[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Antianaemia agents (iron, folic acid, vitamin B12)](https://durgical.com/en/pharmacology/classes/antianaemia-agents/) › Ferric carboxymaltose

# 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.

Updated Nov 1, 2026

## Quick facts

**Group**
[Antianaemia agents (iron, folic acid, vitamin B12)](https://durgical.com/en/pharmacology/classes/antianaemia-agents/)

**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.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

◆**Transferrin, the plasma iron carrier (iron is built into haemoglobin)**Ferric carboxymaltose

ⓘ 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.

**Target in 3D:** Transferrin, the plasma iron carrier (iron is built into haemoglobin). PDB structure 3QYT (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/3QYT) · Drag to rotate · pinch to zoom

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 →](https://durgical.com/en/conditions/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

### Serious (rare, important)

- Severe allergic reactions during or shortly after the infusion
- Severe, prolonged low blood phosphate (hypophosphataemia), with fatigue, muscle or bone pain, osteomalacia and fractures

## 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

## Memory aid

«Carboxy-MALT-ose = iron with a sugar coat»: big iron dose in one visit, then check the phosphate.

## 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.

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[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 3

- [Iron dextran](https://durgical.com/en/pharmacology/iron-dextran/)
- [Iron sucrose](https://durgical.com/en/pharmacology/iron-sucrose/)
- [Ferrous sulfate](https://durgical.com/en/pharmacology/ferrous-sulfate/)

## Related conditions 1

- [Iron deficiency anaemia](https://durgical.com/en/conditions/iron-deficiency-anaemia/)

[← Back to the class: Antianaemia agents (iron, folic acid, vitamin B12)](https://durgical.com/en/pharmacology/classes/antianaemia-agents/)

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](https://medlineplus.gov/druginfo/meds/a614037.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=B03AC&showdescription=no) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/ferric-carboxymaltose/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/ferric-carboxymaltose/