Table 5.
Comparison of FDA-approved iron chelators and their properties
| Chelator | DFO | DFX | DFP |
|---|---|---|---|
| Brand name | Desferal | Exjade, Jadenu | Ferriprox |
| Year of FDA approval | 1968 | 2005 | 2011 |
| Route of administration | IV, IM, SC | PO | PO |
| Indications | Acute and chronic iron overload, Al toxicity in patients with CKD | Chronic iron overload | Transfusional iron overload due to thalassemia syndromes |
| Iron-binding affinity, pM | 26.6 | 22.5 | 19.9 |
| Adverse effects | Abdominal discomfort, nausea, vomiting, diarrhea, hypotension, anaphylaxis | Nausea, vomiting, diarrhea, abdominal pain, rash, cytopenia, hepatic dysfunction, AKI | Nausea, vomiting, abdominal pain, increased ALT, arthralgia, neutropenia |
| Warnings | Auditory and visual toxicity, renal impairment, ARDS | Renal failure, hepatic failure, GI hemorrhage | Agranulocytosis, teratogenicity |
| Elimination t1/2 | 6 h | 8–16 h | 1.9 h |
| Dosing frequency | Continuous pump | Once per d | Three times per d |
| Metabolism | Plasma enzymes | Liver (glucuronidation), mainly UGT 1A1 | Liver (glucuronidation), mainly UGT 1A6 |
| Excretion | Urine, bile/feces | Feces (84%), urine (8%) | Urine (75%–90%) |
| Dose adjustment for renal impairment | eGFR 10–50: not well studieda eGFR <10: contraindicated | eGFR 40–60: ↓dose 50% eGFR <40: contraindicated | No adjustment |
IV, intravenous; IM, intramuscular; SC, subcutaneous; PO, per os; Al, aluminum; ALT, alanine transaminase; ARDS, acute respiratory distress syndrome; GI, gastrointestinal; UGT, UDP-glucuronosyltransferase; ↓, reduction in the recommended dose.
a
A dose reduction to 25%–50% of the normal dose has been recommended by some sources.92