Monoferric

Manufacturer
Pharmacosmos A/S
Effective date
2020-01-24
Label type
HUMAN PRESCRIPTION DRUG LABEL
Version
2
Source
legacy-cache
Hydrated at
2026-08-01 23:42:36

Label at a glance#

ProductMonoferric
Active ingredientFerric derisomaltose
Label structure19 sections

Indications and uses

Monoferric is indicated for the treatment of iron deficiency anemia (IDA) in adult patients: who have intolerance to oral iron or have had unsatisfactory response to oral iron who have non-hemodialysis dependent chronic kidney disease (NDD-CKD)

Dosage and administration

For patients weighing 50 kg or more: Administer 1,000 mg of Monoferric by intravenous infusion over at least 20 minutes as a single dose. Repeat dose if iron deficiency anemia reoccurs. For patients weighing less than 50 kg: Administer Monoferric as 20 mg/kg actual body weight by intravenous infusion over at least 20 minutes as a single dose. Repeat dose if iron deficiency anemia reoccurs. The dosage of Monoferric...

Storage and handling

Monoferric injection is a sterile, dark brown, non-transparent aqueous solution supplied in cartons as single-dose vials (10 mL, 5mL or 1 mL) in the following configurations: Vial size Number of vials per carton NDC 1,000 mg/10 mL 1 49442-9310-1 500 mg/5 mL 1 49442-9305-1 100 mg/mL 5 49442-9301-2 Store at 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F). See the USP controlled room temp...

Label contents#

Full prescribing information#

1 INDICATIONS AND USAGE

INDICATIONS & USAGE SECTION

Monoferric is indicated for the treatment of iron deficiency anemia (IDA) in adult patients:

  • who have intolerance to oral iron or have had unsatisfactory response to oral iron
  • who have non-hemodialysis dependent chronic kidney disease (NDD-CKD)

2 DOSAGE AND ADMINISTRATION

DOSAGE & ADMINISTRATION SECTION

2.2 Preparation and Administration

SPL UNCLASSIFIED SECTION

Inspect parenteral drug products visually for the absence of particulate matter and discoloration prior to administration. The product contains no preservatives.

Each vial of Monoferric is single-dose only. Discard unused portion.

  • Withdraw the appropriate volume of Monoferric and dilute in 100 mL to 500 mL of 0.9% Sodium Chloride Injection, USP.
  • Final diluted concentration should be more than 1 mg iron/mL.
  • Compatibility of Monoferric with other drugs has not been established. Monoferric should not be mixed with or physically added to solutions containing other drugs.
  • Administer the prepared solution via intravenous infusion over at least 20 minutes.
  • Following dilution with 0.9% Sodium Chloride Injection, USP, Monoferric solution may be stored at room temperature for up to 8 hours.
  • Extravasation of Monoferric may cause brown discoloration at the extravasation site which may be long lasting. Monitor for extravasation. If extravasation occurs, discontinue the Monoferric administration at that site.

3 DOSAGE FORMS AND STRENGTHS

DOSAGE FORMS & STRENGTHS SECTION

Monoferric is a sterile, dark brown, non-transparent aqueous solution available as:

  • Injection: 1,000 mg iron/10 mL (100 mg/mL) single-dose vial
  • Injection: 500 mg iron/5 mL (100 mg/mL) single-dose vial
  • Injection: 100 mg iron/mL single-dose vial

4 CONTRAINDICATIONS

CONTRAINDICATIONS SECTION

Monoferric is contraindicated in patients with a history of serious hypersensitivity to Monoferric or any of its components [see Warnings and Precautions (5.1) , Description (11)]. Reactions have included shock, clinically significant hypotension, loss of consciousness, and/or collapse.

5 WARNINGS AND PRECAUTIONS

WARNINGS AND PRECAUTIONS SECTION

5.1 Hypersensitivity Reactions

SPL UNCLASSIFIED SECTION

Serious hypersensitivity reactions, including anaphylactic-type reactions, some of which have been life-threatening and fatal, have been reported in patients receiving Monoferric. Patients may present with shock, clinically significant hypotension, loss of consciousness, and/or collapse. Monitor patients for signs and symptoms of hypersensitivity during and after Monoferric administration for at least 30 minutes and until clinically stable following completion of the infusion. Only administer Monoferric when personnel and therapies are immediately available for the treatment of serious hypersensitivity reactions. Monoferric is contraindicated in patients with prior serious hypersensitivity reactions to Monoferric or any of its components [see Contraindications (4) ]. In clinical trials in patients with IDA and CKD, serious or severe hypersensitivity were reported in 0.3% (6/2008) of the Monoferric treated subjects. These included 3 events of hypersensitivity in 3 patients; 2 events of infusion-related reactions in 2 patients and 1 event of asthma in one patient.

5.2 Iron Overload

SPL UNCLASSIFIED SECTION

Excessive therapy with parenteral iron can lead to excess iron storage and possibly iatrogenic hemosiderosis or hemochromatosis. Monitor the hematologic response (hemoglobin and hematocrit) and iron parameters (serum ferritin and transferrin saturation) during parenteral iron therapy. Do not administer Monoferric to patients with iron overload [see Overdosage (10)].

6 ADVERSE REACTIONS

ADVERSE REACTIONS SECTION

The following clinically significant adverse reactions are discussed in greater detail in other sections of the labeling:

6.1 Clinical Trials Experience

CLINICAL TRIALS EXPERIENCE SECTION

Because clinical trials are conducted under widely varying conditions, the adverse reaction rates observed cannot be directly compared to rates in other clinical trials and may not reflect the rates observed in clinical practice.

