Accrufer (Ferric Maltol) Dosing in the USA
The recommended dosing for Accrufer (ferric maltol) in the USA is 30 mg twice daily. 1
Dosing Details
Accrufer is an oral iron preparation containing ferric maltol, which provides 30 mg of elemental iron per tablet. The standard dosing regimen is:
- One tablet (30 mg elemental iron) twice daily
- Total daily dose: 60 mg elemental iron
This dosing recommendation is clearly outlined in the KDIGO guidelines for anemia management in chronic kidney disease patients 1.
Administration Considerations
- Timing: Morning and evening doses are recommended
- Duration: Continue until iron deficiency is corrected and target hemoglobin levels are achieved
- Monitoring: Regular assessment of iron parameters (ferritin, TSAT) and hemoglobin is recommended
Advantages of Ferric Maltol
Ferric maltol offers several advantages over traditional oral iron supplements:
- Better gastrointestinal tolerability compared to ferrous salts
- Improved absorption characteristics
- May be better tolerated in patients with inflammatory bowel disease or other conditions where traditional iron supplements cause significant side effects
Alternative Dosing Approaches
Recent research suggests that alternate-day dosing of iron supplements may improve absorption by avoiding the hepcidin spike that occurs with consecutive-day dosing 2. However, this approach has not been specifically studied with Accrufer or incorporated into official guidelines for this medication.
Comparison to Other Oral Iron Preparations
| Iron Preparation | Elemental Iron per Tablet | Recommended Daily Dose |
|---|---|---|
| Ferric maltol (Accrufer) | 30 mg | 30 mg twice daily |
| Ferrous sulfate | 65 mg | 1000 mg/day for IDA in CKD |
| Ferrous fumarate | 106 mg | 600 mg/day for IDA in CKD |
| Ferrous gluconate | 38 mg | 1600 mg/day for IDA in CKD |
Important Considerations
- Contraindications: Avoid in patients with iron overload or hemochromatosis
- Drug interactions: Separate administration from certain medications (tetracyclines, quinolones, thyroid hormones) by at least 2 hours
- Monitoring: Follow iron parameters (ferritin, TSAT) and hemoglobin levels regularly to assess response and avoid iron overload
Special Populations
For patients with chronic kidney disease, the dosing remains the same (30 mg twice daily), but more frequent monitoring of iron parameters may be warranted 1.
While some iron preparations require dose adjustments in pediatric populations, the evidence provided does not specify Accrufer dosing for children in the USA.