Deferasirox

Deferasirox is an oral iron chelator used to treat chronic iron overload, most commonly that which results from repeated blood transfusions. It is a tridentate chelator that binds ferric iron (Fe3+) in a 2:1 ratio, forming a complex that is eliminated primarily via the hepatobiliary system and excreted in the feces. By reducing excess body iron, deferasirox aims to limit iron deposition in organs such as the liver, heart, and endocrine glands.

The medication is marketed in two main formulations: Jadenu, a film-coated tablet taken once daily, and Exjade, an oral dispersible tablet that is prepared as a suspension. Typical starting dosing is about 20 mg/kg per day, with adjustments based on ferritin levels, iron burden, and tolerability; maintenance dosing generally ranges from 20 to 40 mg/kg per day. Dosing is tailored to individual iron load and monitoring results and may be adjusted over time.

Pharmacokinetics and monitoring: after administration, deferasirox reaches peak plasma levels within 1–4 hours, with an approximate half-life of 8–16 hours and high protein binding. Regular monitoring includes serum ferritin, liver function tests, and renal function, at baseline and periodically during treatment. Patients should be observed for adverse effects and signs of improving iron burden.

Safety and regulatory status: common adverse effects include abdominal pain, nausea, diarrhea, headache, and rash, with potential elevations in liver enzymes and creatinine. Rare but serious events include renal injury, hepatic injury, and severe skin reactions. Deferasirox should be used with caution in patients with liver or kidney impairment; pregnancy should be avoided if possible. It is approved for transfusional iron overload and is available under brand names Exjade and Jadenu.