The safety of Monoferric was evaluated in 3008 patients with iron deficiency anemia enrolled in two randomized, actively-controlled trials. Trial 1 enrolled adult patients with iron deficiency anemia with intolerance to oral iron or had an unsatisfactory response to oral iron with a clinical need for repletion of iron stores. Eligible subjects were required to have a baseline hemoglobin of ≤11g/dl, transferrin saturation (TSAT) of less than 20% and serum ferritin level of < 100 ng/ml. Trial 2 enrolled adult patients with non-dialysis dependent chronic kidney disease (CKD) with iron deficiency anemia [see Clinical Studies (14)]. Eligible subjects also had to have serum ferritin ≤200 μg/L or ≤300 ng/mL if TSAT ≤30%.

SPL UNCLASSIFIED SECTION

Trial 1 and Trial 2

In the two randomized, actively-controlled clinical trials, Trials 1 and Trial 2 [see Clinical Studies (14)], patients were randomized in a 2: 1 ratio to intravenous Monoferric (n = 2008) or intravenous iron sucrose (n = 1000) respectively. Monoferric was administered as a single intravenous infusion of 1000 mg diluted in 100 mL 0.9 % sodium chloride and given over approximately 20 minutes (approximately 50 mg iron/min). Iron sucrose was administered as 200 mg undiluted intravenous injections over approximately 2-5 minutes and repeated according to standard practice or physician choice up to a maximum of five times (1000 mg) within the first two weeks starting at baseline.

The data described below reflect exposure to Monoferric in 2008 patients exposed to a 1000 mg single intravenous dose of Monoferric. The mean cumulative intravenous Iron exposure was 984 mg.

Trial 1 included 1483 patients with iron deficiency anemia in the safety analysis that had intolerance to oral iron or have had unsatisfactory response to oral iron or with a clinical need for rapid repletion of iron stores. Trial 2 included 1525 patients in the safety analysis who had non-dialysis dependent CKD. The mean (SD) age of the combined study population was 56.4 (18.3) years. The majority of patients were women (75.7%).

Adverse reactions were reported in 8.6% (172/2008) of patients treated with Monoferric.

Adverse reactions related to treatment and reported by ≥ 1% of the treated patients in the combined analysis of Trial 1 and 2 are listed in Table 1.

Table 1. Adverse Reactions (≥ 1 %) in Patients Receiving Monoferric in Clinical Trials 1 and 2
Monoferric (N = 2008)
N (%)
Iron sucrose (N = 1000)
N (%)
Adverse Reaction
Nausea24 (1.2)11 (1.1)
Rash21 (1)1 (0.1)

Adjudicated serious or severe hypersensitivity reactions were reported in 6/2008 (0.3%) patients in the Monoferric group.

Hypophosphatemia (serum phosphate <2.0 mg/dL) was reported in 3.5% of Monoferric-treated patients in Trials 1 & 2.

6.2 Post-marketing Experience

POSTMARKETING EXPERIENCE SECTION

Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. The following adverse reactions have been most commonly reported from the post-marketing spontaneous reports with Monoferric:

Cardiac disorders: Tachycardia

Gastrointestinal disorders: Abdominal pain, nausea and vomiting, constipation, diarrhea

General disorders and administration site conditions: Fatigue, pyrexia, chest pain, chills, Fishbane reaction, extravasation, influenza like symptoms, injection site reactions

Immune System disorders: Anaphylactic/anaphylactoid reaction, hypersensitivity.

Investigations: Hepatic enzymes increased

Musculoskeletal and connective tissue disorders: Back pain, muscle spasms, arthralgia, myalgia

Nervous system disorders: Dizziness, headache, paresthesia, dysgeusia, seizure, loss of consciousness, syncope

Psychiatric disorders: Anxiety

Respiratory, thoracic and mediastinal disorders: Dyspnea, cough

Skin and subcutaneous tissue disorders: Erythema, urticaria, discoloration skin, rash, pruritus, sweating

Vascular disorders: Hypertension, hypotension, flushing, phlebitis

Extravasation of Monoferric at the injection site that may lead to irritation of the skin and potentially long lasting brown discoloration at the site of injection has also been reported.

8 USE IN SPECIFIC POPULATIONS

USE IN SPECIFIC POPULATIONS SECTION

8.1 Pregnancy

PREGNANCY SECTION

SPL UNCLASSIFIED SECTION

Risk Summary

There are no available data on Monoferric use in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. Published studies on the use of intravenous iron products in pregnant women have not reported an association with adverse developmental outcomes. However, these studies cannot establish or exclude the absence of any drug-related risk during pregnancy because the studies were not designed to assess for the risk of major birth defects (see Data). There are risks to the mother and fetus associated with untreated iron deficiency anemia (IDA) in pregnancy (see Clinical Considerations). Iron complexes have been reported to be teratogenic and embryocidal in non-iron depleted pregnant animals. The findings in animals may be due to iron overload and may not be applicable to patients with iron deficiency. Animal reproduction studies of ferric derisomaltose administered to rats and rabbits during the period of organogenesis caused adverse developmental outcomes including structural abnormalities and embryo-fetal mortality at doses approximately 0.09 and 0.4 times the maximum recommended human dose (MRHD) of 1000 mg, respectively, based on body surface area (see Data).

