Deferasirox Glenmark
Iron Chelating Agent — Treatment of Chronic Iron Overload
Deferasirox Glenmark is a prescription iron chelating agent used to treat chronic iron overload caused by repeated blood transfusions in conditions such as beta-thalassemia major, sickle cell disease, and myelodysplastic syndromes (MDS). It works by binding to excess iron in the body and removing it primarily through the feces. This comprehensive guide covers uses, dosage, side effects, drug interactions, and important safety information based on international medical guidelines.
Quick Facts
Key Takeaways
- Deferasirox Glenmark is an oral iron chelator that removes excess iron from the body, primarily used in patients receiving regular blood transfusions for conditions like thalassemia and sickle cell disease.
- The medication is taken once daily and is available as film-coated tablets in 90 mg, 180 mg, and 360 mg strengths, with dosing based on body weight.
- Regular monitoring of kidney function, liver function, and serum ferritin levels is essential during treatment, along with annual vision and hearing assessments.
- Common side effects include gastrointestinal symptoms (nausea, diarrhea, abdominal pain), rash, and headache, with kidney function changes being the most frequently reported finding.
- The medication interacts with many drugs including ciclosporin, hormonal contraceptives, and certain pain relievers — always inform your doctor about all medications you are taking.
What Is Deferasirox Glenmark and What Is It Used For?
Deferasirox Glenmark contains the active substance deferasirox, which belongs to a class of medications known as iron chelating agents. These drugs are specifically designed to capture and remove surplus iron from the body, a process that is critical for patients who accumulate dangerous levels of iron due to chronic transfusion therapy. The human body has no natural mechanism for actively excreting large quantities of iron, making medical intervention essential when transfusion-dependent iron overload develops.
Repeated blood transfusions are frequently required for patients living with various types of anemia, including beta-thalassemia major, sickle cell disease, and myelodysplastic syndromes (MDS). While these transfusions are life-saving, each unit of transfused blood contains approximately 200–250 mg of iron. Over time, this iron accumulates in vital organs, particularly the liver, heart, and endocrine glands, where it generates reactive oxygen species through the Fenton reaction. This oxidative damage can lead to progressive organ failure if left untreated.
In patients with non-transfusion-dependent thalassemia syndromes, iron overload can develop through a different mechanism. Ineffective erythropoiesis (the process of red blood cell production) leads to increased intestinal absorption of dietary iron and suppression of hepcidin, the hormone that regulates iron metabolism. Over time, even without regular transfusions, iron levels can reach clinically significant thresholds that warrant chelation therapy.
Approved Indications
Deferasirox Glenmark is approved for the following clinical indications:
- Transfusion-dependent iron overload: Treatment of chronic iron overload due to frequent blood transfusions (receiving 7 mL/kg/month or more of packed red blood cells) in patients with beta-thalassemia major aged 6 years and older.
- Other transfusion-dependent anemias: When deferoxamine therapy is contraindicated or inadequate, Deferasirox Glenmark may be used for iron overload in patients with beta-thalassemia with infrequent transfusions, other types of anemias, and in children aged 2 to 5 years.
- Non-transfusion-dependent thalassemia: For patients aged 10 years and older with iron overload related to thalassemia syndromes when deferoxamine is contraindicated or insufficient.
The goal of iron chelation therapy is to maintain the body’s iron burden at safe levels, prevent organ damage from iron toxicity, and improve long-term survival and quality of life. Clinical studies, including the landmark EPIC trial (Evaluation of Patients’ Iron Chelation with Exjade), have demonstrated that deferasirox effectively reduces liver iron concentration and serum ferritin levels when used consistently over time.
What Should You Know Before Taking Deferasirox Glenmark?
Contraindications
You must not take Deferasirox Glenmark in the following situations:
- Allergy to deferasirox or any of the other ingredients in the tablets (including microcrystalline cellulose, crospovidone, sodium starch glycolate, magnesium stearate, and the film coating components).
- Moderate or severe kidney disease: Significant renal impairment increases the risk of serious kidney damage, as deferasirox and its metabolites are partially cleared by the kidneys.
