Table 4

Some characteristics of the different iron chelators

	Deferoxamine messylate	Deferiprone	Deferasirox
Brand name	Desferal	Ferriprox	Exjade
Usual dosage	Initial: 40 mg/kg/day (five times weekly); maintenance: 20–40 mg/kg/day	Initial: 75 mg/kg/day; maintenance: 75–100 mg/kg/day	Initial:20 mg/kg/day; maintenance: 10–30 mg/day
Route of administration	Subcutaneous, intravenous, 8–10 h/day	Oral, three times daily	Oral, once daily
Chelator-to-iron binding molar ratio	1:1	3:1	2:1
Plasma half-life	5–10 min	47–143 min	8–16 h
Excretion	Urinary, faecal	Urinary	Faecal, urinary
Advantages	Widely available, inexpensive; extensive clinical experience	Good chelation of hepatic and cardiac iron, inexpensive; extensive clinical experience	Good chelation of hepatic and cardiac iron; no growth abnormalities or agranulocytocis
Disadvantages	Inadequate chelation of cardiac iron; compliance problems	Variable chelation of hepatic and cardiac iron in some cases; dosage schedule	May be distasteful for younger patients
Side-effects	Auditory, ocular and neurological toxicity; growth and skeletal abnormalities	Neutropenia and agranulocytosis; muscle and joint pain; gastric intolerance; hepatic dysfunction; zinc deficiency	Gastrointestinal disturbances; rash; and possible renal toxicity
Monitoring	Annual audiometry and eye examinations	Weekly blood count testing; transaminase monthly for 3–6 months and every 6 months thereafter	Monthly serum creatinine, urinary protein and transaminase testing; regular assessment or iron burden every 3–6 months for dosage adjustment
Approved indications	Iron overload of any aetiology	Iron overload in thalassaemia major when contraindication or failure of deferioxamine in thalassaemia major	Transfusional iron overload in thalassaemia major; contraindication or failure of deferioxamine in thalassaemia major and other transfusional iron overload status