The estimated background risk of major birth defects and miscarriage for the indicated populations is unknown. Adverse outcomes in pregnancy occur regardless of the health of the mother or the use of medications. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.

SPL UNCLASSIFIED SECTION

Clinical Considerations

SPL UNCLASSIFIED SECTION

Disease-associated maternal and/or embryo/fetal risk

Untreated iron deficiency anemia (IDA) in pregnancy is associated with adverse maternal outcomes such as post-partum anemia. Adverse pregnancy outcomes associated with IDA includes increased risk for preterm delivery and low birth weight.

SPL UNCLASSIFIED SECTION

Data

SPL UNCLASSIFIED SECTION

Animal Data

Iron complexes have been reported to be teratogenic and embryocidal in non-anemic pregnant animals at single doses above 125 mg iron/kg body weight. The highest recommended dose in human clinical use is 20 mg iron/kg body weight.

In a combined fertility and embryo-fetal development study in rats, ferric derisomaltose was administered intravenously to female rats 14 days prior to cohabitation and through gestation day (GD) 17 at doses of 3, 11, and 32 mg Fe/kg/day. The doses of 11 and 32 mg Fe/kg/day (approximately 0.1 and 0.3 times the MRHD of 1000 mg, based on body surface area (BSA)) resulted in an increase in the incidence of skeletal developmental delays.

Ferric derisomaltose was administered intravenously to pregnant rabbits during organogenesis, from GD7 to GD20, at doses of 11, 25 and 43 mg Fe/kg/day. The dose of 43 mg Fe/kg/day (approximately 0.8 times the MRHD of 1000 mg, based on BSA) resulted in increased maternal mortality, abortion, and premature delivery, and increased postimplantation loss. Adverse developmental findings at this dose included fetal mortality, reduced fetal weights, and fetal developmental variations and malformations (including domed head, cleft palate, macroglossia, hydrocephaly, small brain). Fetal malformations and reduced fetal weights were also noted in the 25 mg Fe/kg/day group (approximately 0.5 times the MRHD based on BSA).

8.2 Lactation

LACTATION SECTION

SPL UNCLASSIFIED SECTION

Risk Summary

The available data on the use of Monoferric in lactating women demonstrate that iron is present in breast milk. However, the data do not inform the potential exposure of iron for the breastfed child or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for Monoferric in addition to any potential adverse effects on the breastfed child from the drug or from the underlying maternal condition.

SPL UNCLASSIFIED SECTION

Clinical Considerations

Monitor breastfed children for gastrointestinal toxicity (constipation, diarrhea).

8.4 Pediatric Use

PEDIATRIC USE SECTION

Safety and effectiveness have not been established in pediatric patients.

8.5 Geriatric Use

GERIATRIC USE SECTION

Of the 3934 patients in clinical studies of Monoferric, 29% were 65 years and over, while 13% were 75 years and over. No overall differences in safety or effectiveness were observed between these patients and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out.

10 OVERDOSAGE

OVERDOSAGE SECTION

Excessive dosages of Monoferric may lead to accumulation of iron in storage sites potentially leading to hemosiderosis and hemochromatosis. Avoid use of Monoferric in patients with iron overload [see Warnings and Precautions (5.2)].

11 DESCRIPTION

DESCRIPTION SECTION

Monoferric is an iron replacement product containing ferric derisomaltose for intravenous infusion. Ferric derisomaltose is an iron carbohydrate complex with a matrix structure composed of interchanging layers of ferric hydroxide and the carbohydrate derisomaltose. Derisomaltose consists of linear, hydrogenated isomaltooligosaccharides with an average molecular weight of 1000 Da and a narrow molecular weight distribution that is almost devoid of mono- and disaccharides.

Ferric derisomaltose has an average molecular weight of 155,000 Da and has the following empirical formula:

{FeO(1-3X) (OH)(1+3X) (C6H5O7 3-)X}, (H20)T, -

(C6H10O6)R(-C6H10O5-)Z(C6H13O5)R, (NaCl)Y

X= 0.0311; T = 0.25; R = 0.14; Z = 0.49; Y = 0.14

Iron atoms placed in the electronegative cavities of the 3-D structure between and within the derisomaltose molecules. A schematic representation is presented below

11 DESCRIPTION
11 DESCRIPTION

Monoferric is a sterile, dark brown, non-transparent aqueous solution with pH 5.0-7.0, containing ferric derisomaltose dissolved in water for injections and filled into Type I glass vials.

Each 1 mL of solution contains 100 mg of elemental iron as ferric derisomaltose in water for injection.

12 CLINICAL PHARMACOLOGY

CLINICAL PHARMACOLOGY SECTION

12.1 Mechanism of Action

MECHANISM OF ACTION SECTION

Ferric derisomaltose is a complex of iron (III) hydroxide and derisomaltose, an iron carbohydrate oligosaccharide that releases iron. Iron binds to transferrin for transport to erythroid precursor cells to be incorporated into hemoglobin.

12.2 Pharmacodynamics

PHARMACODYNAMICS SECTION

Serum ferritin peaks approximately 7 days after an intravenous dose of Monoferric and slowly returns to stable levels after about 4 weeks.

SPL UNCLASSIFIED SECTION

Cardiac Electrophysiology

Electrocardiogram (ECG) monitoring for QT prolongation was performed in a sub-study in 35 patients randomized to Monoferric in Trial 1. No large mean increase in QTc (i.e. > 20 ms) interval was detected at the 1000 mg single dose of Monoferric.