- Concurrent use of other iron chelating agents: Using Deferasirox Glenmark together with deferoxamine or deferiprone simultaneously can lead to excessive chelation, potentially causing dangerous reductions in essential metal levels.
Warnings and Precautions
Before and during treatment with Deferasirox Glenmark, you should inform your healthcare provider about any of the following conditions or symptoms:
- Kidney or liver disease: Deferasirox can cause kidney injury and liver failure, which can be fatal in rare cases. Baseline and regular monitoring of serum creatinine and liver transaminases is mandatory.
- Heart disease caused by iron overload: Patients with cardiac iron loading require careful monitoring, as chelation therapy can transiently mobilize iron and affect cardiac function.
- Significant decrease in urine output: A marked reduction in urination may indicate kidney problems and requires immediate medical evaluation.
- Severe allergic reactions: Seek emergency medical help if you develop severe rash, difficulty breathing, dizziness, or swelling of the face and throat.
- Severe skin reactions: A combination of rash, red skin, blistering on lips or eyes or mouth, peeling skin, high fever, flu-like symptoms, and swollen lymph nodes may indicate Stevens-Johnson syndrome or toxic epidermal necrolysis.
- Liver symptoms: Drowsiness, upper right abdominal pain, yellowing of the skin or eyes, and dark urine may indicate liver damage.
- Hyperammonemia: Difficulty thinking, reduced alertness, extreme drowsiness with low energy may indicate high ammonia levels in the blood, which can be associated with liver or kidney problems.
- Gastrointestinal bleeding: Vomiting blood or passing black stools requires immediate medical attention.
- Abdominal pain: Frequent stomach pain, especially after eating or taking the medication, may indicate ulceration or other gastrointestinal complications.
- Low blood cell counts: Low platelets or white blood cell counts in blood tests require close monitoring.
- Blurred vision: Visual disturbances should be reported promptly, as deferasirox can affect the eyes.
Treatment Monitoring
During treatment with Deferasirox Glenmark, your healthcare provider will conduct regular tests to ensure safety and effectiveness:
- Blood tests: Serum ferritin (to track iron levels), serum creatinine (kidney function), and liver transaminases (liver function) should be measured regularly — typically monthly or more frequently at the start of treatment.
- Urine tests: Protein in the urine is monitored as an early indicator of kidney stress.
- Kidney biopsy: May be performed if your doctor suspects significant kidney damage.
- MRI scans: Liver MRI (using T2* or R2 techniques) may be used to directly measure liver iron concentration, providing more accurate assessment than serum ferritin alone.
- Vision and hearing tests: Annual ophthalmologic and audiologic assessments are recommended, as deferasirox can rarely cause visual and auditory disturbances.
Pregnancy and Breastfeeding
Deferasirox Glenmark is not recommended during pregnancy unless the benefit clearly outweighs the potential risk to the unborn child. Animal studies have shown reproductive toxicity, and there is limited clinical data in pregnant women. If you are pregnant, think you may be pregnant, or are planning to become pregnant, consult your doctor before using this medicine.
Women of childbearing potential using hormonal contraceptives (birth control pills, patches, or implants) should be aware that deferasirox may reduce the effectiveness of these methods. An additional or alternative contraceptive method, such as condoms, is recommended while taking this medication.
Breastfeeding is not recommended during treatment with Deferasirox Glenmark, as it is unknown whether deferasirox passes into human breast milk.
Use in the Elderly
Deferasirox Glenmark can be used by patients aged 65 years and older at the same dosage as other adults. However, elderly patients may experience side effects more frequently, particularly diarrhea. Close monitoring by a physician is recommended, and dosage adjustments may be necessary based on individual tolerance and kidney function.
Use in Children
Deferasirox Glenmark can be used in children and adolescents aged 2 years and above who receive regular blood transfusions, and in those aged 10 years and above with non-transfusion-dependent thalassemia. The dose is adjusted as the child grows. The medication is not recommended for children younger than 2 years of age.
