deferiprone (Rx)

Brand and Other Names:Ferriprox
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Dosing & Uses

AdultPediatric

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
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Interactions

Interaction Checker

and deferiprone

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              Serious - Use Alternative (81)

              • 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.

              • 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)

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                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

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                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
                • 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
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                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.

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                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

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                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
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                Images

                No images available for this drug.
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                Patient Handout

                Patient Education
                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 fever, persistent sore throat, 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 1000 milligrams 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 1000 milligrams 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 persist or worsen, 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, iron (ferritin) and 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 August 2021. Copyright(c) 2021 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.

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                Formulary

                FormularyPatient Discounts

                Adding plans allows you to compare formulary status to other drugs in the same class.

                To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

                Adding plans allows you to:

                • View the formulary and any restrictions for each plan.
                • Manage and view all your plans together – even plans in different states.
                • Compare formulary status to other drugs in the same class.
                • Access your plan list on any device – mobile or desktop.

                The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                NC NOT COVERED – Drugs that are not covered by the plan.
                Code Definition
                PA Prior Authorization
                Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                QL Quantity Limits
                Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                ST Step Therapy
                Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                OR Other Restrictions
                Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.