12.3 Pharmacokinetics

PHARMACOKINETICS SECTION

The pharmacokinetics of total iron (derisomaltose-bound plus transferrin-bound iron) were evaluated in adult patients with IDA.

After a single dose of Monoferric, maximum concentration (Cmax) and area under the concentration time curve (AUC) of serum total iron increased approximately proportionally over the 100 to 1000 mg dose range. After a 1000 mg single dose, the Cmax and AUCinf of total iron (geometric mean and CV%) of serum total iron were 408 (10.5) μg/mL and 17730 (22.1) μg.h /mL.

SPL UNCLASSIFIED SECTION

Distribution

Circulating iron is removed from the plasma by cells of the reticuloendothelial system. The iron is bound to the available protein moieties to form hemosiderin or ferritin, the physiological storage forms of iron, or to a lesser extent, to the transport molecule transferrin.

SPL UNCLASSIFIED SECTION

Elimination

After a single 1000 mg Monoferric dose, the mean (CV%) half-life of serum total iron is 27 (13.3%) hr.

SPL UNCLASSIFIED SECTION

Excretion

Due to the size of the complex, Monoferric is not excreted via the kidneys. Small quantities of iron are excreted in urine and feces.

13 NONCLINICAL TOXICOLOGY

NONCLINICAL TOXICOLOGY SECTION

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

CARCINOGENESIS & MUTAGENESIS & IMPAIRMENT OF FERTILITY SECTION

Carcinogenicity studies have not been conducted.

Iron oligosaccharide, an earlier formulation of ferric derisomaltose, was not genotoxic in an in vitro bacterial reverse mutation assay, an in vitro chromosomal aberrations test and an in vivo mouse micronucleus assay.

In a combined fertility and embryo-fetal development study in rats, ferric derisomaltose was administered intravenously to male rats 28 days prior to mating and through cohabitation and to female rats 14 days prior to cohabitation and through GD 17. Doses administered were 2, 6, or 19 mg Fe/kg/day in males and 3, 11, or 32 mg Fe/kg/day in females. There was no effect on male or female fertility in rats at up to 19 mg Fe/kg/day (approximately 0.2 times the MRHD of 1000 mg, based on BSA) in males and up to 32 mg Fe/kg/day (approximately 0.3 times the MRHD of 1000 mg based on BSA) in females.

14 CLINICAL STUDIES

CLINICAL STUDIES SECTION

The safety and efficacy of Monoferric for treatment of iron deficiency anemia (IDA) were evaluated in two randomized, open-label, actively-controlled clinical trials performed in a total of 3050 patients with IDA of different etiology. Trial 1 included patients with IDA who had intolerance to oral iron or who had had unsatisfactory response to oral iron or for whom there was a clinical need for rapid repletion of iron stores. Trial 2 included patients with IDA who had non-dialysis dependent chronic kidney disease (NDD-CKD). In these two 8-Week trials, patients were randomized 2:1 to treatment with Monoferric or iron sucrose. Monoferric was intravenously administered as a single dose of 1000 mg.

SPL UNCLASSIFIED SECTION

Iron Deficiency Anemia in Patients Who Had Intolerance to Oral Iron or Who Had Unsatisfactory Response to Oral Iron

In Trial 1 (NCT02940886) 1512 adult patients with IDA caused by different etiologies, who had documented intolerance or lack of response to oral iron or screening hemoglobin (Hb) measurement sufficiently low to require repletion of iron stores were randomized in a 2:1 ratio to treatment with Monoferric or iron sucrose. Adult patients aged ≥18 years with baseline Hb ≤11 g/dL, TSAT <20 %, and s-ferritin <100 ng/mL were eligible for enrollment. The median age of patients was 44 years (range 18-91) and 89 % were women.

The efficacy of Monoferric was established based upon the change in Hb from baseline to week 8. Non-inferiority was demonstrated for change in Hb from baseline to Week 8 (Table 2).

Table 2. Change in Hemoglobin Endpoints in Trial 1
Trial 1Monoferric
N = 1009
Iron sucrose
N = 503
Difference
Mean change in Hb from Baseline to Week 8
Mean* (95% CI), g/dL
(Primary endpoint)
2.49
(2.41;2.56)
2.49
(2.38;2.59)
Estimate†:0.00 (95% CI -0.13;0.13)
Non-inferiority confirmed

* Least square mean

† The estimate is from a mixed model for repeated measures with treatment, week, treatment-by-week and stratum as fixed effects and baseline Hb and baseline-by-week as covariates.

SPL UNCLASSIFIED SECTION

Iron Deficiency Anemia in Patients with Non-Hemodialysis Dependent Chronic Kidney Disease (NDD-CKD)

Trial 2 (NCT02940860) was a randomized controlled trial in 1538 patients with NDD-CKD who were randomized in a 2:1 ratio to treatment with Monoferric or iron sucrose respectively. Adult patients aged ≥18 years with Hb ≤11 g/dL, s-ferritin ≤100 ng/mL (or ≤300 ng/mL if TSAT ≤30%), chronic renal impairment with eGFR between 15-59 mL/min, and either no ESAs or ESAs at a stable dose (+/-20 %) for 4 weeks before randomization were eligible for enrollment. The median age of patients was 69 years (range 25-97), 63% were female.

