Dosing & Uses
Dosage Forms & Strengths
tablet
- 500mg
-
1000-mg tablets
- Note: Two different formulations with different dosage frequencies
- 1000mg (twice a day); imprinted with FPX DR on one side and APO 1000 on the other
- 1000mg (three times a day); imprinted with APO 1000 on one side and plain on the other
oral solution
- 80 mg/mL (40g/400mL; 20g/250mL)
- 100mg/mL (50g/500mL)
Transfusional Iron Overload
Iron chelator indicated for treatment of transfusional iron overload caused by thalassemia syndromes, sickle cell disease, or other anemias
Approval based on serum ferritin level reduction; no controlled trials demonstrating a direct treatment benefit (eg, improvement in disease-related symptoms, functioning, or increased survival)
500-mg tablet
- Initial: 25 mg/kg (actual body weight) PO TID
- Maximum dose: 99 mg/kg/day
- Round dose to nearest 250 mg (half-tablet)
1000-mg tablets
- 75 mg/kg/day (actual body weight) PO initially; maximum dose is 99 mg/kg/day
- Divide total daily dose (eg, BID or TID) based on particular 1000-mg tablet
- Round dose to nearest 500 mg (half-tablet)
Oral solution
- Initial: 25 mg/kg/day (actual body weight) PO TID
- Maximum dose: 99 mg/kg/day
- Round to nearest 2.5 mL (ie, 200 mg for 80 mg/mL; 250 mg for 100 mg/mL)
Dosage Modifications
Gastrointestinal upset
- Reduce initial dose to 45 mg/kg/day to minimize GI upset
- May increase weekly by 15 mg/kg/day increments until full prescribed dose achieved
Ferritin concentration
- Monitor serum ferritin concentration every 2-3 months to assess the effects on body iron stores
- Tailor dose adjustments to patient’s response and therapeutic goals (maintenance or reduction of body iron burden)
- If serum ferritin falls consistently to <500 mcg/L, consider temporary therapy interruption
Renal impairment
- Mild-to-severe (eGFR 15-89 mL/min/1.73 m2): No dose adjustment necessary
- ESRD: Unknown
Hepatic impairment
- Mild or moderate (Child Pugh A or B): No dose adjustment necessary
- Severe: (Child Pugh C): Unknown
Dosing Consideration
Available in two different 1000-mg tablet formulations, which have different oral dosing regimens to achieve the same total daily dosage
Limitation of use
- Safety and effectiveness not established for transfusional iron overload caused by myelodysplastic syndrome or Diamond Blackfan anemia
Siderosis (Orphan)
Orphan designation for treatment of superficial siderosis
Orphan sponsor
- ApoPharma, Inc; 200 Barmac Drive; Canada
Dosage Forms & Strengths
tablet
- 500mg
-
1000-mg tablets
- Note: Two different formulations with different dosage frequencies
- 1000mg (twice a day); imprinted with FPX DR on one side and APO 1000 on the other
- 1000mg (three times a day); imprinted with APO 1000 on one side and plain on the other
oral solution
- 80 mg/mL (40g/400mL; 20g/250mL)
- 100mg/mL (50g/500mL)
Transfusional Iron Overload
Iron chelator indicated for treatment of transfusional iron overload in children aged ≥3 years caused by thalassemia syndromes, sickle cell disease, or other anemias
Approval based on serum ferritin level reduction; no controlled trials demonstrating a direct treatment benefit (eg, improvement in disease-related symptoms, functioning, or increased survival)
<3 years: Safety and efficacy not established
500-mg tablet (aged ≥8 yr)
- Initial: 25 mg/kg (actual body weight) PO TID
- Maximum dose: 99 mg/kg/day
- Round dose to nearest 250 mg (half-tablet)
1000-mg tablets (aged ≥8 yr)
- 75 mg/kg/day (actual body weight) PO initially; maximum dose is 99 mg/kg/day
- Divide total daily dose (eg, BID or TID) based on particular 1000-mg tablet
- Round dose to nearest 500 mg (half-tablet)
Oral solution (aged ≥3 yr)
- Initial: 25 mg/kg/day (actual body weight) PO TID
- Maximum dose: 99 mg/kg/day
- Round to nearest 2.5 mL (ie, 200 mg for 80 mg/mL; 250 mg for 100 mg/mL)
Dosage Modifications
Gastrointestinal upset
- Reduce initial dose to 45 mg/kg/day to minimize GI upset
- May increase weekly by 15 mg/kg/day increments until full prescribed dose achieved
Ferritin concentration
- Monitor serum ferritin concentration every 2-3 months to assess the effects on body iron stores
- Tailor dose adjustments to patient’s response and therapeutic goals (maintenance or reduction of body iron burden)
- If serum ferritin falls consistently to <500 mcg/L, consider temporary therapy interruption
Renal impairment
- Mild-to-severe (eGFR 15-89 mL/min/1.73 m2): No dose adjustment necessary
- ESRD: Unknown
Hepatic impairment
- Mild or moderate (Child Pugh A or B): No dose adjustment necessary
- Severe: (Child Pugh C): Unknown
Dosing Consideration
Available in two different 1000-mg tablet formulations, which have different oral dosing regimens to achieve the same total daily dosage
Limitation of use
- Safety and effectiveness not established for transfusional iron overload caused by myelodysplastic syndrome or Diamond Blackfan anemia
Neurodegeneration With Brain Iron Accumulation (Orphan)
Orphan designation treatment of neurodegeneration with brain iron accumulation (NBIA)
Sponsor
- ApoPharma, Inc; 200 Barmac Drive, M9L 2Z7; Canada
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (82)
- abemaciclib
deferiprone, abemaciclib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- acalabrutinib
deferiprone, acalabrutinib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- ado-trastuzumab emtansine
deferiprone, ado-trastuzumab emtansine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- aldesleukin
deferiprone, aldesleukin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- baricitinib
baricitinib, deferiprone. Either increases toxicity of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Baricitinib is not recommended in combination with other JAK inhibitors, biologic DMARDs, or potent immunosuppressives.
