• Miscellaneous hematological agents

Miscellaneous hematological agents:

Indications for FERRIPROX:

Treatment of transfusional iron overload due to thalassemia syndromes when current chelation therapy is inadequate.

Limitations of Use:

Not for use in treating other chronic anemias.

Adult:

Individualize. Initially 25mg/kg three times daily (total dose 75mg/kg/day). Max: 33mg/kg three times daily (total dose 99mg/kg/day). Round dose to the nearest 250mg or 500mg. Adjust dose to individual response and therapeutic goals. Consider temporary dose interruption if serum ferritin falls consistently <500mcg/L.

Children:

Not established.

Warnings/Precautions:

Risk of neutropenia or fatal agranulocytosis. Measure ANC before starting therapy and monitor weekly during. Interrupt therapy if infection or neutropenia develops (ANC <1.5×109/L). If neutropenia occurs, obtain CBCs, WBCs, ANC, and platelets daily until recovery (ANC ≥1.5×109/L). Monitor serum ALT monthly; consider interruption if persistent increase in transaminase levels. Monitor serum ferritin every 2–3 months. Monitor plasma zinc, supplement if deficient. Severe hepatic impairment. Elderly. Embryo-fetal toxicity. Advise use of highly effective contraception during and for 6 months (females of reproductive potential) or for 3 months (males w. female partners) after the last dose. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended (during and for 2 weeks after the last dose).

Pharmacologic Class:

Iron chelating agent.

Interactions:

Avoid concomitant use with other drugs associated with neutropenia or agranulocytosis. Allow at least 4-hour interval with antacids or mineral supplements containing polyvalent cations (eg, iron, aluminum, zinc). Avoid concomitant UGT1A6 inhibitors (eg, diclofenac, probenecid, milk thistle).

Adverse Reactions:

Nausea, vomiting, abdominal pain, increased ALT, arthralgia, neutropenia, chromaturia; agranulocytosis (manage appropriately if occurs; do not resume).

Generic Availability:

NO

How Supplied:

Tabs 500mg—100; 1000mg—50