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sodium ferric gluconate

Generic Ferrlecit
Used for Anemia, Iron Deficiency
Used for Anemia, Iron Deficiency

Ferrlecit, the brand name for sodium ferric gluconate complex, is an iron supplement that's given as an injection through the vein. It's FDA approved to treat iron-deficiency anemia in adults and children with chronic kidney disease (CKD) who are receiving hemodialysis and epoetin alfa (Epogen, Procrit, Retacrit). Ferrlecit (sodium ferric gluconate) is given with each dialysis session. It's administered by a healthcare professional typically as an intravenous (IV) infusion over an hour, but it can also be given as a faster injection for adults. Side effects can include low blood pressure, stomach upset, and headaches.

Reviewed by:
reviewer
Robert Chad Hakim, PharmD, BCCCP
reviewer
Allison Gourley, PharmD
Last reviewed on August 20, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsAlternativesLatest newsReferencesPricesMedicare
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What is Ferrlecit (sodium ferric gluconate)?

What is Ferrlecit (sodium ferric gluconate) used for?

How Ferrlecit (sodium ferric gluconate) works

Ferrlecit (sodium ferric gluconate) is an iron supplement that helps replenish your body with this important mineral. Iron helps your bone marrow make red blood cells. It also helps make hemoglobin, a protein in red blood cells that's essential for delivering oxygen to different parts of your body.

Are you looking for information on ferumoxytol (Feraheme) or ferrous gluconate instead?

Drug Facts

Common BrandsFerrlecit
Drug ClassIron supplement
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
basics-icon

What are the side effects of Ferrlecit (sodium ferric gluconate)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Adults:
  • Nausea, vomiting, or diarrhea (35%)
  • Injection site reaction (33%)
  • Lower blood pressure (29%)
  • Cramps (25%)
  • Higher blood pressure (13%)
  • Dizziness (13%)
  • Abnormal changes in red blood cells (11%)
  • Shortness of breath (11%)
  • General pain (10%)
  • Chest pain (10%)
  • Leg cramps (10%)
Children:
  • Lower blood pressure (35%)
  • Headache (24%)
  • Higher blood pressure (23%)
  • Fast heart rate (17%)
  • Vomiting (11%)

Other Side Effects

Adults:
  • Weakness
  • Headache
  • Fatigue
  • Back or arm pain
  • Itchiness
  • Fever
  • Infections
Children:
  • Nausea
  • Diarrhea
  • Stomach pain
  • Sore throat
  • Fever
  • Infections

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Serious allergic reaction: wheezing, excessive sweating, back pain, chest pain, nausea, chills, flushing, rash, itching
  • Low blood pressure: fainting, dizziness, weakness, blurry vision, clammy skin, shallow breathing
  • High iron levels: fatigue, weakness, darkening of skin color, stomach or joint pain

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Abdominal or stomach pain

anxiety

arm, back, or jaw pain

bladder pain

bloating or swelling of the face, arms, hands, lower legs, or feet

bloody or cloudy urine

bloody, black, or tarry stools

blue lips and fingernails

blurred vision

chest pain or discomfort

chest tightness or heaviness

cold sweats

confusion

convulsions

cool, pale skin

cough or hoarseness

coughing that sometimes produces a pink frothy sputum

decreased level of consciousness

decreased urine

depression

diarrhea

difficult or labored breathing

difficult, burning, or painful urination

difficult, fast, or noisy breathing, sometimes with wheezing

dizziness

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

dry mouth

eye pain

fainting

fast or slow heartbeat

fast, pounding, or irregular heartbeat or pulse

feeling of warmth or heat

fever or chills

flushing or redness of the skin, especially on the face and neck

frequent urge to urinate

general feeling of discomfort or illness

headache

increased hunger

increased sweating

increased thirst

irregular heartbeat

joint pain

leg cramps

lightheadedness

loss of appetite

lower back or side pain

mood changes

muscle aches and pains

muscle cramps

nausea or vomiting

nervousness

nightmares

numbness or tingling in the hands, feet, or lips

pain or discomfort in the arms, jaw, back, or neck

pale skin

pounding in the ears

rapid weight gain

rapid, shallow breathing

runny nose

shakiness

shivering

shortness of breath

slow or irregular heartbeat

slurred speech

sore throat

sweating

swelling in the legs and ankles

swollen, painful, or tender lymph glands in the neck, armpit, or groin

tenderness, pain, swelling, warmth, skin discoloration, and prominent superficial veins over the affected area