- betibeglogene autotemcel
betibeglogene autotemcel increases effects of deferiprone by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Discontinue iron chelators at least 7 days before starting conditioning. Some iron chelators are myelosuppressive. After infusion, avoid use of these iron chelators for 6 months. If iron chelation is needed, consider administration of nonmyelosuppressive iron chelators. Phlebotomy can be used in lieu of iron chelation, when appropriate.
- capecitabine
deferiprone, capecitabine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- chloramphenicol
deferiprone, chloramphenicol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- cidofovir
deferiprone, cidofovir. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- clozapine
deferiprone, clozapine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- colchicine
deferiprone, colchicine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- cyclophosphamide
deferiprone, cyclophosphamide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- daratumumab
deferiprone, daratumumab. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- dasatinib
deferiprone, dasatinib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- docetaxel
deferiprone, docetaxel. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- doxorubicin
deferiprone, doxorubicin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- edetate calcium disodium
deferiprone, edetate calcium disodium. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- epirubicin
deferiprone, epirubicin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- estramustine
deferiprone, estramustine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- everolimus
deferiprone, everolimus. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- floxuridine
deferiprone, floxuridine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- flucytosine
deferiprone, flucytosine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- fluorouracil
deferiprone, fluorouracil. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- hydroxyurea
deferiprone, hydroxyurea. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- ibrutinib
deferiprone, ibrutinib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- idarubicin
deferiprone, idarubicin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- idelalisib
deferiprone, idelalisib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- ifosfamide
deferiprone, ifosfamide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- imatinib
deferiprone, imatinib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- inotuzumab
deferiprone, inotuzumab. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- interferon alfa 2b
deferiprone, interferon alfa 2b. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- interferon beta 1a
deferiprone, interferon beta 1a. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- interferon beta 1b
deferiprone, interferon beta 1b. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- interferon gamma 1b
deferiprone, interferon gamma 1b. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- irinotecan
deferiprone, irinotecan. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- ixabepilone
deferiprone, ixabepilone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- lenalidomide
deferiprone, lenalidomide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- levetiracetam
deferiprone, levetiracetam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- linezolid
deferiprone, linezolid. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- lomustine
deferiprone, lomustine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- mebendazole
deferiprone, mebendazole. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- mercaptopurine
deferiprone, mercaptopurine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- methotrexate
deferiprone, methotrexate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- mitomycin
deferiprone, mitomycin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- mitoxantrone
deferiprone, mitoxantrone. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- nelarabine
deferiprone, nelarabine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- nilotinib
deferiprone, nilotinib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- obinutuzumab
deferiprone, obinutuzumab. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- osimertinib
deferiprone, osimertinib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- oxaliplatin
deferiprone, oxaliplatin. Either increases toxicity of the other by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- paclitaxel
deferiprone, paclitaxel. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- paclitaxel protein bound
deferiprone, paclitaxel protein bound. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- pazopanib
deferiprone, pazopanib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- peginterferon alfa 2a
deferiprone, peginterferon alfa 2a. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- peginterferon alfa 2b
deferiprone, peginterferon alfa 2b. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- pemetrexed
deferiprone, pemetrexed. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- pentostatin
deferiprone, pentostatin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- pomalidomide
deferiprone, pomalidomide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- ponatinib
deferiprone, ponatinib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- primaquine
deferiprone, primaquine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- procarbazine
deferiprone, procarbazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- pyrimethamine
deferiprone, pyrimethamine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- ribociclib
