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Oral iron chelator Pregnancy: No clinical data on exposed pregnancies; animal studies showed reproductive toxicity at maternally toxic doses. Not recommended during pregnancy unless clearly necessary. May reduce efficacy of hormonal contraceptives. Breast-feeding not recommended.

Deferasirox

Brand names: Exjade, Jadenu

Deferasirox is an orally active iron-chelating agent used to treat chronic iron overload, typically from repeated blood transfusions in conditions such as thalassaemia and other transfusion-dependent anaemias.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Transfusional iron overload: 14 mg/kg/day (starting dose). Non-transfusion-dependent thalassaemia (NTDT): 7 mg/kg/day (starting dose)
Route: Oral
Frequency: Once daily
Max: 28 mg/kg/day (transfusional iron overload); doses above 28 mg/kg/day are not recommended
Doses are for deferasirox FILM-COATED tablets (a 30% lower dose than dispersible tablets). Treatment initiated and maintained by physicians experienced in chronic iron overload. Transfusional iron overload: start 14 mg/kg/day after ~20 units (about 100 ml/kg) of packed red blood cells or when chronic iron overload is evident (e.g. serum ferritin >1,000 microg/l); alternative starting doses 7 mg/kg/day (low transfusion, no iron reduction needed) or 21 mg/kg/day (high transfusion, iron reduction needed); patients well-managed on deferoxamine may start at one third of the deferoxamine dose. Adjust every 3-6 months in steps of 3.5-7 mg/kg/day guided by monthly serum ferritin. NTDT: initiate only with evidence of iron overload (LIC >=5 mg Fe/g dw or serum ferritin consistently >800 microg/l); start 7 mg/kg/day. Same weight-based dosing applies to paediatric patients (dose per kg calculated and rounded to nearest whole tablet).

Dose adjustments

Renal

Contraindicated if estimated creatinine clearance <60 ml/min. Dose-dependent rises in serum creatinine occur; monitor renal function per recommended schedule.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients
  • Combination with other iron chelator therapies (safety not established)
  • Estimated creatinine clearance <60 ml/min

Side effects

  • Gastrointestinal disturbances - nausea, vomiting, diarrhoea, abdominal pain, constipation, dyspepsia (common)
  • Skin rash; severe cutaneous adverse reactions including Stevens-Johnson syndrome, toxic epidermal necrolysis and DRESS reported
  • Dose-dependent increases in serum creatinine / decreased creatinine clearance; elevated liver transaminases
  • Headache (common); dizziness (uncommon)
  • Cataract, maculopathy, deafness (uncommon); rare optic neuritis

Interactions

  • May decrease the efficacy of hormonal contraceptives - additional or alternative non-hormonal contraception recommended
  • Combination with other iron chelators is contraindicated (safety not established)

Clinical monograph

How it works

It is a tridentate ligand that selectively binds iron with high affinity, forming a complex that is excreted predominantly in the faeces.

Prescribing in practice

  • Carries warnings of serious renal impairment (including acute kidney injury), hepatic failure and gastrointestinal haemorrhage; renal and hepatic function must be assessed before and during treatment and the dose adjusted or stopped if function deteriorates.
  • Formulations are not interchangeable on a milligram-for-milligram basis, so prescriptions should specify the formulation clearly to avoid dosing errors.
  • Use cautiously with other potentially nephrotoxic agents and with medicines metabolised by the liver, as relevant interactions can occur.

Monitoring

Monitor serum ferritin together with renal function, liver function and full blood count regularly, and arrange auditory and ophthalmic testing as recommended.

Counselling the patient

  • Report symptoms such as reduced urine output, abdominal pain, vomiting or black stools promptly.
  • Attend for all scheduled blood tests so iron levels and organ function can be tracked.

Evidence & guidelines

Use of iron chelation in transfusion-dependent iron overload is supported by MHRA safety guidance and established haematology practice.

Reference: NICE TA161; BSH iron overload; MHRA Drug Safety Update; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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