Injectafer
Injectafer (ferric carboxymaltose) is an iron supplement that's given as an infusion through the vein. It treats iron-deficiency anemia in people who can't take iron supplements by mouth and in certain adults with chronic kidney disease (CKD). Injectafer (ferric carboxymaltose) can also treat iron deficiency in certain adults with heart failure. This medication is given by a healthcare provider, typically as one or two infusions. While the medication helps replace iron in your blood, it can cause side effects like nausea and flushing of the skin.
What is Injectafer (ferric carboxymaltose)?
What is Injectafer (ferric carboxymaltose) used for?
Iron-deficiency anemia (anemia due to low iron levels) in:
People 1 year of age and older who either can't take or don't respond well to iron supplements that are taken by mouth
Adults who have chronic kidney disease (CKD) and who aren't on dialysis
Iron deficiency (low iron levels) in certain adults with heart failure
How Injectafer (ferric carboxymaltose) works
Injectafer (ferric carboxymaltose) is an iron supplement that helps replenish your body with iron. Iron is an important mineral for your health. Your body needs iron to make hemoglobin, a protein in your red blood cells that helps carry and deliver oxygen through your body.
Drug Facts
More on Injectafer (ferric carboxymaltose) essentials
What are the side effects of Injectafer (ferric carboxymaltose)?
Common Side Effects
- Nausea (7%)
- High blood pressure (4%)
- Flushing of the skin (up to 4%)
- Injection site reactions (pain, irritation, redness, bruising, itching, swelling, or redness; 3%)
- Dizziness (2%)
- Vomiting (2%)
- Low blood phosphate levels (2%)
Other Side Effects
- Constipation
- Changes in taste
- Headache
- Low blood pressure
- Rash
Serious Side Effects
- Serious allergic reactions: rash, hives, shortness of breath, low blood pressure, fast heartbeat, dizziness, flushing (feeling warm all of a sudden)
- Low blood phosphate levels: seizures, muscle pain or weakness, general weakness or numbness, bone pain, weak bones, bone fracture
- Extremely high blood pressure: chest pain, shortness of breath, severe headache, changes in vision
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:
Less common
Blurred vision
confusion
dizziness
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
feeling of warmth
headache
nervousness
pounding in the ears
redness of the face, neck, arms, and occasionally, upper chest
slow or fast heartbeat
sweating
unusual tiredness or weakness
Incidence not known
Chest discomfort
chills
difficult or labored breathing
difficulty swallowing
fainting
fast, pounding, or irregular heartbeat or pulse
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
skin rash
tightness in the chest
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
Less common
Change in taste
discoloration at the injection site
loss of taste
vomiting
Rare
Abdominal or stomach pain
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
difficulty having a bowel movement (stool)
pain or irritation at the injection site
Incidence not known
Back pain
difficulty with moving
hives or welts
muscle pain or stiffness
pain in the joints
redness of the skin
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 of Injectafer (ferric carboxymaltose)
Pros
Given as 1 or 2 infusions for most people
Infusion takes about 15 minutes
Can use for children as young as 1 year old who can't take iron supplements by mouth
Can help improve ability to exercise in adults with heart failure and low iron levels
Cons
Must be injected into the vein by a healthcare provider
Must be given at an infusion center or provider's office
Brand-name medication only
Pharmacist tips for Injectafer (ferric carboxymaltose)
Mark your appointment(s) on your calendar to help you remember when to visit your provider's office or infusion center to get your infusion of Injectafer (ferric carboxymaltose).
To prepare for your infusion, make sure to wear comfortable clothes. You can eat as you usually do; there are no food restrictions or requirements that you need to follow.
The infusion typically takes about 15 minutes.
Your provider will ask you to stay at the clinic or infusion center for at least 30 more minutes after your infusion. This is so your provider can continue to watch out for any serious reactions that you might have from Injectafer (ferric carboxymaltose).
Make sure you get your blood work) done on time if your provider instructs you to. The results from these blood tests help your provider check your iron levels during treatment with Injectafer (ferric carboxymaltose).
It's generally recommended that you follow an iron-rich diet to help restore your iron levels. Foods that are high in iron include red meats (like beef or pork), dark leafy greens (like broccoli or spinach), beans, and iron-enriched pasta and rice.
Frequently asked questions about Injectafer (ferric carboxymaltose)
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What are the risks and warnings for Injectafer (ferric carboxymaltose)?
Injectafer (ferric carboxymaltose) 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.
Allergic reactions
Risk factors: History of allergic reaction to another IV iron product
Injectafer (ferric carboxymaltose) can cause serious allergic reactions that can be life-threatening, including anaphylaxis. Symptoms of an allergic reaction can include rash, hives, shortness of breath, low blood pressure, fast heartbeat, dizziness, and flushing. Some people have also passed out or collapsed. Your provider will keep an eye on you to check for allergic reactions during your infusion and for at least 30 minutes after the infusion. Seek medical help right away if you experience any symptoms of an allergic reaction.
