Health Guide

Ferric citrate

Ferric Citrate is a unique form of iron that serves a dual purpose: it acts as a dietary iron supplement to treat deficiency, and it is FDA-approved to control serum phosphorus levels in patients with chronic kidney disease (CKD). Chemically, it combines elemental 'ferric' iron (Fe3+) with citrate, a salt of citric acid. This combination improves the stability and absorption of iron compared to older forms. For the everyday person, it is primarily known as a highly effective, non-calcium-based phosphate binder that helps manage mineral balance without contributing to calcium overload.

Evidence BasedDietary Supplement

VERIFIED SOURCE

Bio-Activity Analysis

Phosphate Binding Efficacy (In Vitro)

SCIENTIFIC DATA VISUALIZATION

Y-Axis

Binding Capacity (mg/g)

Binder Type →

Health Benefits & Sources

Why You Need It

Combats Iron Deficiency Anemia: It provides a bioavailable source of iron to restore hemoglobin levels, reducing fatigue and weakness.
Phosphorus Control: It binds to dietary phosphate in the gut, preventing its absorption. This is critical for kidney patients to protect bones and blood vessels.
Reduces Calcium Load: Unlike traditional phosphate binders (like calcium acetate), Ferric Citrate does not add calcium to the body, lowering the risk of vascular calcification.

Deep Dive

Ferric Citrate works by a simple chemical exchange in your digestive tract. The citrate portion helps keep the iron soluble, while the ferric iron binds to phosphate from the food you eat. By binding this phosphate, the compound turns it into an insoluble complex that passes out of the body in stool rather than entering the bloodstream. This process mimics the body's natural regulation of minerals. For those not suffering from kidney disease, the iron is absorbed to replenish iron stores, while the citrate supports energy metabolism.

Natural Food Sources

Unlike some nutrients, Ferric Citrate is not found naturally in whole foods as a standalone compound. It is a synthetic modification designed for medical use. However, you can support your body's iron and citrate levels through diet:

Food	Amount	% DV (Approximate)
Red Meat (Beef)	High	15-20% per 3oz
Spinach (Cooked)	Medium	10-15% per 1/2 cup
Lentils	Medium	15-20% per 1/2 cup
Citrus Fruits	Variable	High in Citrate
Fortified Cereals	High	25-50% per serving

Supplementation

Dosage: Prescription doses typically range from 1 to 12 grams per day, divided into multiple doses with meals. Usage: It must be taken with meals so it can bind to the phosphate in your food. Do not take it on an empty stomach if you are taking it for phosphorus control. Who Should Take It: Primarily individuals diagnosed with chronic kidney disease (CKD) requiring phosphate control, or those with diagnosed iron-deficiency anemia who tolerate other iron supplements poorly.

Top Food Sources

Red Meat

Heme iron source (best absorption)

Spinach/Kale

Non-heme iron (pair with Vitamin C)

Lentils/Beans

High iron and fiber

Citrus Fruits

Source of citric acid

Fortified Grains

Check labels for 100% DV iron

Frequently Asked Questions

It is a specific type of iron supplement, but it is chemically distinct from common ferrous sulfate. It is unique because it is also a phosphate binder, making it a dual-purpose medication often prescribed for kidney patients.

Actually, Ferric Citrate tends to cause diarrhea rather than constipation. This is due to the osmotic effect of the citrate and iron salts drawing water into the bowel.

This is a normal and expected side effect called melena. It is caused by the unabsorbed iron reacting with sulfur in your gut. It does not indicate bleeding.

Iron needs increase during pregnancy, but Ferric Citrate is a prescription drug. You should consult your OB-GYN, as standard prenatal iron is usually preferred unless specific medical conditions exist.

Safety & Side Effects

Safety & Interactions

Who should avoid it?

Individuals with hemochromatosis (iron overload disorder) or other disorders of iron metabolism.
Patients with active inflammatory bowel disease or intestinal obstruction.

Potential Side Effects:

Common: Gastrointestinal upset is the most frequent side effect, including diarrhea, nausea, and abdominal pain. The stool may appear dark green or black.
Serious: Iron toxicity can occur if taken in excess.

Interactions:

Antibiotics (Tetracyclines, Fluoroquinolones): Take Ferric Citrate at least 2 hours before or 4 hours after these antibiotics to prevent reduced absorption of the medication.
Levothyroxine: Separate administration by at least 4 hours.

Scientific References

[1]U.S. Pharmaceutical and Medical Device Safety: Ferric Citrate (Auryxia) FDA Approval History.
[2]Journal of Renal Nutrition: 'Ferric Citrate as an Iron Supplement and Phosphate Binder'.
[3]Clinical Journal of the American Society of Nephrology: Efficacy and Safety of Ferric Citrate.