How Does Deferasirox Glenmark Interact with Other Drugs?
Drug interactions can significantly affect the safety and effectiveness of Deferasirox Glenmark. Deferasirox is metabolized primarily by glucuronidation (via UGT1A1 and UGT1A3) and to a lesser extent by oxidative metabolism (via CYP1A2 and CYP2C8). It also inhibits CYP1A2 and CYP2C8 and induces CYP3A4. These metabolic pathways create the potential for clinically significant interactions with a wide range of medications.
Major Interactions
| Medication | Category | Interaction Effect | Recommendation |
|---|---|---|---|
| Other iron chelators (deferoxamine, deferiprone) | Iron chelation | Excessive chelation; dangerous reduction of essential metals | Contraindicated — do not combine |
| Aluminum-containing antacids | Antacid | Chelation of aluminum; reduced absorption of deferasirox | Do not take at the same time of day |
| Ciclosporin | Immunosuppressant | Decreased ciclosporin levels due to CYP3A4 induction by deferasirox | Monitor ciclosporin levels closely; adjust dose as needed |
| Repaglinide | Diabetes | Increased repaglinide levels due to CYP2C8 inhibition | Monitor blood glucose closely; dose adjustment may be needed |
| Busulfan | Chemotherapy / transplant preparation | Increased busulfan exposure due to CYP3A4 pathway involvement | Monitor busulfan levels; dose adjustment may be required |
| Theophylline | Respiratory | Increased theophylline levels due to CYP1A2 inhibition | Monitor theophylline levels closely |
| NSAIDs (ibuprofen, aspirin) | Pain / anti-inflammatory | Increased risk of gastrointestinal ulceration and bleeding | Avoid combination if possible; monitor for GI bleeding |
| Anticoagulants (warfarin) | Blood thinner | Increased risk of bleeding; possible pharmacokinetic interaction | Monitor INR closely; dose adjustment may be needed |
Other Notable Interactions
| Medication | Used For | Interaction Detail |
|---|---|---|
| Simvastatin | Cholesterol lowering | CYP3A4 substrate; levels may be affected by deferasirox |
| Hormonal contraceptives | Birth control | Reduced effectiveness; use additional contraception |
| Midazolam | Anxiety / sedation | CYP3A4 substrate; levels may decrease with concurrent use |
| Rifampicin | Tuberculosis | UGT inducer; may reduce deferasirox levels significantly |
| Phenytoin / Carbamazepine / Phenobarbital | Epilepsy | UGT inducers; may reduce deferasirox levels |
| Cholestyramine | Cholesterol lowering | May reduce deferasirox absorption by binding it in the gut |
| Ritonavir | HIV treatment | Complex enzyme interactions; monitor closely |
| Paclitaxel | Cancer treatment | CYP2C8 substrate; increased paclitaxel exposure possible |
| Corticosteroids | Anti-inflammatory | Increased risk of gastrointestinal side effects |
| Oral bisphosphonates | Osteoporosis | Increased gastrointestinal irritation risk |
Always inform your healthcare provider and pharmacist about all medications you are currently taking, have recently taken, or plan to take. This includes prescription medicines, over-the-counter drugs, herbal supplements, and vitamins. Some interactions may require additional blood tests for monitoring drug levels.
What Is the Correct Dosage of Deferasirox Glenmark?
Treatment with Deferasirox Glenmark should be supervised by a physician experienced in the management of iron overload from blood transfusions. The dose is individualized based on body weight, the rate of iron intake from transfusions, and the patient’s treatment goals. Regular monitoring of serum ferritin and other parameters guides dose adjustments over time.
Adults — Transfusion-Dependent Patients
Standard Dosing (Film-Coated Tablets)
- Starting dose: 14 mg/kg body weight per day
- Maintenance dose: Adjusted in steps of 3.5–7 mg/kg based on response
- Maximum dose: 28 mg/kg body weight per day
A higher or lower starting dose may be recommended by your doctor based on your individual treatment needs, including the current transfusion rate and baseline serum ferritin.