The efficacy of Monoferric was established based upon the demonstration of non-inferiority for change in hemoglobin from baseline to Week 8 (Table 3).

Table 3. Change in Hemoglobin Endpoints in Trial 2
Trial 2Monoferric
N = 1027
Iron sucrose
N = 511
Difference
Mean change in Hb from Baseline to Week 8
Mean* (95% CI), g/dL
(Primary endpoint)
1.22
(1.14;1.31)
1.14
(1.03;1.26)
Estimate†:0.08 (95% CI -0.06;0.23)
Non-inferiority confirmed

* Least square mean

† The estimate is from a mixed model for repeated measures with treatment, week, treatment-by-week and stratum as fixed effects and baseline Hb and baseline-by-week as covariates.

16 HOW SUPPLIED/STORAGE AND HANDLING

HOW SUPPLIED SECTION

16.1 How Supplied

SPL UNCLASSIFIED SECTION

Monoferric injection is a sterile, dark brown, non-transparent aqueous solution supplied in cartons as single-dose vials (10 mL, 5mL or 1 mL) in the following configurations:

Vial sizeNumber of vials per cartonNDC
1,000 mg/10 mL149442-9310-1
500 mg/5 mL149442-9305-1
100 mg/mL549442-9301-2

16.2 Storage and Handling

STORAGE AND HANDLING SECTION

Store at 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F). See the USP controlled room temperature.

Do not freeze.

When added to an infusion bag containing 0.9% Sodium Chloride Injection, USP, Monoferric solution may be stored for up to 8 hours at room temperature.

17 PATIENT COUNSELING INFORMATION

INFORMATION FOR PATIENTS SECTION

Advise the patient to read the FDA-approved patient labeling (Patient Information).

SPL UNCLASSIFIED SECTION

Prior History of Allergies to Parenteral Iron Products

Question patients regarding any prior history of reactions to parenteral iron products [see Warnings and Precautions (5.1)].

SPL UNCLASSIFIED SECTION

Hypersensitivity Reactions

Advise patients to report any signs and symptoms of hypersensitivity that may develop during and following Monoferric administration, such as rash, itching, dizziness, lightheadedness, swelling and breathing problems [see Warnings and Precautions (5.1)].

SPL UNCLASSIFIED SECTION

Distributed by: Pharmacosmos A/S, Roervangsvej 30, DK-4300 Holbaek, Denmark
Company Registration number (CVR no.): 15517085
VAT no.: DK15517085
Monoferric is manufactured under license from Pharmacosmos A/S, Denmark

SPL PATIENT PACKAGE INSERT SECTION

This Patient Information has been approved by the U.S. Food and Drug Administration.Issued: Month/Year
Patient Information
MONOFERRIC (mon-oh-fer-ik)
(ferric derisomaltose)
Injection
What is MONOFERRIC?
MONOFERRIC is a prescription iron replacement medicine used to treat iron deficiency anemia in adults who have:
  • intolerance to oral iron or who have not responded well to treatment with oral iron
  • non-dialysis dependent chronic kidney disease
It is not known if MONOFERRIC is safe and effective for use in children less than 18 years old.
Who should not receive MONOFERRIC?
Do not
receive MONOFERRIC if you are allergic to ferric derisomaltose or any of the ingredients in MONOFERRIC.
See the end of this leaflet for a complete list of ingredients in MONOFERRIC.
Before receiving MONOFERRIC, tell your healthcare provider about all of your medical conditions, including if you:
  • have had an allergic reaction to IV iron
  • are pregnant or plan to become pregnant. It is not known if MONOFERRIC will harm your unborn baby.
  • are breastfeeding or plan to breastfeed. MONOFERRIC passes into your breast milk and may harm your baby. Talk to your healthcare provider about the best way to feed your baby during treatment with MONOFERRIC.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
Know the medicines you take. Keep a list of them to show to your healthcare provider and pharmacist when you get a new medicine.
How will I receive MONOFERRIC?
MONOFERRIC is given into your vein (intravenously) by your healthcare provider over at least 20 minutes.
What are the possible side effects of MONOFERRIC?
MONOFERRIC may cause serious side effects, including:
  • Allergic (hypersensitivity) reactions. Serious life-threatening allergic reactions have happened in people who receive MONOFERRIC. Symptoms of an allergic reaction including rash, itching, hives, dizziness, lightheadedness, breathing problems and low blood pressure have also happened during treatment with MONOFERRIC. Tell your healthcare provider right away if you develop any of the above symptoms of a serious allergic reaction or if you have ever had any unusual or allergic reaction to any IV iron in the past.
  • Too much iron stored in your body (iron overload). Your healthcare provider should check the iron level in your blood before you start and during treatment with MONOFERRIC.
The most common side effects of MONOFERRIC include rash and nausea.
These are not all the possible side effects of MONOFERRIC.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
General information about MONOFERRIC
Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. You can ask your pharmacist or healthcare provider for information about MONOFERRIC that is written for health professionals.
What are the ingredients in MONOFERRIC?
Active ingredient:
ferric derisomaltose
Inactive ingredients: water for injection
Manufactured under license from Pharmacosmos A/S, Denmark
Distributed by: Pharmacosmos A/S, Roervangsvej 30, DK-4300 Holbaek, Denmark
Company Registration number (CVR no.): 15517085 VAT no.: DK15517085
For more information go to www.pharmacosmos.com or call 1-888-828-0655.