deferiprone, ribociclib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- ruxolitinib
deferiprone, ruxolitinib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- streptozocin
deferiprone, streptozocin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- sulfasalazine
deferiprone, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- sunitinib
deferiprone, sunitinib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- tedizolid
deferiprone, tedizolid. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- temozolomide
deferiprone, temozolomide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- teniposide
deferiprone, teniposide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- thalidomide
deferiprone, thalidomide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- thioguanine
deferiprone, thioguanine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- thiotepa
deferiprone, thiotepa. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- tofacitinib
deferiprone, tofacitinib. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- topotecan
deferiprone, topotecan. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- trabectedin
deferiprone, trabectedin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- trastuzumab deruxtecan
deferiprone, trastuzumab deruxtecan. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- vinblastine
deferiprone, vinblastine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- vinorelbine
deferiprone, vinorelbine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- vorinostat
deferiprone, vorinostat. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- zidovudine
deferiprone, zidovudine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- ziv-aflibercept
deferiprone, ziv-aflibercept. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
Monitor Closely (42)
- aluminum hydroxide
aluminum hydroxide decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- aluminum hydroxide/magnesium carbonate
aluminum hydroxide/magnesium carbonate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- calcium acetate
calcium acetate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- calcium carbonate
calcium carbonate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- calcium chloride
calcium chloride decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- calcium citrate
calcium citrate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- calcium gluconate
calcium gluconate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- calcium/vitamin D
calcium/vitamin D decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- carbonyl iron
carbonyl iron decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- choline magnesium trisalicylate
choline magnesium trisalicylate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- citric acid/glucono-delta-lactone/magnesium carbonate
citric acid/glucono-delta-lactone/magnesium carbonate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- dichlorphenamide
dichlorphenamide, deferiprone. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.
- diclofenac
diclofenac will increase the level or effect of deferiprone by decreasing metabolism. Use Caution/Monitor. Coadministration with UGT1A6 inhibitors may increase serum concentration of deferiprone.
- eltrombopag
eltrombopag will increase the level or effect of deferiprone by decreasing metabolism. Use Caution/Monitor. Coadministration with UGT1A6 inhibitors may increase serum concentration of deferiprone.
- ferric carboxymaltose
ferric carboxymaltose decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- ferric citrate
ferric citrate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- ferric gluconate
ferric gluconate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- ferric maltol
ferric maltol decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
deferiprone decreases levels of ferric maltol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferiprone chelates iron. - ferric pyrophosphate DIALYSATE
ferric pyrophosphate DIALYSATE decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- ferrous fumarate
ferrous fumarate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- ferrous gluconate
ferrous gluconate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- ferrous sulfate
ferrous sulfate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- ferumoxytol
ferumoxytol decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- iron dextran complex
iron dextran complex decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- iron sucrose
iron sucrose decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- magnesium chloride
magnesium chloride decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- magnesium citrate
magnesium citrate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- magnesium gluconate
magnesium gluconate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- magnesium hydroxide
magnesium hydroxide decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- magnesium oxide
magnesium oxide decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- magnesium salicylate
magnesium salicylate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- magnesium supplement
magnesium supplement will decrease the level or effect of deferiprone by Other (see comment). Modify Therapy/Monitor Closely. Drug may form a chelate with polyvalent cations; may decrease absorption by the intestinal tract; applies to oral forms; may administer 4 hr from polyvalent cation administration
- mechlorethamine
deferiprone, mechlorethamine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Mechlorethamine may enhance the toxicities of myelosuppressive agents. Monitor for increased risk of myelosuppression.
