Issoferrol (Deferasirox)

Deferasirox is used to manage iron overload conditions associated with chronic transfusion therapy.

• Transfusional iron overload: Reduces excess iron stores and helps maintain safe ferritin levels.
• Thalassemia major: Improves iron balance and reduces organ damage risk in patients receiving regular transfusions.
• Sickle cell disease: Controls iron accumulation resulting from repeated transfusions, supporting better clinical outcomes.

• Deferasirox binds free iron ions with high affinity, forming a stable, lipophilic complex that is eliminated primarily via the fecal route. By chelating intracellular and plasma iron, it lowers total body iron burden, preventing deposition in vital organs such as the heart, liver and endocrine glands. The drug’s oral absorption allows systemic distribution, and its selective chelation avoids significant removal of essential metals such as zinc and copper.

Deferasirox may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Nausea and vomiting
• Diarrhea or abdominal pain
• Skin rash or pruritus
• Elevated serum creatinine
• Increased liver enzymes

Serious or Rare Side Effects

• Acute kidney injury
• Severe hepatic failure
• Visual or auditory disturbances
• Blood dyscrasias such as neutropenia
• Severe skin reactions like Stevens‑Johnson syndrome

Before initiating therapy with Issoferrol, several precautions should be observed to ensure patient safety.

• Renal function monitoring: Assess serum creatinine and eGFR regularly.
• Hepatic function monitoring: Check liver enzymes and bilirubin at baseline and during treatment.
• Serum ferritin assessment: Evaluate iron burden before and throughout therapy.
• Concomitant nephrotoxic drugs: Avoid or use with caution when combined with other kidney‑harmful agents.
• Pregnancy and lactation: Use only if potential benefit justifies potential risk; discuss with a specialist.
• Store at room temperature: Keep below 25 °C in the original container, protect from moisture and light.

Deferasirox can interact with other medicines, affecting its efficacy or safety.

Major Interactions (Avoid)

• Co‑administration with other iron chelators (e.g., deferoxamine) due to additive toxicity.
• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) increasing deferasirox plasma levels.
• Nephrotoxic agents (e.g., aminoglycosides, NSAIDs) heightening renal risk.
• High‑dose vitamin C supplements that may enhance iron mobilization.

Moderate Interactions (Monitor Closely)

• Antihypertensives such as ACE inhibitors or ARBs that affect renal function.
• Diuretics that may alter electrolyte balance.
• Oral anticoagulants (warfarin) where deferasirox may affect INR.
• Statins, as hepatic metabolism may be shared.