trouble sleeping

troubled breathing with exertion

unusual bleeding or bruising

unusual tiredness or weakness

unusual weight gain or loss

weakness or heaviness of the legs

weight gain

wheezing

Incidence not known

Bleeding gums

bluish color

changes in skin color

cold, clammy skin

coughing up blood

excessive muscle tone

face is warm or hot to touch

fast, weak pulse

hives

increased menstrual flow or vaginal bleeding

itching

muscle stiffness

muscle tension or tightness

nosebleeds

paralysis

prolonged bleeding from cuts

puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

red or black, tarry stools

red or dark brown urine

skin rash

sweating

tenderness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Accumulation of pus

acid or sour stomach

anxiety

belching

bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site

body aches or pain

burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings

burning, dry, or itching eyes

cramps

deafness

difficulty with moving

discharge or excessive tearing

double vision

ear congestion

excess air or gas in the stomach or intestines

feeling unusually cold

full feeling

heartburn

hyperventilation

increased sweating

indigestion

irritability

longer or heavier menstrual periods

loss of appetite

loss of voice

passing of gas

redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid

restlessness

rolling of the eyes

seeing double

shivering

sleepiness or unusual drowsiness

sneezing

stomach discomfort or upset

swollen, red, or tender area of infection

voice changes

watery eyes

weight loss

Incidence not known

Change in taste

loss of taste

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Ferrlecit (sodium ferric gluconate)

thumbs-up

Pros

IV infusion can be given at the same time as dialysis, so it's convenient for people with a busy schedule

Safe for children as young as 6 years old with chronic kidney disease (CKD)

thumbs-down

Cons

Requires blood pressure monitoring to make sure this medication is safe for you

Not a recommended option during pregnancy

Has a risk of severe allergic reactions

pharmacist-tips

Pharmacist tips for Ferrlecit (sodium ferric gluconate)

pharmacist

  • Make sure to get your routine blood tests done on time while you're receiving Ferrlecit (sodium ferric gluconate). These blood tests check your iron levels and red blood cells. They help your prescriber check that the medication is working and is safe for you.

    • Be sure to plan for some extra time after your appointment. Your care team will need to check your blood pressure during the infusion and for up to 30 minutes after you've received Ferrlecit (sodium ferric gluconate). This is because the medication can cause dangerously low blood pressure. Tell your care team right away if you faint or feel dizzy or nauseous after you've received Ferrlecit (sodium ferric gluconate).

      • Your care team will watch for allergic reactions during your infusion and after you've received Ferrlecit (sodium ferric gluconate). This medication can sometimes cause allergic reactions that can be life-threatening. Tell your care team right away if you experience wheezing, shortness of breath, dizziness, chest pain, a lot of sweating, chills, flushing, or itching. They'll know how to help relieve these symptoms.

        • Don't take any other iron supplements while you're getting treated with Ferrlecit (sodium ferric gluconate). This can raise your risk for having too much iron in the body, which can cause fatigue, weakness, darkening skin color, or joint pain.

          • In general, it's recommended that you follow an iron-rich diet to help restore your iron levels. Examples of high-iron foods include red meats (like beef or pork), dark leafy greens (like broccoli or spinach), beans, and iron-enriched pasta and rice. Talk to your care team about how much iron you need to include in your diet every day.

            faqs

            Frequently asked questions about Ferrlecit (sodium ferric gluconate)

