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Iron Chelation — Oral Pregnancy: Contraindicated — teratogenic in animal studies; effective contraception required during treatment

Deferiprone

Brand names: Ferriprox

Adult dose

Dose: 25 mg/kg three times daily
Route: Oral
Frequency: Three times daily (with or without food)
Max: 33 mg/kg three times daily (99 mg/kg/day total)
Oral iron chelator for transfusional iron overload in thalassaemia major when desferrioxamine is inadequate or contraindicated. More effective than desferrioxamine at removing cardiac iron — preferred when cardiac siderosis is the primary concern.

Paediatric dose

Dose: 25 mg/kg mg/kg
Route: Oral
Frequency: Three times daily
Max: 33 mg/kg three times daily
BNFc: licensed from age 6 years in thalassaemia major. Liquid formulation available (80 mg/mL). Dose as per adult weight-based calculation.

Dose adjustments

Renal

Limited data — use with caution; increase monitoring frequency

Hepatic

Use with caution — hepatic toxicity reported; monitor LFTs

Paediatric weight-based calculator

BNFc: licensed from age 6 years in thalassaemia major. Liquid formulation available (80 mg/mL). Dose as per adult weight-based calculation.

Clinical pearls

  • Superior to desferrioxamine for cardiac iron removal — cardiac MRI T2* monitoring recommended to guide treatment choice
  • Agranulocytosis: weekly FBC mandatory throughout treatment; interrupt immediately if neutrophil count <1.5 × 10⁹/L; stop permanently if <0.5 × 10⁹/L
  • MHRA: agranulocytosis risk requires weekly blood count monitoring — prescribers must enrol patients in monitoring programme
  • Can be combined with desferrioxamine for enhanced chelation (combination chelation) — used when single-agent therapy is inadequate
  • Arthropathy affects ~10–15% of patients — dose-related; often reversible on dose reduction or discontinuation
  • Chromaturia (red/brown urine) — inform patients this is expected and harmless (due to iron-deferiprone chelate excretion)

Contraindications

  • Pregnancy
  • Breastfeeding
  • History of agranulocytosis/recurrent neutropenia
  • Hypersensitivity to deferiprone

Side effects

  • Agranulocytosis (most serious — 1–2%)
  • Neutropenia (7%)
  • Nausea/vomiting (most common)
  • Arthropathy (joint pain and swelling)
  • Zinc deficiency
  • Elevated LFTs
  • Chromaturia (red/brown urine — harmless)

Interactions

  • Antacids containing aluminium — bind deferiprone; avoid concomitant use
  • UGT1A6 inhibitors — may increase deferiprone levels

Monitoring

  • FBC weekly (mandatory)
  • Serum ferritin (every 3 months)
  • Cardiac MRI T2* annually
  • LFTs
  • Zinc levels

Reference: BNFc; BNF 90; BNFc; MHRA Drug Safety Update; UK Thalassaemia Society Guidelines 2022; Pennell et al. Blood 2006. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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