Deferiprone

How it works

It binds iron and forms a complex that is excreted mainly in the urine, and its small size allows access to intracellular iron pools including the myocardium.

Prescribing in practice

• It can cause agranulocytosis and neutropenia, which may be life-threatening, so the neutrophil count must be monitored regularly and the drug stopped immediately if neutropenia or infection develops.
• It is generally avoided in pregnancy and in patients with a history of recurrent neutropenia, and concurrent drugs that suppress the marrow should be avoided.
• Gastrointestinal upset, arthralgia, raised liver enzymes and reddish-brown discolouration of the urine can occur.

Monitoring

Monitor the full blood count, especially the neutrophil count, at regular intervals throughout treatment, alongside liver function and serum ferritin.

Counselling the patient

• Report any sign of infection such as sore throat, fever or feeling generally unwell straight away and have a blood count checked.
• Do not miss your scheduled blood tests, as they detect a serious fall in white cells.
• Reddish-brown urine is expected and harmless, but report severe joint pain or persistent nausea.

Evidence & guidelines

Deferiprone is recognised for its cardiac iron-removal efficacy and its agranulocytosis risk is the basis of mandatory blood-count monitoring highlighted in MHRA and SPC guidance.