Ferric carboxymaltose
Antianaemia agents (iron, folic acid, vitamin B12)
Antianaemia agents (iron, folic acid, vitamin B12)
An intravenous iron that refills iron stores in a short infusion, used for iron-deficiency anaemia when oral iron fails or is not tolerated.
Quick facts
- Group
- Antianaemia agents (iron, folic acid, vitamin B12)
- Target
- Transferrin, the plasma iron carrier (iron is built into haemoglobin)
- Key effects
- Nausea · Headache · Flushing or hot flushes
- Monitor
- Blood pressure and signs · Haemoglobin
- ATC
- B03AC
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows human serum transferrin carrying two ferric iron ions; iron released from the complex travels in the blood this way to the marrow.
Ferric carboxymaltose is a ferric hydroxide core inside a carbohydrate shell. The complex is taken up by macrophages of the liver, spleen and marrow, which release the iron to transferrin. The marrow then uses it to make haemoglobin, and the body's stores are refilled.
- The iron–carbohydrate complex is infused into a vein
- Macrophages in marrow, liver and spleen take it up
- Iron is handed to transferrin and carried to the marrow
- Haemoglobin rises and iron stores refill
Indications
- Iron-deficiency anaemia when oral iron is ineffective, not tolerated or too slow Iron deficiency anaemia →
Adverse effects
Common
- Nausea, vomiting, taste changes
- Headache, dizziness
- Flushing or hot flushes
- Injection-site pain, swelling or bruising
- Long-lasting brown skin staining if the drug leaks out of the vein
Contraindications
- Hypersensitivity to ferric carboxymaltose or other IV iron
- Caution in conditions that lower phosphate or vitamin D (malabsorption, inflammatory bowel disease, parathyroid disease)
Key interactions
- Oral iron supplements
- Reported to the team; oral iron is usually adjusted or paused during IV treatment
What is monitored
- Blood pressure and signs of hypersensitivity during and for at least 30 minutes after the infusion
- Serum phosphate before a repeat course
- Haemoglobin, ferritin and transferrin saturation to judge response
Administration and safety
- Intravenous infusion or slow injection in a facility able to treat anaphylaxis
- Check the cannula: leakage stains the skin brown for a long time
- Stop at once if a severe reaction appears
- Different IV irons are not interchangeable product for product: check the name
Pregnancy and breastfeeding
It may harm the fetus according to MedlinePlus; a pregnancy is reported, and use is weighed by the treating team.
Nursing care
- Ask about previous reactions to IV iron and allergies
- Observe the patient during and for at least 30 minutes after the infusion
- Teach to report tiredness, muscle or bone pain (low phosphate)
- Tell the laboratory about the treatment before blood tests
Pharmacokinetics
- Absorption
- Intravenous only
- Distribution
- Cleared quickly from the blood; about 80% goes to the marrow, the rest to liver and spleen
Test yourself
Think of the answer, then tap the question to see it.
Which electrolyte disturbance is typical of ferric carboxymaltose?
Hypophosphataemia (low phosphate).
How long is the patient observed after the infusion?
At least 30 minutes.
When is IV iron chosen over oral iron?
When oral iron fails, is not tolerated or cannot be absorbed.
Connections
← Back to the class: Antianaemia agents (iron, folic acid, vitamin B12)
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Ferric Carboxymaltose Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2025); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.