Recommended Dose of Ferric Carboxymaltose for Heart Failure with Iron Deficiency
For a patient weighing 60.27 kg with heart failure and severe iron deficiency anemia, administer ferric carboxymaltose 1000 mg intravenously on Day 1, followed by 500 mg at Week 6, based on the FDA-approved dosing regimen for iron deficiency in heart failure patients. 1
Weight-Based Dosing Algorithm
The FDA label provides specific dosing for heart failure patients with iron deficiency based on body weight and hemoglobin levels 1:
For patients weighing less than 70 kg (which includes your 60.27 kg patient):
- If Hb < 10 g/dL: 1000 mg on Day 1, then 500 mg at Week 6
- If Hb 10-14 g/dL: 1000 mg on Day 1, no additional dose at Week 6
- If Hb > 14 to < 15 g/dL: 500 mg on Day 1, no additional dose at Week 6 1
Administration Details
Ferric carboxymaltose should be administered as an intravenous infusion over at least 15 minutes, either undiluted as a slow IV push (at approximately 100 mg per 2 mL per minute) or diluted in up to 250 mL of sterile 0.9% sodium chloride 1. The maximum single dose is 1000 mg per administration 2, 1.
Maintenance Dosing Strategy
Administer maintenance doses of 500 mg at 12,24, and 36 weeks if:
- Serum ferritin remains < 100 ng/mL, OR
- Serum ferritin is 100-300 ng/mL with transferrin saturation < 20% 1
This maintenance strategy ensures sustained iron repletion and prevents recurrence of iron deficiency 1.
Evidence Supporting This Approach
The dosing regimen is based on robust clinical trial evidence in heart failure populations:
- The FAIR-HF trial demonstrated that ferric carboxymaltose improved symptoms, functional capacity, and quality of life in heart failure patients with iron deficiency, using doses up to 1000 mg per administration 3
- The AFFIRM-AHF trial showed that ferric carboxymaltose reduced heart failure hospitalizations when dosed according to the extent of iron deficiency, with a rate ratio of 0.74 (95% CI 0.58-0.94, p=0.013) 4
- The 2012 ESC Guidelines specifically recommend ferric carboxymaltose for iron deficiency in heart failure patients, noting improved patient global assessment and NYHA functional class 2
Important Clinical Considerations
Iron deficiency definition in heart failure: Iron deficiency is defined as serum ferritin < 100 μg/L, or ferritin 100-299 μg/L with transferrin saturation < 20% 2, 4. This differs from the general population cutoff of < 30 ng/mL due to the inflammatory nature of heart failure 2.
Safety monitoring: Check serum phosphate levels in patients requiring repeat courses within 3 months, as ferric carboxymaltose can cause hypophosphatemia 1. Ensure resuscitation facilities are available during administration, though serious hypersensitivity reactions are extremely rare (< 1:250,000 administrations) 2.
Common pitfall: A real-world study found that administering lower-than-prescribed doses of ferric carboxymaltose had no impact on iron deficiency correction or clinical outcomes 5. Therefore, it is critical to administer the full target dose rather than empirically reducing it.
Timing of reassessment: Do not recheck iron parameters immediately after infusion, as ferritin levels are falsely elevated. Wait 8-10 weeks before repeating iron studies to assess treatment response 2.
Alternative Dosing for Iron Deficiency Anemia (Non-Heart Failure Context)
If this patient had iron deficiency anemia without heart failure, the FDA-approved dosing would be different: 750 mg IV in two doses separated by at least 7 days (total 1500 mg per course) for patients ≥ 50 kg 1. However, the heart failure-specific dosing regimen should take precedence given the patient's diagnosis 1.