PRINCIPAL DISPLAY PANEL - 100 mg/mL Vial Box

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL

PHARMACOSMOS

MonoFerric®
(ferric derisomaltose) injection

100 mg / mL

FOR INTRAVENOUS INFUSION AFTER DILUTION
Discard unused portion
Sterile
Rx Only

5 x 1 mL Single-Dose Vials

PRINCIPAL DISPLAY PANEL - 100 mg/mL Vial Box
PRINCIPAL DISPLAY PANEL - 100 mg/mL Vial Box

PRINCIPAL DISPLAY PANEL - 500 mg/5 mL Vial Box

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL

MonoFerric®
(ferric derisomaltose)
injection

500 mg / 5 mL
(100 mg/mL)

FOR INTRAVENOUS INFUSION
AFTER DILUTION
One single-dose vial
Discard unused portion
Sterile

Rx Only

PRINCIPAL DISPLAY PANEL - 500 mg/5 mL Vial Box
PRINCIPAL DISPLAY PANEL - 500 mg/5 mL Vial Box

PRINCIPAL DISPLAY PANEL - 1000 mg/10 mL Vial Box

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL

MonoFerric®
(ferric derisomaltose)
injection

1000 mg / 10 mL
(100 mg/mL)

FOR INTRAVENOUS INFUSION
AFTER DILUTION
One single-dose vial
Discard unused portion
Sterile

Rx Only

PRINCIPAL DISPLAY PANEL - 1000 mg/10 mL Vial Box
PRINCIPAL DISPLAY PANEL - 1000 mg/10 mL Vial Box

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Product NDC, Package NDC table
Product NDCPackage NDC
49442-930149442-9301-2
49442-930549442-9305-1
49442-931049442-9310-1

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Application-product, Trade name, Ingredient table
Application-productTrade nameIngredientStrengthDosage form / routeTE codesRLD / RSApproval date
N208171-001MONOFERRICFERRIC DERISOMALTOSE100MG/ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-16
N208171-002MONOFERRICFERRIC DERISOMALTOSE500MG/5ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-16
N208171-003MONOFERRICFERRIC DERISOMALTOSE1GM/10ML (100MG/ML)SOLUTION / INTRAVENOUSRLD, RS2020-01-16

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Application-productPatentExpirationUse codeCoverage / statusSubmission date
N208171-001104148312029-03-25Drug substance, Drug product2020-02-14
N208171-001118515042029-03-25Drug substance, Drug product2024-01-11
N208171-001120309622029-03-25Drug substance, Drug product2024-08-05
N208171-00188153012029-08-14U-2734Drug substance, Drug product2020-02-14
N208171-001116334892036-06-22U-35942023-05-24
N208171-002104148312029-03-25Drug substance, Drug product2020-02-14
N208171-002118515042029-03-25Drug substance, Drug product2024-01-11
N208171-002120309622029-03-25Drug substance, Drug product2024-08-05
N208171-00288153012029-08-14U-2734Drug substance, Drug product2020-02-14
N208171-002116334892036-06-22U-35942023-05-24
N208171-003104148312029-03-25Drug substance, Drug product2020-02-14
N208171-003118515042029-03-25Drug substance, Drug product2024-01-11
N208171-003120309622029-03-25Drug substance, Drug product2024-08-05
N208171-00388153012029-08-14U-2734Drug substance, Drug product2020-02-14
N208171-003116334892036-06-22U-35942023-05-24

Observed Orange Book product history#

Observed FDA ZIP history: Each table is queried independently by exact application/product key from successfully parsed Orange Book snapshots. Capture times identify archived source observations; absence or a change between snapshots is not inferred. FDA publication files that were not recoverable as structured ZIP data are not represented as states.

Product history page 1 of 3 · 117 observed states.

