Table 4

Some characteristics of the different iron chelators

Deferoxamine messylateDeferiproneDeferasirox
Brand nameDesferalFerriproxExjade
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 administrationSubcutaneous, intravenous, 8–10 h/dayOral, three times dailyOral, once daily
Chelator-to-iron binding molar ratio1:13:12:1
Plasma half-life5–10 min47–143 min8–16 h
ExcretionUrinary, faecalUrinaryFaecal, 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-effectsAuditory, ocular and neurological toxicity; growth and skeletal abnormalitiesNeutropenia and agranulocytosis; muscle and joint pain; gastric intolerance; hepatic dysfunction; zinc deficiencyGastrointestinal disturbances; rash; and possible renal toxicity
MonitoringAnnual 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 indicationsIron overload of any aetiologyIron 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