            Can Ferrlecit (sodium ferric gluconate) cause joint pain after the infusion?
            It's possible. Some people have had joint pain after their Ferrlecit (sodium ferric gluconate) infusion. But joint pain generally doesn't appear to be a common side effect of the medication. People have had other types of pain, like leg cramps and leg pain, more commonly (at least 10% of adults taking Ferrlecit (sodium ferric gluconate) in clinical trials). Tell your prescriber or primary care provider if you have joint pain after you get Ferrlecit (sodium ferric gluconate) infused.
            Does the Ferrlecit (sodium ferric gluconate) iron infusion make you urinate a lot?
            No, Ferrlecit (sodium ferric gluconate) IV infusions don't typically make you urinate more. In general, more urination or frequent urination isn't a usual side effect with IV iron infusions. Talk to your care team or CKD specialist if you notice that you're going to the bathroom more than usual. They can help figure out what might be causing it.
            Do Ferrlecit (sodium ferric gluconate) iron infusions cause black stools?
            No, black stool isn't a typical side effect of IV iron infusions like Ferrlecit (sodium ferric gluconate). But iron supplements that are taken by mouth, like ferrous sulfate, can cause you to have black stools as a side effect.
            Can Ferrlecit (sodium ferric gluconate) be given daily?
            Ferrlecit (sodium ferric gluconate) is FDA approved for use with dialysis sessions. But the manufacturer doesn't specify whether there's a minimum time frame required between doses. One study suggested that Ferrlecit (sodium ferric gluconate) can be given once per day safely. Keep in mind, though, that the study was about adults with heart failure who were in the hospital and not about people with chronic kidney disease who need hemodialysis. Also, the dose was slightly different and given daily for 4 days. Discuss with your care team about how often you need Ferrlecit (sodium ferric gluconate).
            What's the difference between Ferrlecit and Venofer?
            Ferrlecit (sodium ferric gluconate) and Venofer (iron sucrose) are different IV iron supplements that treat iron-deficiency anemia. Both medications are approved for people receiving hemodialysis, but Venofer is also approved for people receiving peritoneal dialysis and people who don't need dialysis. In addition, children 6 years and older can take Ferrlecit whereas children as young as 2 can take Venofer. Also, Ferrlecit generally takes a little longer to infuse than Venofer. And although severe allergic reactions aren't common, studies suggest that the risk for these reactions might be higher with Ferrlecit than with Venofer. Talk with your care team to learn more about comparisons between the two medications.
            What's the difference between Ferrlecit and Feraheme?
            Both Ferrlecit (sodium ferric gluconate) and Feraheme (ferumoxytol) are IV iron products that help raise iron levels in the body. Ferrlecit is approved for people ages 6 years and older with chronic kidney disease (CKD) whereas Feraheme is approved for only adults with and without CKD. In addition, a treatment course of Feraheme is only about 2 doses because each dose contains a good amount of iron. But you'll probably need more doses of Ferrlecit to complete treatment because each dose of Ferrlecit has a smaller amount of iron than that of Feraheme. In addition, studies suggest that Feraheme has a higher risk of severe allergic reactions than Ferrlecit. Discuss with your care team about comparing between the two medications.
            Can Ferrlecit (sodium ferric gluconate) be used for people who don't need dialysis?
            Currently, Ferrlecit (sodium ferric gluconate) is only FDA approved for people with iron-deficiency anemia (IDA) who are receiving dialysis and epoetin alfa (Epogen, Procrit, Retacrit). But a small study suggested that Ferrlecit (sodium ferric gluconate) might work well and be safe for treating IDA in people who don't have kidney problems (which also means that they don't need dialysis). More research is needed to learn more about the medication's role in treating IDA for people who don't need dialysis.
            Is Ferrlecit (sodium ferric gluconate) safe during pregnancy?
            It's not completely clear how safe Ferrlecit (sodium ferric gluconate) is during pregnancy because it hasn't been well-studied. But in general, it's recommended to avoid Ferrlecit (sodium ferric gluconate) while pregnant unless the benefits are clearly greater than the risks. This is because Ferrlecit (sodium ferric gluconate) contains benzyl alcohol as a preservative, which can cause gasping syndrome (a life-threatening condition that leads to difficulty breathing) in babies who were born early or have a low birth weight. Ask your healthcare professional about safer treatment options if you're pregnant and you require treatment with iron infusions.
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            warings-icon

            What are the risks and warnings for Ferrlecit (sodium ferric gluconate)?

            Ferrlecit (sodium ferric gluconate) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

            risk-warning

            Serious allergic reactions

            • Risk factors: History of allergy to another iron product

              Ferrlecit (sodium ferric gluconate) can cause allergic reactions that can sometimes be serious and life-threatening, for example, anaphylaxis. Some symptoms of an allergic reaction are changes in blood pressure, fast heart rate, dizziness, rash, hives, difficulty breathing, throat tightness, and nausea. Your care team will keep an eye on you for allergic reactions for at least 30 minutes after the IV infusion. Seek medical help right away if you have any symptoms of an allergic reaction.

              risk-warning

              Low blood pressure

              Ferrlecit (sodium ferric gluconate) can lower your blood pressure. If a drop in blood pressure happens, it's typically after the IV infusion and then the blood pressure usually goes back up within 1 to 2 hours. Your care team might check your blood pressure or watch for symptoms of low blood pressure, like lightheadedness, dizziness, and weakness, after your infusion.

              risk-warning

              Too much iron in the body

              Your care team will make sure that you get the right amount of IV iron supplementation that you need to treat your IDA. Too much iron in the body (iron overload) can be harmful. It can lead to liver, heart, and joint problems, as well as other organ damage.

