Deferasirox

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.