Captured, Edition, Application-product table
CapturedEditionApplication-productTrade nameStrengthDosage form / routeProduct TE source textRLD / RSApproval dateSource SHA-256
2026-09-14 22:38:342026-08N208171-001MONOFERRIC100MG/ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-1684e616aacf4f…
2026-09-14 22:38:342026-08N208171-002MONOFERRIC500MG/5ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-1684e616aacf4f…
2026-09-14 22:38:342026-08N208171-003MONOFERRIC1GM/10ML (100MG/ML)SOLUTION / INTRAVENOUSRLD, RS2020-01-1684e616aacf4f…
2026-08-18 06:07:402026-07N208171-001MONOFERRIC100MG/ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-16caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-002MONOFERRIC500MG/5ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-16caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-003MONOFERRIC1GM/10ML (100MG/ML)SOLUTION / INTRAVENOUSRLD, RS2020-01-16caaa826d4ba7…
2026-02-19 14:30 UTC2026-02N208171-001MONOFERRIC100MG/ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-16011fe1cb6892…
2026-02-19 14:30 UTC2026-02N208171-002MONOFERRIC500MG/5ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-16011fe1cb6892…
2026-02-19 14:30 UTC2026-02N208171-003MONOFERRIC1GM/10ML (100MG/ML)SOLUTION / INTRAVENOUSRLD, RS2020-01-16011fe1cb6892…
2025-12-14 10:44 UTC · 2 captures of this ZIP2025-12N208171-001MONOFERRIC100MG/ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-1631067a03dcf5…
2025-12-14 10:44 UTC · 2 captures of this ZIP2025-12N208171-002MONOFERRIC500MG/5ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-1631067a03dcf5…
2025-12-14 10:44 UTC · 2 captures of this ZIP2025-12N208171-003MONOFERRIC1GM/10ML (100MG/ML)SOLUTION / INTRAVENOUSRLD, RS2020-01-1631067a03dcf5…
2025-08-23 18:47 UTC2025-08N208171-001MONOFERRIC100MG/ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-166a471c1ec25d…
2025-08-23 18:47 UTC2025-08N208171-002MONOFERRIC500MG/5ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-166a471c1ec25d…
2025-08-23 18:47 UTC2025-08N208171-003MONOFERRIC1GM/10ML (100MG/ML)SOLUTION / INTRAVENOUSRLD, RS2020-01-166a471c1ec25d…
2025-03-22 03:13 UTC · 3 captures of this ZIP2025-03N208171-001MONOFERRIC100MG/ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-16fd3edfee7708…
2025-03-22 03:13 UTC · 3 captures of this ZIP2025-03N208171-002MONOFERRIC500MG/5ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-16fd3edfee7708…
2025-03-22 03:13 UTC · 3 captures of this ZIP2025-03N208171-003MONOFERRIC1GM/10ML (100MG/ML)SOLUTION / INTRAVENOUSRLD, RS2020-01-16fd3edfee7708…
2025-02-26 10:13 UTC · 3 captures of this ZIP2025-02N208171-001MONOFERRIC100MG/ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-16b8a1b40f171c…
2025-02-26 10:13 UTC · 3 captures of this ZIP2025-02N208171-002MONOFERRIC500MG/5ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-16b8a1b40f171c…
2025-02-26 10:13 UTC · 3 captures of this ZIP2025-02N208171-003MONOFERRIC1GM/10ML (100MG/ML)SOLUTION / INTRAVENOUSRLD, RS2020-01-16b8a1b40f171c…
2025-01-19 17:59 UTC · 7 captures of this ZIP2025-01N208171-001MONOFERRIC100MG/ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-1603ed91905a0d…
2025-01-19 17:59 UTC · 7 captures of this ZIP2025-01N208171-002MONOFERRIC500MG/5ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-1603ed91905a0d…
2025-01-19 17:59 UTC · 7 captures of this ZIP2025-01N208171-003MONOFERRIC1GM/10ML (100MG/ML)SOLUTION / INTRAVENOUSRLD, RS2020-01-1603ed91905a0d…
2024-12-13 21:23 UTC · 2 captures of this ZIP2024-12N208171-001MONOFERRIC100MG/ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-162680178bc6a6…
2024-12-13 21:23 UTC · 2 captures of this ZIP2024-12N208171-002MONOFERRIC500MG/5ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-162680178bc6a6…
2024-12-13 21:23 UTC · 2 captures of this ZIP2024-12N208171-003MONOFERRIC1GM/10ML (100MG/ML)SOLUTION / INTRAVENOUSRLD, RS2020-01-162680178bc6a6…
2024-09-14 05:58 UTC · 2 captures of this ZIP2024-09N208171-001MONOFERRIC100MG/ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-165bbf6a4d5a75…
2024-09-14 05:58 UTC · 2 captures of this ZIP2024-09N208171-002MONOFERRIC500MG/5ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-165bbf6a4d5a75…
2024-09-14 05:58 UTC · 2 captures of this ZIP2024-09N208171-003MONOFERRIC1GM/10ML (100MG/ML)SOLUTION / INTRAVENOUSRLD, RS2020-01-165bbf6a4d5a75…
2024-11-08 22:44 UTC · 3 captures of this ZIP2024-11N208171-001MONOFERRIC100MG/ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-16d8e5a09893c0…
2024-11-08 22:44 UTC · 3 captures of this ZIP2024-11N208171-002MONOFERRIC500MG/5ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-16d8e5a09893c0…
2024-11-08 22:44 UTC · 3 captures of this ZIP2024-11N208171-003MONOFERRIC1GM/10ML (100MG/ML)SOLUTION / INTRAVENOUSRLD, RS2020-01-16d8e5a09893c0…
2024-10-29 15:01 UTC2024-10N208171-001MONOFERRIC100MG/ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-16d06236e962d9…
2024-10-29 15:01 UTC2024-10N208171-002MONOFERRIC500MG/5ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-16d06236e962d9…
2024-10-29 15:01 UTC2024-10N208171-003MONOFERRIC1GM/10ML (100MG/ML)SOLUTION / INTRAVENOUSRLD, RS2020-01-16d06236e962d9…
2024-08-13 05:28 UTC · 3 captures of this ZIP2024-08N208171-001MONOFERRIC100MG/ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-1679d66fd596c7…
2024-08-13 05:28 UTC · 3 captures of this ZIP2024-08N208171-002MONOFERRIC500MG/5ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-1679d66fd596c7…
2024-08-13 05:28 UTC · 3 captures of this ZIP2024-08N208171-003MONOFERRIC1GM/10ML (100MG/ML)SOLUTION / INTRAVENOUSRLD, RS2020-01-1679d66fd596c7…
2024-07-13 05:37 UTC · 2 captures of this ZIP2024-07N208171-001MONOFERRIC100MG/ML (100MG/ML)SOLUTION / INTRAVENOUSRLD2020-01-16301d65b070ca…

Observed Orange Book patent history#

Patent history page 1 of 10 · 386 observed states.

