Table 2.
Usual Doses of Deferoxamine or Deferasirox for Transfusional Iron Overload.*
| Hepatic Iron Concentration |
No Cardiac Iron Overload (T2★, ≥20 msec) | Cardiac Iron Overload (T2★, <20 msec) | |||
|---|---|---|---|---|---|
| Daily Transfusional Iron Intake | Mild to Moderate | Severe | |||
| <0.3 mg/kg of body weight | 0.3 to 0.5 mg/kg of body weight | >0.5 mg/kg of body weight | T2★ 10 to <20 msec | T2★, <10 msec | |
| ≥15 mg/g, dry weight | Deferoxamine: 40–50 mg/kg/day, 8 to 10 hr/day, 6 or 7 days/wk, by subcutaneous infusion; deferasirox: oral dose of 30–40 mg/kg daily | Deferoxamine: 40–50 mg/kg/day, 8 to 10 hr/day, 6 or 7 days/wk, by subcutaneous infusion; deferasirox: oral dose of 30–40 mg/kg daily | Deferoxamine: 40–50 mg/kg/day, 8 to 10 hr/day, 6 or 7 days/wk, by subcutaneous infusion; deferasirox: oral dose of 30–40 mg/kg daily | Deferoxamine: 50 mg/kg/day by continuous intravenous infusion28; deferasirox: oral dose of 40 mg/kg daily, but uncertain efficacy in reducing cardiac iron | Deferoxamine: 50 mg/kg/day by continuous intravenous infusion28; deferasirox: oral dose of 40 mg/kg daily, but uncertain efficacy in reducing cardiac iron |
| 7 to <15 mg/g, dry weight | Deferoxamine: 30–40 mg/kg/day, 8 to 10 hr/day, 5 days/wk, by subcutaneous infusion; deferasirox: oral dose of 20–30 mg/kg daily | Deferoxamine: 40–50 mg/kg/day, 8 to 10 hr/day, 6 or 7 days/wk, by subcutaneous infusion; deferasirox: oral dose of 30–40 mg/kg daily | Deferoxamine: 40–50 mg/kg/day, 8 to 10 hr/day, 6 or 7 days/wk, by subcutaneous infusion; deferasirox: oral dose of 30–40 mg/kg daily | Deferoxamine: 40–50 mg/kg/day, 8 to 10 hr/day, 6 or 7 days/wk, by subcutaneous infusion; deferasirox: oral dose of 30–40 mg/kg daily | Deferoxamine: 40–50 mg/kg/day by continuous infusion28; deferasirox: oral dose of 30–40 mg/kg daily |
| 3 to <7 mg/g, dry weight | Deferoxamine: 30–40 mg/kg/day, 8 to 10 hr/day, 5 days/wk, by subcutaneous infusion; deferasirox: oral dose of 20–30 mg/kg daily | Deferoxamine: 30–40 mg/kg/day, 8 to 10 hr/day, 5 days/wk, by subcutaneous infusion; deferasirox: oral dose of 20–30 mg/kg daily | Deferoxamine: 30–40 mg/kg/day, 8 to 10 hr/day, 5 days/wk, by subcutaneous infusion; deferasirox: oral dose of 20–30 mg/kg daily | Deferoxamine: 40–50 mg/kg/day, 8 to 10 hr/day, 6 or 7 days/wk, by subcutaneous infusion; deferasirox: oral dose of 30–40 mg/kg daily | Deferoxamine: 40–50 mg/kg/day by continuous infusion28; deferasirox: oral dose of 30–40 mg/kg daily |
| <3 mg/g, dry weight | Deferoxamine: suspend therapy; deferasirox: suspend therapy | Deferoxamine: suspend therapy; deferasirox: suspend therapy | Deferoxamine: suspend therapy; deferasirox: suspend therapy | Deferoxamine: adjust intravenous or subcutaneous dose according to therapeutic index32; deferasirox: adjust oral dose, monitoring renal and hepatic function and blood count | Deferoxamine: adjust intravenous or subcutaneous dose according to therapeutic index32; deferasirox: adjust oral dose, monitoring renal and hepatic function and blood count |
*
To minimize interference with growth and skeletal development, the dose of deferoxamine in young children should not exceed 25 to 30 mg per kilogram of body weight. The dose should be adjusted according to the therapeutic index.32 The bioavailability of deferasirox may affect the response. T2★ denotes the cardiac effective transverse relaxation time on magnetic resonance imaging.