- milk thistle
milk thistle will increase the level or effect of deferiprone by decreasing metabolism. Use Caution/Monitor. Coadministration with UGT1A6 inhibitors may increase serum concentration of deferiprone.
- multivitamins
multivitamins decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- polysaccharide iron
polysaccharide iron decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- potassium bicarbonate
potassium bicarbonate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.
- probenecid
probenecid will increase the level or effect of deferiprone by decreasing metabolism. Use Caution/Monitor. Coadministration with UGT1A6 inhibitors may increase serum concentration of deferiprone.
- selenium
selenium will decrease the level or effect of deferiprone by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate deferiprone administration from ingestion of polyvalent cations by at least 4 h.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride decreases levels of deferiprone by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer deferiprone at least 2 hr before and after each dose to avoid chelation with magnesium. .
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate decreases levels of deferiprone by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer deferiprone at least 2 hr before and after each dose to avoid chelation with magnesium. .
Minor (0)
Adverse Effects
>10%
Nausea (13%)
1-10%
Abdominal pain/discomfort (10%)
Vomiting (10%)
Arthralgia (10%)
Increased alanine aminotransferase (7%)
Neutropenia (6%) Diarrhea (3%)
Dyspepsia (2%)
Back pain (2%)
Pain in extremity (2%)
Headache (2%)
Agranulocytosis (2%)
Increased aspartate aminotransferase (1%)
Decrease appetite (1%)
Arthropathy (1%)
Postmarketing Reports
Blood and lymphatic system disorders: Thrombocytosis, pancytopenia
Cardiac disorders: Atrial fibrillation, cardiac failure
Congenital, familial and genetic disorders: Hypospadias
Eye disorders: Diplopia, papilledema, retinal toxicity
Gastrointestinal disorders: Enterocolitis, rectal hemorrhage, gastric ulcer, pancreatitis, parotid gland enlargement
General disorders and administration site conditions: Chills, pyrexia, edema peripheral, multi-organ failure
Hepatobiliary disorders: Jaundice, hepatomegaly. Immune system disorders: anaphylactic shock, hypersensitivity
Infections and infestations: Cryptococcal cutaneous infection, enteroviral encephalitis, pharyngitis, pneumonia, sepsis, furuncle, infectious hepatitis, rash pustular, subcutaneous abscess
Investigations: Blood bilirubin increased, blood creatinine phosphokinase increased
Metabolism and nutrition disorders: Metabolic acidosis, dehydration
Musculoskeletal and connective tissue disorders: Myositis, chondropathy, trismus
Nervous system disorders: Cerebellar syndrome, cerebral hemorrhage, convulsion, gait disturbance, intracranial pressure increased, psychomotor skills impaired, pyramidal tract syndrome, somnolence
Psychiatric disorders: Bruxism, depression, obsessive-compulsive disorder
Renal disorders: Glycosuria, hemoglobinuria
Respiratory, thoracic and mediastinal disorders: Acute respiratory distress syndrome, epistaxis, hemoptysis, pulmonary embolism
Skin, subcutaneous tissue disorders: Hyperhidrosis, periorbital edema, photosensitivity reaction, pruritus, urticaria, rash, Henoch-SchÖnlein purpura
Vascular disorders: Hypotension, hypertension
Warnings
Black Box Warnings
Can cause agranulocytosis that can lead to serious infections and death; neutropenia may precede agranulocytosis
Measure absolute neutrophil count (ANC) before initiating and monitor weekly while on therapy
Interrupt treatment if infection develops and monitor ANC more frequently
Advise patients taking to report immediately any symptoms indicative of infection
Contraindications
Hypersensitivity; Henoch-SchÖnlein purpura, urticaria, and periorbital edema with skin rash have been reported
Cautions
May cause fetal harm; women should be advised of the potential hazard to the fetus and to avoid pregnancy while on this drug
Monitor serum ferritin concentration every 2-3 months to assess the effects on body iron stores
Thorough QT interval studies have not been conducted
In clinical studies, subjects treated developed increased ALT values; monitor
Decreased plasma zinc concentrations; monitor plasma zinc, and supplement in the event of a deficiency
Agranulocytosis and neutropenia
- Fatal agranulocytosis can occur
- May also cause neutropenia, which may foreshadow agranulocytosis
- Obtain absolute neutrophil count (ANC) before starting therapy and monitor weekly during therapy
- Reduction in frequency of ANC monitoring should be considered on an individual patient basis, according to health care provider’s assessment of the patient’s understanding of risk minimization measures required during therapy
- If neutropenia develops (ANC <1.5 x 109/L) or if infection develops: Interrupt therapy and closely monitor ANC
- For agranulocytosis (ANC <0.5 x 109/L): Consider hospitalization and other management as clinically appropriate; do not resume if agranulocytosis develops unless potential benefits outweigh potential risks; do not rechallenge if neutropenia develops unless potential benefits outweigh potential risks