Low blood phosphate levels
Risk factors: History of stomach problems related to poor absorption of nutrients | Inflammatory bowel disease (IBD) | Taking or have taken medications that can affect kidney function | Low vitamin D levels | Poor nutrition
Injectafer (ferric carboxymaltose) can lower your blood phosphate levels. Your risk is higher if you have a stomach problem that doesn't allow your body to absorb vitamins and nutrients very well or vitamin D deficiency. While most people don't have symptoms of low phosphate levels, some might have muscle pain or weakness, general weakness or numbness, weak bones, or bone fractures.
Before you start a course of treatment of Injectafer (ferric carboxymaltose), your provider will order a blood test to check your phosphate levels. Then, your provider might periodically check your blood phosphate levels while you're taking the medication and give you appropriate treatment if needed. Most times, phosphate levels go back to normal within 3 months.
High blood pressure
Injectafer (ferric carboxymaltose) can raise your blood pressure. In clinical studies, elevations in blood pressure typically happened right after the infusion and went away within 30 minutes. High blood pressure sometimes occurred with flushing of the face, dizziness, or nausea. Let your provider know if you experience any of these symptoms or other symptoms of very high blood pressure, such as chest pain, shortness of breath, severe headache, and changes in vision.
Injectafer (ferric carboxymaltose) dosage forms
Typical dosing for Injectafer (ferric carboxymaltose)
Iron-deficiency anemia (IDA)
For people weighing 110 pounds (50 kg) or more: Each treatment course is typically a total dose of 1,500 mg that's injected into the vein (intravenously or IV). This total dose is given as two 750-mg injections separated by at least 1 week. Alternatively, adults can receive a one-time injection of 15 mg/kg of body weight (up to a maximum of 1,000 mg) for their treatment course.
For people weighing less than 110 pounds (50 kg): Each treatment course is a total dose of 15 mg/kg of body weight, given IV as two doses separated by at least 1 week.
Iron-deficiency in adults with heart failure
The dosage and number of infusions you need depend on your weight and your hemoglobin levels. Ask your provider how many infusions you need.
For adults weighing 154 pounds (70 kg) or more: The typical dose is 500 mg or 1,000 mg given IV on day 1 of treatment. If you need a second infusion, it will be given 6 weeks later at a dose of 500 mg.
For adults weighing less than 154 pounds (70 kg): The typical dose is 500 mg or 1,000 mg given IV on day 1 of treatment. If you need a second infusion, it will be given 6 weeks later at a dose of either 500 mg or 1,000 mg.
Your provider might give you 3 additional doses (a 500-mg dose given every 12 weeks). This depends on your blood test results that give your provider information about your iron levels.
You might need to repeat a treatment course of Injectafer (ferric carboxymaltose) if your IDA or iron deficiency comes back.
Interactions between Injectafer (ferric carboxymaltose) and other drugs
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.
- Delafloxacin
- Minocycline
- Mycophenolic Acid
- Zinc
What are alternatives to Injectafer (ferric carboxymaltose)?
Iron-deficiency anemia (anemia due to low iron levels) in:
People 1 year of age and older who either can't take or don't respond well to iron supplements that are taken by mouth
Adults who have chronic kidney disease (CKD) and who aren't on dialysis
Iron deficiency (low iron levels) in certain adults with heart failure
Iron deficiency (including iron-deficiency anemia) in people who either have already tried or can't take oral iron supplements
Iron-deficiency anemia (anemia due to low iron levels) in adults who either have already tried or can't take iron supplements in pill form
Iron-deficiency anemia in adults with chronic kidney disease (CKD)and aren't on hemodialysis
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References
Best studies we foundAmerican Regent, Inc. (2023). Injectafer- ferric carboxymaltose injection injection, solution; ferric carboxymaltose injection, solution [package insert]. DailyMed.
American Regent, Inc. (2022). Preparing for your Injectafer infusion.
Garzon, S., et al. (2020). Iron deficiency anemia in pregnancy: Novel approaches for an old problem. Oman Medical Journal.
MedlinePlus. (2021). Iron tests.
MedlinePlus. (2022). Hemoglobin.
National Institutes of Health, Office of Dietary Supplements. (2023). Iron: Fact sheet for consumers.
National Kidney Foundation. (n.d.). Dialysis.
National Kidney Foundation. (n.d.). Phosphorus and your diet.
Ponikowski, P., et al. (2015). Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. European Heart Journal.
Sharma, S., et al. (2022). Hypophosphatemia. StatPearls.
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