Table 3.
Al-hijamah versus iron chelation therapy for treating iron overload
| Iron chelation therapy | Al-hijamah (triple S technique) | |
|---|---|---|
| Examples and nature of treatment | • Deferoxamine, deferasirox and deferiprone • Pharmacological treatments • Better to be combined with Al-hijamah for treating iron overload |
• Al-hijamah is a simple percutaneous excretory procedure that is distinct from traditional WCT • Better to be combined with iron chelation therapy |
| Route of administration (or method of practice)95–98 | For deferoxamine: Subcutaneous or intravenous as continuous infusion 5–7 days weekly; not orally available; 20–60 mg/kg/day averaged over a week if not given daily For deferasirox: Oral, as a suspension, once daily (or in some circumstances divided twice daily); 20–40 mg/kg/day, highly individualized and is dependent on the transfusion rate For deferiprone: Oral as tablets, generally in three divided doses; 75 mg/kg/day |
Percutaneous |
| Mechanism of action95–98 | For deferoxamine: Binds free iron in the blood to enhance its urinary excretion Removes excess tissue iron; eg, the liver Affects expression and release of inflammatory mediators by specific cell types60,61 For deferasirox: Selective for iron (as Fe3+) Binds iron with high affinity in a 2:1 ratio For deferiprone: Has an affinity for ferric ion (iron III). Deferiprone binds with ferric ions to form neutral complexes that are stable over a wide range of pH values |
Pressure-dependent, size-dependent nonspecific filtration of blood circulation through the fenestrated dermal capillaries causing nonspecific blood clearance;1,18 eg, excretion of iron and ferritin |
| Nature of iron excretion | Pharmacological iron excretion | Physiological pressure-dependent mechanism |
| Methodology | Indirect iron excretion | Direct iron excretion |
| Clearance of blood and interstitial fluids | Reported to clear blood of excess iron and ferritin | Reported to clear both blood and interstitial fluids from excess pathological substances; eg, autoantibodies and ferritin in a nonspecific manner1,13 |
| Indications | Iron overload conditions | A long list of disease conditions that include pain conditions (eg, back pain), autoimmune diseases (eg, rheumatoid arthritis), neurological conditions (eg, headache), infections (eg, cellulitis), and others1–3,13,63 |
| Route of iron excretion | Urine and stool | Percutaneous |
| Frequency of administration | Daily | Every 1–3 months |
| Tolerability | Tolerable in most cases except when allergy or severe side effects develop | Tolerable |
| Duration per a single treatment | For deferoxamine, Infusion takes about 8 hours per session For deferasirox and deferiprone, treatment is oral |
0.5–1 hour |
| Plasma half-life95–98 | For deferoxamine: Short (∼20–30 minutes) For deferasirox: Long (11–16 hours) For deferiprone: Intermediate (∼2–3 hours) |
No half-life as Al-hijamah is a minor surgical excretory procedure |
| Other therapeutic benefits | None | Pharmacological potentiation, immunological potentiation, analgesic effect, improvement of microcirculation, and others |
| Therapeutic values of combining Al-hijamah with iron chelation therapy | Al-hijamah-induced excretion of iron and ferritin may: • Improve the therapeutic effects of iron chelators • Decrease the needed drug doses • Decrease the frequency of drug administration • Decrease the duration of scheduled treatment • Decrease the drug-induced side effects |
Combining iron chelators with Al-hijamah may: • Potentiate the state of negative iron balance (Fe output > Fe input) • Mobilize more iron from tissues to blood • Enhance iron excretion • Protect vital organs from tissue damage |
| Treatment of other diseases or associated disease | None | Yes. WCT and Al-hijamah were reported to treat many disease conditions that are different in etiology and pathogeneses |
Abbreviation: WCT, wet cupping therapy.