Iron Chelation 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, most commonly from repeated blood transfusions in conditions such as thalassaemia and other 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

Haematology context (iron chelation in transfusion-dependent and non-transfusion-dependent anaemias). 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 selectively binds ferric iron with high affinity, forming a stable complex that is excreted predominantly via the faeces, thereby reducing total body iron burden.

Prescribing in practice

It can cause serious renal and hepatic impairment, gastrointestinal haemorrhage and rare fatal events, so renal and liver function must be checked before and regularly during treatment and the drug withheld for significant deterioration.
Avoid combining with other iron chelators and use caution with agents that are renally cleared or ulcerogenic such as NSAIDs and corticosteroids.
Cytopenias and hypersensitivity (including severe skin reactions) can occur, so a baseline assessment and ongoing review are needed.

Monitoring

Monitor serum ferritin monthly together with regular renal function, liver function tests, urine protein and periodic auditory and ophthalmic assessments.

Counselling the patient

Take the tablets consistently in relation to food as directed and do not double up on missed doses.
Report reduced urine output, severe abdominal pain, black stools, vomiting blood or a widespread rash promptly.
Attend for regular blood and urine tests so your iron levels and organ function can be tracked.

Evidence & guidelines

Its efficacy and safety in transfusional iron overload are established through randomised trials versus desferrioxamine and reflected in MHRA safety advice on renal and hepatic monitoring.

Reference: MHRA Drug Safety Update (2014); UK Thalassaemia Society Guidelines 2022; ESCALATOR Trial; 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).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways