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Iron Chelation Pregnancy: Contraindicated — embryotoxic in animal studies; effective contraception required

Deferasirox

Brand names: Exjade, Jadenu

Adult dose

Dose: 14–28 mg/kg/day (dispersible tablet) or 7–21 mg/kg/day (film-coated tablet — Jadenu)
Route: Oral
Frequency: Once daily (30 minutes before food for dispersible; with or without food for Jadenu)
Max: 40 mg/kg/day
Oral iron chelator for chronic iron overload due to blood transfusions (thalassaemia, MDS, sickle cell, aplastic anaemia). Starting dose based on transfusion burden and serum ferritin. Adjust dose based on ferritin trend every 3–6 months.

Paediatric dose

Dose: 14–28 mg/kg mg/kg
Route: Oral
Frequency: Once daily
Max: 40 mg/kg/day
BNFc: licensed from age 2 years. Starting dose 14 mg/kg/day for transfusion-dependent iron overload; adjust based on ferritin. Dispersible tablet dissolved in water, apple juice, or orange juice.

Dose adjustments

Renal

Avoid if eGFR <40 mL/min/1.73m²; reduce dose by 50% if creatinine rises >33% above baseline on two consecutive measures

Hepatic

Avoid in severe hepatic impairment; use with caution in moderate impairment — hepatic metabolism

Paediatric weight-based calculator

BNFc: licensed from age 2 years. Starting dose 14 mg/kg/day for transfusion-dependent iron overload; adjust based on ferritin. Dispersible tablet dissolved in water, apple juice, or orange juice.

Clinical pearls

  • MHRA 2014: risk of agranulocytosis, aplastic anaemia, and other serious blood dyscrasias — monitor FBC monthly
  • Renal tubular dysfunction (Fanconi syndrome) reported — monitor urinary glucose and protein; measure creatinine before initiation and monthly
  • Audiometry and ophthalmological examination annually (cochlear and lens toxicity)
  • Target ferritin <1000 mcg/L; consider dose reduction if ferritin consistently <500 mcg/L
  • Dispersible tablet (Exjade): dissolve in 100–200 mL water/juice; do not chew or swallow whole
  • Preferred over desferrioxamine (IV) for convenience — similar efficacy in thalassaemia major (ESCALATOR trial)

Contraindications

  • eGFR <40 mL/min/1.73m²
  • Severe hepatic impairment
  • High-risk MDS (rapidly progressing disease)
  • Pregnancy

Side effects

  • Renal impairment (Fanconi syndrome)
  • GI disturbance (nausea, diarrhoea, abdominal pain)
  • Transient LFT elevation
  • Skin rash
  • Auditory and ocular toxicity (rare)
  • Agranulocytosis (rare — MHRA warning)

Interactions

  • Aluminium-containing antacids — avoid concomitant use (impairs chelation)
  • Ciclosporin — increased ciclosporin levels
  • Repaglinide — increased levels via CYP2C8 inhibition

Monitoring

  • Serum ferritin (every 3 months)
  • Renal function and urinary protein (monthly)
  • LFTs (monthly)
  • FBC (monthly)
  • Annual audiology and ophthalmology

Reference: BNFc; BNF 90; BNFc; MHRA Drug Safety Update (2014); UK Thalassaemia Society Guidelines 2022; ESCALATOR Trial. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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