Issoferrol (Deferasirox)

Deferasirox is used to manage conditions characterized by iron overload, primarily in patients receiving regular blood transfusions.

• Chronic iron overload due to transfusion‑dependent anemias (e.g., thalassemia, sickle cell disease): lowers systemic iron burden and helps maintain target ferritin levels.
• Iron overload in myelodysplastic syndromes: facilitates iron excretion and reduces organ toxicity.
• Iron overload in other transfusion‑dependent disorders: supports long‑term chelation therapy to prevent organ damage.

• Deferasirox binds free iron in the plasma and intracellular compartments with high affinity, forming a stable complex that is eliminated primarily via fecal excretion. By reducing the labile plasma iron pool, it limits iron deposition in vital organs and helps restore normal iron homeostasis in patients with chronic transfusion‑related iron accumulation.

Deferasirox may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Nausea: mild to moderate gastrointestinal discomfort.
• Diarrhea: loose stools that may affect hydration.
• Elevated serum creatinine: indicates changes in renal function.
• Skin rash: localized itching or erythema.
• Abdominal pain: intermittent discomfort in the stomach area.

Serious or Rare Side Effects

• Acute renal failure: sudden loss of kidney function requiring medical attention.
• Hepatic injury: elevated liver enzymes or hepatitis.
• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Hematologic abnormalities: pancytopenia or severe thrombocytopenia.
• Hypotension: marked drop in blood pressure, especially with rapid infusion of oral solution.

Before initiating deferasirox therapy, clinicians should consider several safety measures.

• Renal monitoring: assess serum creatinine and eGFR regularly.
• Hepatic monitoring: check liver function tests at baseline and periodically.
• Ferritin assessment: measure serum ferritin to guide chelation intensity.
• Pregnancy and lactation: avoid use unless benefits outweigh potential risks, as safety data are limited.
• Concomitant nephrotoxic drugs: use with caution when combined with NSAIDs or aminoglycosides.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

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

Major Interactions (Avoid)

• Other iron chelators (e.g., deferoxamine, deferiprone): may increase toxicity.
• Strong CYP3A4 inducers (e.g., rifampin, carbamazepine): reduce deferasirox plasma levels.
• High‑dose vitamin C supplements: enhance iron mobilization and risk of renal injury.

Moderate Interactions (Monitor Closely)

• Antacids containing aluminum or magnesium: may decrease absorption of deferasirox.
• NSAIDs: increase risk of renal impairment when used together.
• ACE inhibitors or ARBs: require monitoring of renal function and electrolytes.
• Diuretics: may potentiate changes in serum creatinine.
• Oral contraceptives: possible alteration in hormone levels, monitor efficacy.