Non-Transfusion-Dependent Patients (Adults)
- Starting dose: 7 mg/kg body weight per day
- Maximum dose: 14 mg/kg body weight per day
Children and Adolescents
Transfusion-Dependent Children (Ages 2+)
- Starting dose: 14 mg/kg body weight per day
- Maximum dose: 28 mg/kg body weight per day
- Dose is adjusted as the child grows and based on treatment response
Non-Transfusion-Dependent Children (Ages 10+)
- Starting dose: 7 mg/kg body weight per day
- Maximum dose: 7 mg/kg body weight per day
Deferasirox Glenmark is not recommended for children younger than 2 years of age.
Elderly Patients (65 Years and Older)
The same dosing recommendations apply to elderly patients as for other adults. However, elderly patients should be monitored more closely for adverse effects, particularly diarrhea, as they may be more susceptible to side effects. Dose adjustments should be made cautiously, taking into account kidney function, which naturally declines with age.
| Patient Group | Starting Dose | Maximum Dose | Notes |
|---|---|---|---|
| Adults (transfusion-dependent) | 14 mg/kg/day | 28 mg/kg/day | Adjust based on serum ferritin |
| Adults (non-transfusion-dependent) | 7 mg/kg/day | 14 mg/kg/day | Monitor liver iron concentration |
| Children 2+ (transfusion-dependent) | 14 mg/kg/day | 28 mg/kg/day | Adjust as child grows |
| Children 10+ (non-transfusion-dependent) | 7 mg/kg/day | 7 mg/kg/day | Close monitoring required |
| Elderly (65+) | 14 mg/kg/day | 28 mg/kg/day | Enhanced monitoring for side effects |
How to Take Deferasirox Glenmark
- Take once daily, at approximately the same time each day, with water.
- Film-coated tablets can be taken on an empty stomach or with a light meal.
- For patients who cannot swallow whole tablets, they may be crushed and sprinkled on soft food such as yogurt or applesauce. The food must be consumed immediately and completely — do not store for later use.
- Taking the medication at the same time each day helps establish a consistent routine and maintain stable blood levels.
Missed Dose
If you forget a dose, take it as soon as you remember on the same day. Take the next dose at the scheduled time. Do not take a double dose the next day to make up for a missed dose. Consistency is important for effective iron chelation, so try to establish a daily routine for taking your medication.
Overdose
If you take more Deferasirox Glenmark than prescribed, or if a child accidentally ingests the medication, seek immediate medical attention. Contact your local poison control center or emergency services. Bring the medication packaging to show the healthcare provider. Overdose symptoms may include abdominal pain, diarrhea, nausea, vomiting, and potentially serious kidney or liver damage.
Duration of Treatment
Deferasirox Glenmark is a long-term treatment that may continue for months or years, as long as iron chelation therapy is needed. Do not stop taking the medication without consulting your doctor, as discontinuation will allow excess iron to accumulate again. Your doctor will monitor your condition regularly and determine when treatment should be modified or discontinued based on your iron levels and overall health status.
What Are the Side Effects of Deferasirox Glenmark?
Like all medicines, Deferasirox Glenmark can cause side effects, although not everybody gets them. Most side effects are mild to moderate and generally resolve within the first few days to weeks of treatment as the body adjusts. However, some side effects can be serious and require immediate medical attention.
