Prescribing and dosing patterns of ferric carboxymaltose for iron deficiency anemia: a real-world study from Saudi Arabia.

INTRODUCTION: Ferric carboxymaltose (FCM) is increasingly used for iron deficiency anemia, yet real-world prescribing patterns and dosing appropriateness remain poorly characterized, particularly in regions with high anemia prevalence. This study evaluated FCM prescribing patterns, dosing appropriateness, and associated clinical and financial implications at a Saudi tertiary hospital. METHODS: This retrospective observational study examined adult patients who received FCM at a tertiary care general hospital in Saudi Arabia over a 6-month period. Dosing appropriateness was determined by comparing prescribed cumulative doses (PCD) with calculated cumulative doses (CCD) per the Summary of Product Characteristics. Hemoglobin response and financial impact were also assessed. RESULTS: Of 182 patients treated with FCM, 79 met the inclusion criteria (97.5% female; mean age 34.6 ± 8.3 years). Overall, 82% of prescriptions exhibited an inappropriate cumulative dose, with 88% subtherapeutic. Mean PCD (1,118 ± 492 mg) was substantially lower than CCD (1,640 ± 438 mg), a mean under-dosing gap of 522.6 mg (p < 0.001). In addition, 63.3% of patients were iron-therapy naïve. Hemoglobin response was reduced (1.35 g/dL rise) versus suitably dosed populations (2.5-3.0 g/dL). No predictor of inappropriate dosing reached significance. Projected complication costs (171,055 SAR) substantially exceeded apparent medication savings (19,599 SAR). DISCUSSION: Widespread subtherapeutic FCM dosing compromises therapeutic outcomes and increases downstream costs. Implementation of electronic clinical decision support and standardized dosing protocols is urgently needed to optimize intravenous iron utilization.