Miscellaneous hematological agents:
Indications for FERRIPROX:
Treatment of transfusional iron overload due to thalassemia syndromes when current chelation therapy is inadequate.
Limitations of Use:
The safety and efficacy for the treatment of transfusional iron overload in other chronic anemias have not been established.
Individualize. Round dose to the nearest 250mg or 500mg tab or 2.5mL soln. 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, arthralgia, neutropenia, chromaturia; agranulocytosis (manage appropriately if occurs; do not resume).
Tabs 500mg—100; 1000mg (three times a day)—50; 1000mg (twice a day)—50, 500; Oral soln—500mL (w. measuring cup)