg (1 ea, 100 ea)
Solution, Hemodialysis [preservative free]:
Triferic: 27.2 mg/5 mL (5 mL)
Solution, Intravenous:
Triferic AVNU: 6.75 mg/4.5 mL (5 mL)
No
Intradialytic: Administer after admixed into bicarbonate concentrate dialysate at each dialysis session.
IV: Administer as slow continuous infusion over 3 to 4 hours via the pre-dialyzer infusion line, post-dialyzer infusion line, or via a separate connection to the venous blood line at each dialysis session.
Iron replacement therapy in hemodialysis-dependent patients: Replacement of iron to maintain hemoglobin in adult patients with hemodialysis-dependent chronic kidney disease (HDD-CKD)
Limitations of use: Not intended for use in patients receiving peritoneal dialysis; has not been studied in patients receiving home hemodialysis
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not always defined.
>10%: Cardiovascular: Procedural hypotension (22%)
1% to 10%:
Cardiovascular: Peripheral edema (7%), clotted AV fistula (3%), dialysis access hemorrhage (3%)
Central nervous system: Headache (9%), fatigue (4%), dizziness
Dermatologic: Pruritus
Gastrointestinal: Constipation, nausea
Genitourinary: Urinary tract infection (5%)
Neuromuscular & skeletal: Muscle spasm (10%), limb pain (7%), back pain (5%), weakness (4%)
Respiratory: Dyspnea (6%)
Miscellaneous: Fever (5%)
<1%, postmarketing, and/or case reports: Anaphylaxis, hypersensitivity
There are no contraindications listed in the manufacturer's labeling.
Concerns related to adverse effects:
• Hypersensitivity: Serious hypersensitivity reactions, including anaphylactic-type reactions (some fatal) have been reported in patients receiving parenteral iron products. Monitor for signs and symptoms of hypersensitivity (eg, shock, hypotension, loss of consciousness, collapse) during and after hemodialysis.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Dimercaprol: May enhance the nephrotoxic effect of Iron Preparations. Risk X: Avoid combination
The manufacturer recommends effective contraception during therapy and for at least 2 weeks after treatment is complete in females of reproductive potential.
Adverse events were observed in some animal reproduction studies.
Maternal iron requirements increase during pregnancy. Adequate iron concentrations to the fetus can be maintained regardless of maternal iron status, except in severe cases of anemia (IOM 2001).
Iron is present in breast milk (IOM 2001). It is not known if maternal exposure to ferric pyrophosphate citrate significantly changes breast milk concentrations.
According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy should take into account the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.
Monitor for hypersensitivity reactions during and after the dialysis session. Determine iron status on predialysis blood samples, as postdialysis serum iron parameters may overestimate serum iron and transferrin saturation. Patients with chronic kidney disease should have anemia indices (including hemoglobin, hematocrit, and iron studies) assessed as clinically indicated in routine care.
Iron delivered into the circulation binds to transferrin for transport to erythroid precursor cells to be incorporated into hemoglobin.
Distribution: Vd: 0.765 to 0.859 L
Half-life elimination: ~1.48 hours
Pack (Triferic Hemodialysis)
272 mg (per each): $96.00
Solution (Triferic AVNU Intravenous)
6.75MG/4.5ML (per mL): $2.88
Solution (Triferic Hemodialysis)
27.2 mg/5 mL (per mL): $2.28
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