              To lower your risk for having too much iron in the body, don't take any other iron supplements during your treatment with Ferrlecit (sodium ferric gluconate). Tell your care team right away if you have fatigue, weakness, darkening skin color, or joint pain. These might be signs of high iron levels in your blood. Keep these signs in mind if your prescriber recommends that you take another iron supplement after you complete your treatment with Ferrlecit (sodium ferric gluconate).

              risk-warning

              Not approved for newborns or infants because of risk of serious breathing problem (gasping syndrome)

              • Risk factors: Newborns | Infants with low birth weight | Currently pregnant | Breastfeeding

                Ferrlecit (sodium ferric gluconate) isn't approved for use in newborns or infants. This is because certain Ferrlecit (sodium ferric gluconate) products contain a preservative called benzyl alcohol. Newborns and infants with low birth weight who are given products containing this preservative can develop a rare, but serious and sometimes life-threatening, medical condition called gasping syndrome.

                If you're pregnant or breastfeeding, talk with your care team before you receive Ferrlecit (sodium ferric gluconate). This is because it's possible that your baby could potentially be exposed to benzyl alcohol in the womb or through your breast milk. Ferrlecit (sodium ferric gluconate) isn't the preferred choice for iron infusions during pregnancy. To be safe, your prescriber will probably choose a different iron supplement product for you.

                dosage

                Ferrlecit (sodium ferric gluconate) dosage forms

                Typical dosing for Ferrlecit (sodium ferric gluconate)

                Ferrlecit (sodium ferric gluconate) is usually given by a healthcare professional in a healthcare setting (such as a dialysis center or infusion center). Your prescriber will determine the appropriate dose for you or your child each time the medication is given.

                • Adults (age 18 and over): The typical dose is 125 mg injected into a vein (IV) once every dialysis session. The dose is either given as an IV infusion over 1 hour or as a quicker injection over 10 minutes.

                • Children (age 6 and over): The dose will depend on the child’s weight. In general, the typical dose is 1.5 mg/kg (maximum 125 mg) injected into a vein once every dialysis session. The dose is given as an IV infusion over 1 hour.

                interactions

                Interactions between Ferrlecit (sodium ferric gluconate) and other drugs

                Ferrlecit (sodium ferric gluconate) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Ferrlecit (sodium ferric gluconate). Please note that only the generic name of each medication is listed below.

                Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

                Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                • Baloxavir Marboxil
                • Bictegravir
                • Dimercaprol
                • Eltrombopag
                • Erdafitinib
                • Raltegravir

                Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                alternatives

                What are alternatives to Ferrlecit (sodium ferric gluconate)?

                There are a number of medications that your doctor can prescribe in place of Ferrlecit (sodium ferric gluconate). Compare a few possible alternatives below.
                Ferrlecit (sodium ferric gluconate)
                Used for:
                View Prices
                Ferumoxytol (Feraheme)
                Used for:
                View Prices
                INFeD (iron dextran)
                Used for:
                $41.17 Lowest GoodRx priceView Prices

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                References

                Best studies we found

                American Red Cross. (n.d.). Red blood cells and why they are important.

                Center for Disease Control and Prevention. (1982). Neonatal deaths associated with use of benzyl alcohol -- United States. Morbidity and Mortality Weekly Report.

                Dave, C. V., et al. (2022). Risks for anaphylaxis with intravenous iron formulations: A retrospective cohort study. Annals of Internal Medicine.

                View All References (12)

                Drambarean, B., et al. (2023). Pharmacotherapy considerations in pregnant patients on hemodialysis. Hemodialysis International.

                Eche, I. M., et al. (2021). Safety and effectiveness of an accelerated intravenous iron administration protocol in hospitalized patients with heart failure. Journal of Cardiovascular Pharmacology and Therapeutics.

                Hamilton, J. P. A., et al. (2022). Secondary iron overload. Merck Manual Consumer Version.

                MedGen. (n.d.). Gasping syndrome.

                MedlinePlus. (2022). Hemoglobin.

                MedlinePlus. (2024). Iron tests.

                Miller, H. J., et al. (2005). Efficacy and tolerability of intravenous ferric sodium gluconate in the treatment of iron deficiency anemia in non-kidney disease patients. Blood.

                National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Hemodialysis.

                National Kidney Foundation. (2024). Hemodialysis.

                National Kidney Foundation. (n.d.). Peritoneal dialysis.

                sanofi-aventis U.S. LLC. (2022). Ferrlecit- sodium ferric gluconate complex injection [package insert]. DailyMed.

                Wang, C., et al. (2015). Comparative risk of anaphylactic reactions associated with intravenous iron products. Journal of the American Medical Association.

                GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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