Ferric Carboxymaltose Injection Frequency
The maximum recommended frequency is 1000 mg of ferric carboxymaltose per week, with doses separated by at least 7 days. 1, 2
Standard Dosing Schedule for Iron Deficiency Anemia
For patients ≥50 kg:
- Administer 750 mg intravenously in two doses separated by at least 7 days for a total cumulative dose of 1,500 mg per course 2
- Alternatively, a single dose of up to 1,000 mg may be given per course 2
For patients <50 kg:
- Administer 15 mg/kg body weight intravenously in two doses separated by at least 7 days per course 2
Heart Failure-Specific Dosing Protocol
For iron deficiency in heart failure patients (NYHA class II/III): 2
Patients <70 kg:
- Day 1: 1,000 mg if Hb <10 g/dL; 1,000 mg if Hb 10-14 g/dL; 500 mg if Hb >14 to <15 g/dL
- Week 6: 500 mg if Hb <10 g/dL; no additional dose if Hb ≥10 g/dL
Patients ≥70 kg:
- Day 1: 1,000 mg if Hb <10 g/dL; 1,000 mg if Hb 10-14 g/dL; 500 mg if Hb >14 to <15 g/dL
- Week 6: 1,000 mg if Hb <10 g/dL; 500 mg if Hb 10-14 g/dL; no dose if Hb >14 g/dL
Maintenance dosing: Administer 500 mg at 12,24, and 36 weeks if serum ferritin <100 ng/mL or ferritin 100-300 ng/mL with transferrin saturation <20% 2
Administration Guidelines
Infusion parameters:
- Administer undiluted as slow IV push at approximately 100 mg (2 mL) per minute for doses ≤750 mg 2
- For 1,000 mg doses, administer over 15 minutes 2
- When diluted in 0.9% sodium chloride (concentration ≥2 mg iron/mL), infuse over at least 15 minutes 2
- Critical safety measure: Observe patients for adverse effects for at least 30 minutes following each IV injection 1
Monitoring and Re-Treatment Schedule
Initial follow-up:
- Re-evaluate iron status 3 months after initial treatment 1, 3
- Avoid early re-evaluation within 4 weeks as ferritin levels are markedly elevated immediately following IV iron administration and cannot be used as an indicator of iron status during this time 1, 3, 4
Long-term monitoring:
- Evaluate iron status 1-2 times per year in patients with chronic heart failure 1, 3
- Check serum phosphate levels in patients requiring repeat courses within 3 months, as ferric carboxymaltose is associated with hypophosphatemia with repeated dosing 4, 2
Re-treatment criteria:
- Treatment may be repeated if iron deficiency anemia or iron deficiency in heart failure recurs 2
- The frequency of repeat administration depends on the underlying etiology; a single total dose infusion may suffice if the cause has been eliminated 5
Important Clinical Caveats
Maximum weekly dose limitation: The 1,000 mg per week maximum is a critical safety threshold that should not be exceeded 1, 2. This differs from some older IV iron formulations that required more frequent, smaller doses.
Superiority over oral iron: Two 750 mg ferric carboxymaltose infusions are significantly more effective than oral iron in increasing hemoglobin levels in patients with inadequate oral iron response 6. This supports the use of higher, less frequent dosing rather than attempting to replicate oral iron's daily administration pattern.
Rapid administration advantage: Ferric carboxymaltose permits administration of up to 1,000 mg over just 15 minutes 7, 8, making it far more convenient than older formulations like iron sucrose (which requires 200-500 mg over 30-210 minutes) 1.
Contraindications to dosing: Do not administer if hemoglobin >15 g/dL 5, if there is evidence of iron overload 3, or in patients with active bacteremia 3.