Captured, Edition, Application-product table
CapturedEditionApplication-productPatentExpirationUse codeCoverage / statusSubmission dateSource SHA-256
2026-09-14 22:38:342026-08N208171-001104148312029-03-25Drug substance, Drug product2020-02-1484e616aacf4f…
2026-09-14 22:38:342026-08N208171-001118515042029-03-25Drug substance, Drug product2024-01-1184e616aacf4f…
2026-09-14 22:38:342026-08N208171-001120309622029-03-25Drug substance, Drug product2024-08-0584e616aacf4f…
2026-09-14 22:38:342026-08N208171-00188153012029-08-14U-2734Drug substance, Drug product2020-02-1484e616aacf4f…
2026-09-14 22:38:342026-08N208171-001116334892036-06-22U-35942023-05-2484e616aacf4f…
2026-09-14 22:38:342026-08N208171-002104148312029-03-25Drug substance, Drug product2020-02-1484e616aacf4f…
2026-09-14 22:38:342026-08N208171-002118515042029-03-25Drug substance, Drug product2024-01-1184e616aacf4f…
2026-09-14 22:38:342026-08N208171-002120309622029-03-25Drug substance, Drug product2024-08-0584e616aacf4f…
2026-09-14 22:38:342026-08N208171-00288153012029-08-14U-2734Drug substance, Drug product2020-02-1484e616aacf4f…
2026-09-14 22:38:342026-08N208171-002116334892036-06-22U-35942023-05-2484e616aacf4f…
2026-09-14 22:38:342026-08N208171-003104148312029-03-25Drug substance, Drug product2020-02-1484e616aacf4f…
2026-09-14 22:38:342026-08N208171-003118515042029-03-25Drug substance, Drug product2024-01-1184e616aacf4f…
2026-09-14 22:38:342026-08N208171-003120309622029-03-25Drug substance, Drug product2024-08-0584e616aacf4f…
2026-09-14 22:38:342026-08N208171-00388153012029-08-14U-2734Drug substance, Drug product2020-02-1484e616aacf4f…
2026-09-14 22:38:342026-08N208171-003116334892036-06-22U-35942023-05-2484e616aacf4f…
2026-08-18 06:07:402026-07N208171-001104148312029-03-25Drug substance, Drug product2020-02-14caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-001118515042029-03-25Drug substance, Drug product2024-01-11caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-001120309622029-03-25Drug substance, Drug product2024-08-05caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-00188153012029-08-14U-2734Drug substance, Drug product2020-02-14caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-001116334892036-06-22U-35942023-05-24caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-002104148312029-03-25Drug substance, Drug product2020-02-14caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-002118515042029-03-25Drug substance, Drug product2024-01-11caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-002120309622029-03-25Drug substance, Drug product2024-08-05caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-00288153012029-08-14U-2734Drug substance, Drug product2020-02-14caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-002116334892036-06-22U-35942023-05-24caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-003104148312029-03-25Drug substance, Drug product2020-02-14caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-003118515042029-03-25Drug substance, Drug product2024-01-11caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-003120309622029-03-25Drug substance, Drug product2024-08-05caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-00388153012029-08-14U-2734Drug substance, Drug product2020-02-14caaa826d4ba7…
2026-08-18 06:07:402026-07N208171-003116334892036-06-22U-35942023-05-24caaa826d4ba7…
2026-02-19 14:30 UTC2026-02N208171-001104148312029-03-25Drug substance, Drug product2020-02-14011fe1cb6892…
2026-02-19 14:30 UTC2026-02N208171-001118515042029-03-25Drug substance, Drug product2024-01-11011fe1cb6892…
2026-02-19 14:30 UTC2026-02N208171-001120309622029-03-25Drug substance, Drug product2024-08-05011fe1cb6892…
2026-02-19 14:30 UTC2026-02N208171-00188153012029-08-14U-2734Drug substance, Drug product2020-02-14011fe1cb6892…
2026-02-19 14:30 UTC2026-02N208171-001116334892036-06-22U-35942023-05-24011fe1cb6892…
2026-02-19 14:30 UTC2026-02N208171-002104148312029-03-25Drug substance, Drug product2020-02-14011fe1cb6892…
2026-02-19 14:30 UTC2026-02N208171-002118515042029-03-25Drug substance, Drug product2024-01-11011fe1cb6892…
2026-02-19 14:30 UTC2026-02N208171-002120309622029-03-25Drug substance, Drug product2024-08-05011fe1cb6892…
2026-02-19 14:30 UTC2026-02N208171-00288153012029-08-14U-2734Drug substance, Drug product2020-02-14011fe1cb6892…
2026-02-19 14:30 UTC2026-02N208171-002116334892036-06-22U-35942023-05-24011fe1cb6892…

openFDA label cross-check#

OpenFDA label data provides additional search and identifier links. DailyMed’s Structured Product Label is the canonical label on FDA.report. Matching records are deduplicated before they are shown below.

Matched openFDA labels page 1 of 1 · 1 matching rows.

Brand, Generic, Manufacturer table
BrandGenericManufacturerSPL set IDEffective dateAvailable safety fieldsJoin
ab9863f8-3910-570e-e053-2a95a90a9180f94f86d2-8319-4055-ac88-8814aa3c2eeb2020-07-29Warnings, Adverse reactionsExact identifier
spl set id: f94f86d2-8319-4055-ac88-8814aa3c2eeb

Reported adverse events (FAERS/openFDA)#

Adverse event summaries are temporarily unavailable. Other product information remains available.