deferiprone

Absorption: Well absorbed following oral administration.

Distribution: Widely distributed to extravascular tissues.

Metabolism/Excretion: Mostly metabolized (by UGT1A6 enzyme system); 75–90% excreted in urine as metabolites.

Half-Life: 1.9 hr.

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	within 5–10 min	1–2 hr	8–12 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
OB: Pregnancy;
Lactation: Lactation .

Use Cautiously in:

Pedi: Children <8 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

CV: TORSADES DE POINTES

GI: abdominal pain, nausea, ↑liver enzymes, change in appetite, vomiting

GU: chromaturia

Hemat: AGRANULOCYTOSIS, neutropenia

MS: arthralgia, arthropathy, back pain, extremity pain

Neuro: headache

Misc: ↓zinc levels

Interactions ⬆ ⬇

Drug-drug:

Concurrent use of other drugs that cause neutropenia/agranulocytosis may ↑ risk of neutropenia/agranulocytosis.
May also chelate other concurrently administered polyvalent cations in mineral supplements and antacids, including iron, aluminum, and zinc; wait 4 hr between administration.

Route/Dosage ⬆ ⬇

Twice Daily Regimen

PO (Adults and Children ≥8 yr): 1000-mg tablet (for twice daily administration): 37.5 mg/kg (actual body weight) every 12 hr; may be adjusted up to 49.5 mg/kg (actual body weight) every 12 hr. Dose should be rounded to the nearest 1/2 tablet (500 mg).

Three Times Daily Regimen

PO (Adults and Children ≥8 yr): 500-mg tablet, 1000-mg tablet (for 3 times daily administration), or oral solution: 25 mg/kg (actual body weight) 3 times daily; may be adjusted up to 33 mg/kg (actual body weight) 3 times daily. Dose should be rounded to the nearest 1/2 tablet or the nearest 2.5 mL.

Availability ⬆ ⬇

(Generic available)

Oral solution bubble gum flavor: 100 mg/mL
Tablets: 500 mg; 1000 mg (for twice daily administration); 1000 mg (for 3 times daily administration)

Assessment ⬆ ⬇

Monitor for signs and symptoms of infection (fever, chills, sore throat, cough, painful urination). If infection occurs, discontinue deferiprone and monitor ANC closely.

Lab Test Considerations:

Verify negative pregnancy test before starting therapy.
- Monitor serum ferritin every 2–3 mo to assess efficacy. If serum ferritin falls consistently <500 mcg/L, consider temporarily interrupting deferiprone therapy.
- Measure ANC before starting and weekly for 1st 6 mo of therapy. Monitor every 2 wk for the next 6 mo. After 1 yr of therapy, monitor ANC every 2–4 wk (or at patient’s blood transfusion interval in patients who have not experienced an interruption due to any ↓ in ANC). Interrupt deferiprone if neutropenia (ANC <1.5 × 10⁹/L) or infection develops. If ANC <1.5 × 10⁹/L and >0.5 × 10⁹/L, obtain CBC with WBC corrected for presence of nucleated red blood cells, ANC, and platelet count daily until recovery (ANC ≥1.5 × 10⁹/L. For agranulocytosis (ANC <0.5 × 10⁹/L), consider hospitalization and manage as clinically appropriate. Do not resume deferiprone in patients who develop agranulocytosis or rechallenge patients who develop neutropenia, unless benefits outweigh risks.
- Monitor serum AST and ALT monthly during therapy. Interrupt therapy if persistent ↑ in serum transaminases occurs.
- Monitor plasma zinc levels before and regularly during therapy. ↓ may occur and may require supplementation.

Implementation ⬆ ⬇

Ensure tablet formulation is appropriate for the dosing regimen. Each tablet has different identifying characteristics.
PO: Three-times-a-day dosing: Administer 1st dose in the morning, 2nd dose midday, and 3rd dose in the evening. May be taken with meals to decrease nausea.
- Twice-daily dosing: Administer 12 hr apart with food.
- Allow ≥4 hr between deferiprone and iron, aluminum, or zinc.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take deferiprone as directed. Take missed doses as soon as remembered, but not just before next dose. Do not double doses. Advise patient to read Medication Guide before starting with each Rx refill in case of changes.
Advise patient to stop therapy and notify health care provider immediately if signs and symptoms of infection (fever, sore throat) or if palpitations, dizziness, syncope, or seizures occur.
Inform patient that reddish/brown urine may occur; common and not harmful.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications. Instruct patient to allow ≥4 hr between deferiprone and mineral supplements and antacids that contain iron, aluminum, or zinc.
Rep: May cause fetal harm. Advise women of reproductive potential to use effective contraception during therapy and for ≥6 mo after last dose and avoid breastfeeding during therapy and for ≥2 wk after last dose. Advise men with female partners of reproductive potential to use effective contraception during therapy and for ≥3 mo after last dose. If pregnancy is planned or suspected, notify health care provider promptly.

Evaluation/Desired Outcomes ⬆ ⬇

Decrease in serum ferritin levels.

US Brand Names ⬆ ⬇

Code ⬆

NDC Code

0054- Hikma Pharmaceuticals USA Inc.
- 0054-0576- Deferiprone
  - 0054-0576-25- 100 TABLET, COATED in 1 BOTTLE (0054-0576-25)

0054- Hikma Pharmaceuticals USA Inc.
- 0054-0711- Deferiprone
  - 0054-0711-19- 50 TABLET, COATED in 1 BOTTLE (0054-0711-19)

0054- Hikma Pharmaceuticals USA Inc.
- 0054-0711- Deferiprone
  - 0054-0711-23- 150 TABLET, COATED in 1 BOTTLE (0054-0711-23)

0054- Hikma Pharmaceuticals USA Inc.
- 0054-0711- Deferiprone
  - 0054-0711-28- 300 TABLET, COATED in 1 BOTTLE (0054-0711-28)

10122- Chiesi USA, Inc.
- 10122-100- FERRIPROX
  - 10122-100-10- 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (10122-100-10)

10122- Chiesi USA, Inc.
- 10122-101- FERRIPROX
  - 10122-101-50- 500 mL in 1 BOTTLE, PLASTIC (10122-101-50)

10122- Chiesi USA, Inc.
- 10122-103- FERRIPROX
  - 10122-103-05- 50 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (10122-103-05)

10122- Chiesi USA, Inc.
- 10122-104- FERRIPROX
  - 10122-104-01- 50 TABLET in 1 BLISTER PACK (10122-104-01)

10122- Chiesi USA, Inc.
- 10122-104- FERRIPROX
  - 10122-104-05- 50 TABLET in 1 BOTTLE, PLASTIC (10122-104-05)

15308- Aarti Pharmalabs Limited
- 15308-2908-
  - 15308-2908-0- 20 kg in 1 PACKAGE (15308-2908-0)

17349- B.V. KATWIJK CHEMIE
- 17349-0023-
  - 17349-0023-1- 25 kg in 1 DRUM (17349-0023-1)

51672- Sun Pharmaceutical Industries, Inc.
- 51672-4196- Deferiprone
  - 51672-4196-1- 100 TABLET in 1 BOTTLE (51672-4196-1)

51672- Sun Pharmaceutical Industries, Inc.
- 51672-4237- Deferiprone
  - 51672-4237-4- 50 TABLET in 1 BOTTLE (51672-4237-4)

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