General

Pronunciation:
fe-rik mawl-tol

Trade Name(s)

• Accrufer

Ther. Class.

antianemics

Pharm. Class.

iron supplements

Indications

Iron deficiency anemia.

Action

Enters the bloodstream and is transported to the organs of the reticuloendothelial system (liver, spleen, bone marrow) where it becomes part of iron stores.

Therapeutic Effect(s):

Resolution of iron deficiency anemia.

Pharmacokinetics

Absorption: Dissociates in the GI tract allowing iron and maltol to be absorbed separately; food ↓ iron absorption.

Distribution: Unknown.

Metabolism and Excretion: Maltol is metabolized in liver via glucuronidation by UGT1A6 and via sulfation. Maltol is primarily excreted in urine as glucuronide metabolite.

Half-life: Unknown.

TIME/ACTION PROFILE (plasma concentrations)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity;
• Iron overload syndromes including hemochromatosis;
• Recipient of multiple blood transfusions (↑ risk of iron overload);
• Concurrent use of IV iron (↑ risk of iron overload);
• Active flare of inflammatory bowel disease (may ↑ risk of inflammation in GI tract).

Use Cautiously in:

• OB:  Not absorbed systemically as an intact complex; not expected to result in fetal exposure;
• Lactation: Not absorbed systemically as an intact complex; not expected to result in exposure to infant;
• Pedi:   Safety and effectiveness not established in children.

Adverse Reactions/Side Effects

GI: abdominal pain, constipation, diarrhea, discolored feces, flatulence, nausea, vomiting

Hemat: iron overload

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

May ↓ the absorption of  ciprofloxacin,  doxycycline,  ethinyl estradiol, and  mycophenolate mofetil ; separate administration by ≥4 hr.

Route/Dosage

PO (Adults): 30 mg twice daily for ≥12 wk (until ferritin levels normal).

Availability

Capsules: 30 mg

Assessment

• Assess nutritional status and dietary history to determine need for patient teaching.

Lab Test Considerations:

Assess iron parameters before starting and periodically during therapy.

Implementation

• PO Administer twice daily, 1 hr before or 2 hr after a meal.  DNC: Swallow capsules whole; do not open, break, or chew.  

Patient/Family Teaching

• Instruct patient to take ferric maltol as directed. Advise patient to read  Patient Information  before starting therapy and with each Rx refill in case of changes.
• Advise patient that ferric maltol may cause dark stools; this is normal for medications containing iron.
• Inform patient that ferric maltol may cause diarrhea, constipation, gas, stomach pain, nausea, vomiting, bloating. Notify health care professional if GI symptoms become severe or persistent.
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications. Medications may need to be taken separately from ferric maltol.
• Advise patient to store ferric maltol out of reach of children; if accidentally ingested by a child seek immediate medical attention.
• Rep:  Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Resolution of iron deficiency anemia.