deferasirox: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
deferasirox: clinical details
Prescribing considerations
- Specialist initiation and maintenance are required.
- Confirm clinically significant iron overload and define therapeutic goals before treatment.
- Assess comorbidity, transfusional iron input and over-chelation risk.
- Maintain hydration during vomiting, diarrhoea or other volume-depleting illness, particularly in children.
- Use caution in older people and those with pre-existing renal or hepatic disease, low platelet counts, or medicines that impair renal function or gastrointestinal integrity.
Contraindications and cautions
- Hypersensitivity to deferasirox or an excipient
- Concurrent treatment with another iron chelator
- Estimated creatinine clearance below 60 mL/min
Monitoring
- Before treatment: duplicate serum creatinine, creatinine clearance or cystatin C, urine protein, liver tests, ferritin, hearing and ophthalmic assessment.
- Intensify renal monitoring after initiation or a formulation change, then continue regular monitoring.
- Monitor serum transaminases, bilirubin and alkaline phosphatase closely at initiation and regularly thereafter.
- Follow ferritin trends to assess response and avoid over-chelation; use liver iron concentration where clinically indicated.
- Assess renal tubular markers when indicated, including glycosuria without diabetes and electrolyte or phosphate abnormalities.
- Repeat hearing and ophthalmic assessments periodically; monitor growth and sexual development in children.
Clinical pharmacology
An orally active tridentate chelator selective for ferric iron. Two deferasirox molecules bind one iron atom. Metabolism is mainly by UGT1A1 and UGT1A3, with biliary and faecal elimination and minimal renal excretion.
Formulation and product differences
- Film-coated tablets may be swallowed or crushed onto soft food; they are not intended for dispersion in liquid.
- Film-coated and dispersible tablets have different bioavailability and are not directly interchangeable without recalculation and monitoring.
- A formulation switch requires renewed renal surveillance because exposure may change.
deferasirox preparations and strengths
deferasirox interactions
Tell the specialist team and pharmacist about prescribed, over-the-counter and complementary products. Important examples include:
Other iron chelators
Do not combine them with deferasirox under the selected licence because safety has not been established.
Rifampicin, carbamazepine, phenytoin, phenobarbital or ritonavir
These may reduce deferasirox exposure and effectiveness, requiring specialist monitoring.
Repaglinide
Deferasirox can substantially increase repaglinide exposure, so the combination should generally be avoided.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.