- For neutropenia (ANC >0.5 to <1.5 x 109/L): Instruct patients to immediately discontinue treatment and all other medications with a potential to cause neutropenia; obtain a complete blood cell (CBC) count, including a white blood cell (WBC) count corrected for the presence of nucleated red blood cells, an ANC, and a platelet count daily until recovery (ANC ≥1.5 x 109/L)
- Advise patients to immediately interrupt therapy and report to their physician if they experience any symptoms indicative of infection
- Mechanism of drug-associated agranulocytosis is unknown
- Agranulocytosis and neutropenia usually resolve upon discontinuation, but there have been reports of agranulocytosis leading to death
Drug interactions overview
- Avoid coadministration with other drugs known to cause neutropenia or agranulocytosis; however, if this is not possible, closely monitor the absolute neutrophil count
- Allow at least a 4-hour interval between deferiprone and mineral supplements, and antacids that contain polyvalent cations (eg, iron, aluminum, zinc) to avoid binding and malabsorption of supplements
- Avoid use of UGT1A6 inhibitors (eg, diclofenac, probenecid, or silymarin [milk thistle]) with deferiprone
Pregnancy & Lactation
Pregnancy
Limited available data with use in pregnant women are insufficient to inform a drug-associated risk of major birth defects and miscarriage
Verify the pregnancy status of females of reproductive potential prior to initiating therapy
Animal data
- May cause fetal harm when administered to a pregnant woman based on genotoxicity and developmental toxicity in animal studies
- In animal reproduction studies, administration of deferiprone to pregnant animals during the period of organogenesis resulted in adverse developmental outcomes including embryofetal death and malformations in rats and rabbits at doses much lower than the MRHD (maximum recommended human dose) based on body surface area
Contraception
- Females: Advise females of reproductive potential to avoid pregnancy during treatment and 6 months of contraception is recommended after cessation of therapy; advise females to immediately report pregnancy
- Males: Advise males with female sexual partners of reproductive potential to use effective contraception during treatment and 3 months of contraception is recommended after cessation of therapy
Lactation
There is no information regarding the presence of deferiprone in human milk, the effects on the breastfed child, or the effects on milk production
Because of the potential for serious adverse reactions, including the potential for tumorigenicity shown for deferiprone in animal studies, advise not to breastfeed during treatment and for 2 weeks after last dose
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Chelating agent with an affinity for ferric ion (iron III); binds with ferric ions to form neutral 3:1 (deferiprone:iron) complexes that are stable over a wide range of pH values
Has a lower binding affinity for other metals (eg, copper, aluminum, zinc) than for iron
Absorption
Absorption: Rapidly absorbed from upper GI within 5-10 minutes of PO administration
Peak plasma time: 1 hr (fasting); 2 hr (with food)
Peak plasma concentration: 20 mcg/mL
AUC: 53 mcg•hr/mL
Food decreases Cmax by 38% and AUC by 10%, but magnitude of exposure change does not warrant dose adjustment
Metabolism
Primarily eliminated via metabolism to the 3-O-glucuronide (lacks iron binding capability)
UGT 1A6 is primarily responsible for glucuronidation
Distribution
Protein bound: <10%
Vd: 1.6 L/kg (in patients with thalassemia); 1 L/kg (in healthy subjects)
Elimination
Half-life: 1.9 hr
Excretion: 75-90% excreted within 24 hr in urine as metabolite
Administration
Oral Administration
NOTE: Available in 2 different 1000-mg tablet formulations, which have different oral dosing regimens to achieve the same total daily dosage; see prescribing information for detailed description
Tablets and oral solution: May take with or without food
Separate administration times of deferiprone and other drugs or supplements containing polyvalent cations such as iron, aluminum, or zinc by at least 4 hr
Oral solution
- Pour prescribed dose of oral solution into the measuring cup
- Swallow dose; add ~10-15 mL of water to the measuring cup; gently swirl the measuring cup to mix the water and any remaining drug in the measuring cup
Storage
Tablet: Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)
Oral solution
- Unused bottle: Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)
- Store in the original bottle and carton to protect from light
- After first opening of the bottle, discard any unused portion after 8 weeks
Images
Patient Handout
deferiprone oral
DEFERIPRONE - ORAL
(de-FER-i-prone)
COMMON BRAND NAME(S): Ferriprox
WARNING: This medication may rarely cause a very serious low white blood cell count, which increases your risk of serious, possibly fatal infections. To lower your risk, your doctor will check your blood counts with a blood test before and regularly during treatment. Get medical help right away if you develop any signs of infection such as sore throat that doesn't go away, fever, chills, or flu-like symptoms.
