From the Guidelines
Ferric carboxy maltose (FCM) is a macromolecular ferric hydroxide carbohydrate complex.
Key Characteristics of FCM
- It facilitates slow release of elemental iron after injection, allowing a large dose of 1000 mg to be administered in 15 to 30 min 1.
- FCM is used to treat various conditions associated with iron deficiency, including chronic kidney disease, pregnancy, heavy uterine bleeding, inflammatory bowel disease, and congestive heart failure.
- The formulation is available in different doses, with a 1000 mg single infusion commonly used in Europe and Asia, while in the United States, it is distributed as a 750 mg vial 1.
- Administration of FCM has been associated with treatment-emergent hypophosphatemia, and it should be avoided in patients who require repeat infusions 1.
- FCM should be diluted in 100 mL of normal saline and infused over 20–30 min, with precautions to observe for acute onset of minor infusion reactions 1.
From the Research
Iron Complex Type
- Ferric carboxy maltose (Iron isomaltoside 1000) is a macromolecular ferric hydroxide carbohydrate complex, which allows for controlled delivery of iron within the cells of the reticuloendothelial system and subsequent delivery to the iron-binding proteins ferritin and transferrin, with minimal risk of release of large amounts of ionic iron in the serum 2.
- It is a nondextran intravenous iron which can be administered in high single doses 3.
- Ferric carboxymaltose is a new iron formulation (150 kDa) that can be given at high doses (20 mg/kg, up to 1000 mg) over a short period (≤ 15 min), without test dosing 4.
Comparison with Other Iron Complexes
- Ferric carboxymaltose is associated with a 75% lower risk for hypersensitivity reactions compared with iron isomaltoside-1000 5.
- The efficacy of ferric carboxymaltose for correcting anemia is similar to that of iron sucrose, and it is superior to oral iron or placebo in replenishing iron stores 4.
- Ferric carboxymaltose, ferric derisomaltose (FDI; also known as iron isomaltoside), and ferumoxytol (FER) are successful treatments for iron deficiency and iron deficiency anemia, with an improved safety profile over predecessors 6.
Key Safety Aspects
- Hypersensitivity reactions can occur with any intravenous iron and are usually mild; severe reactions - particularly anaphylaxis - are extremely rare 6.
- Severe, persistent, hypophosphatemia is a specific side effect of ferric carboxymaltose 6.
- No cardiovascular safety signal has been identified for intravenous iron 6.