Miscellaneous hematological agents:
Indications for: FERRIPROX
Transfusional iron overload due to thalassemia syndromes, sickle cell disease or other anemias.
Limitations of Use:
The safety and efficacy for the treatment of transfusional iron overload in patients with myelodysplastic syndrome or with Diamond Blackfan anemia have not been established.
Adults and Children:
<8yrs: not established. Individualize. Round dose to the nearest half-tab (250mg or 500mg). ≥8yrs: Initially 25mg/kg 3 times daily (total of 75mg/kg/day). Adjust dose to individual response and therapeutic goals; max 33mg/kg 3 times daily (total of 99mg/kg/day). Consider temporary dose interruption if serum ferritin falls consistently <500mcg/L.
Agranulocytosis and neutropenia.
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 and supplement if deficient. Embryo-fetal toxicity. Advise to use effective contraception during and for ≥6 months (females of reproductive potential) or ≥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).
Iron chelating agent.
Avoid concomitant other drugs associated with neutropenia or agranulocytosis; if unavoidable, closely monitor ANC. Avoid concomitant UGT1A6 inhibitors (eg, diclofenac, probenecid, milk thistle). Allow ≥4-hour interval with antacids or mineral supplements containing polyvalent cations (eg, iron, aluminum, zinc).
Nausea, vomiting, abdominal pain, increased ALT/AST, arthralgia, neutropenia, chromaturia, pyrexia, bone pain, headache, pain in extremity, sickle cell anemia with crisis, back pain, oropharyngeal pain, nasopharyngitis, cough; agranulocytosis (manage appropriately if occurs; do not resume).
Generic Drug Availability:
Tabs 500mg—100; 1000mg (three times a day)—50; 1000mg (twice a day)—50, 500; Oral soln 80mg/mL—250mL, 500mL; 100mg/mL—500mL