USES: This medication is used by people with certain blood disorders (such as thalassemia, sickle cell anemia) who have too much iron in the body, caused by repeated blood transfusions. Blood transfusions help people with blood disorders but they also bring extra iron into the body. It is important to get rid of the extra iron because high levels of iron can cause health problems (such as heart failure, liver disease, diabetes, delayed growth in children). Deferiprone is used if you have trouble taking other traditional iron-removal medications or you continue to have high iron levels after taking other iron-removal medications.Deferiprone belongs to a class of drugs known as iron chelators. It works by attaching to iron which helps your body pass the extra iron out in the urine.
HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking deferiprone and each time you get a refill. If you have any questions, ask your doctor or pharmacist.This medication comes in different tablets that are made to be taken either twice a day or 3 times a day. Some tablets may not be substituted for each other, even if they are the same strength. Carefully follow your doctor's directions for how often and when you should take your dose. If you are not sure, check with your doctor or pharmacist.If you are taking the tablets made to be taken twice a day, take them with food as directed by your doctor, usually 2 times a day in the morning and in the evening (about 12 hours apart). Taking this medication with food may help lessen nausea. Avoid drinking alcoholic beverages. Doing so may change how well the medication works and increase the risk of side effects.If you are taking the tablets made to be taken 3 times a day, take them with or without food. Taking this medication with food may help lessen nausea. Take your doses in the morning, at midday, and in the evening.If you are using the liquid form of this medication, also read the Patient Instructions for Use. Carefully measure the dose using a special measuring cup. Do not use a household spoon because you may not get the correct dose. After you swallow each dose, add about 2 to 3 teaspoonsful (10 to 15 milliliters) of water to the measuring cup. Gently swirl to mix, then drink all of the mixture to make sure you get your full dose. Wash the measuring cup as directed after each time you use it.Take this medication 4 hours apart from products that may bind to it, decreasing its effectiveness. Ask your pharmacist about the other products you take. Some examples include antacids, vitamins/minerals (such as those containing iron, aluminum, zinc), among others.The dosage is based on your medical condition, weight, and response to treatment (including lab test results). To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Your treatment may need to be adjusted or stopped if you develop serious side effects. Follow your doctor's instructions carefully. Keep all medical/lab appointments.Take this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.
SIDE EFFECTS: See also Warning and How To Use sections.Nausea, vomiting, stomach/abdominal pain, or joint pain may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.This medication may cause your urine to turn a reddish-brown color. This effect is harmless and will disappear when the medication is stopped.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing, bloody stools.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking deferiprone, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, low white blood cell count.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. Discuss the risks and benefits with your doctor. Your doctor may direct you to get a pregnancy test before starting this medication. Women taking this medication should use reliable forms of birth control during treatment and for 6 months after stopping treatment. Men using this medication should use reliable forms of birth control during treatment and for 3 months after stopping treatment. If you or your partner become pregnant, tell your doctor right away.It is unknown if deferiprone passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this medication and for 2 weeks after stopping treatment is not recommended. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: See also How To Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: vision problems, weak muscles, unusual/slowed movements.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as liver function, complete blood counts, ferritin/zinc levels) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.For the tablets made to be taken 3 times a day, store tightly closed in the original bottle.For the liquid, store it only in the original container and carton to protect it from light. After the bottle is first opened, throw away any unused liquid after 35 days.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised February 2022. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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