Very Common
- Abnormal kidney function tests (elevated serum creatinine)
Common
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Bloating / flatulence
- Constipation
- Indigestion (dyspepsia)
- Rash
- Headache
- Abnormal liver function tests (elevated transaminases)
- Itching (pruritus)
- Protein in urine (proteinuria)
Uncommon
- Dizziness
- Fever
- Sore throat
- Swollen arms or legs (edema)
- Skin color changes (pigmentation changes)
- Anxiety
- Sleep disturbances
- Fatigue
Frequency Not Known
- Decreased platelet count (thrombocytopenia)
- Worsening anemia
- Decreased white blood cell count (neutropenia)
- Pancytopenia (decrease of all blood cell types)
- Hair loss (alopecia)
- Kidney stones
- Low urine output
- Stomach or intestinal ulcers
- Severe upper abdominal pain (pancreatitis)
- Abnormal blood acid levels (metabolic acidosis)
Serious Side Effects Requiring Immediate Medical Attention
- Severe rash, difficulty breathing, dizziness, or swelling of the face and throat (signs of a severe allergic reaction)
- Rash, red skin, blistering on lips/eyes/mouth, peeling skin, high fever, flu-like symptoms, swollen lymph nodes (signs of severe skin reactions such as Stevens-Johnson syndrome)
- Marked decrease in urine output (signs of kidney problems)
- Drowsiness, upper right abdominal pain, yellowing of skin or eyes, dark urine (signs of liver problems)
- Difficulty thinking, reduced alertness, extreme drowsiness (signs of high ammonia levels)
- Vomiting blood or black stools (signs of gastrointestinal bleeding)
- Severe upper abdominal pain (possible pancreatitis)
- Blurred or disturbed vision
- Hearing loss or impairment
If you experience blurred or cloudy vision, or if you notice decreased hearing, inform your doctor as soon as possible. While these effects are uncommon, early detection allows for appropriate management and potential dose adjustment.
If any of the common side effects become severe or persistent, or if you notice any effects not listed here, please consult your doctor or pharmacist. Reporting suspected side effects helps regulatory authorities continuously monitor the benefit-risk balance of medicines.
How Should You Store Deferasirox Glenmark?
Proper storage of Deferasirox Glenmark is essential to maintain the medication’s effectiveness and safety throughout its shelf life. The following guidelines should be observed:
- Keep out of sight and reach of children. Store in a secure location to prevent accidental ingestion, which can be dangerous.
- Check the expiry date printed on the blister pack and the outer carton (marked “EXP”). The expiry date refers to the last day of the stated month. Do not use the medication after this date.
- Do not use if packaging is damaged or appears to have been previously opened, as this may affect the quality of the tablets.
- Dispose of properly. Do not discard medicines in wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use. These measures help protect the environment.
Deferasirox Glenmark film-coated tablets are available in blister packs containing 30 or 90 tablets, bottles with child-resistant caps containing 30 tablets, and bulk packs containing 1,000 tablets. Not all pack sizes may be marketed in all countries.
What Does Deferasirox Glenmark Contain?
Active Ingredient
| Tablet Strength | Deferasirox Content | Appearance | Imprint |
|---|---|---|---|
| 90 mg | 90 mg deferasirox | Light blue, oval, biconvex, beveled edges | L / 663 |
| 180 mg | 180 mg deferasirox | Medium blue, oval, biconvex, beveled edges | L / 664 |
| 360 mg | 360 mg deferasirox | Dark blue, oval, biconvex, beveled edges | L / 665 |
Inactive Ingredients (Excipients)
The tablet core contains: microcrystalline cellulose, crospovidone, colloidal anhydrous silicon dioxide, poloxamer, povidone, sodium starch glycolate, and magnesium stearate.
The film coating contains: hypromellose, titanium dioxide (E171), macrogol 4000, talc, and indigo carmine aluminum lake (E132).
Can You Drive While Taking Deferasirox Glenmark?
Deferasirox Glenmark may cause dizziness in some patients, which is classified as an uncommon side effect. If you experience dizziness or any other symptoms that may affect your concentration or reaction time, refrain from driving vehicles or operating tools and machinery until these effects have resolved. You are personally responsible for assessing whether you are fit to drive or perform tasks that require alertness. Consider the effects and side effects of this medication when making this determination, and discuss any concerns with your doctor or pharmacist.
Frequently Asked Questions about Deferasirox Glenmark
Deferasirox Glenmark is an oral iron chelating agent used to treat chronic iron overload caused by repeated blood transfusions in patients with conditions such as beta-thalassemia major (from age 6 and above), sickle cell disease, and myelodysplastic syndromes. It is also used for non-transfusion-dependent thalassemia syndromes where iron overload develops over time. The medication works by binding excess iron and facilitating its removal from the body primarily through the feces.
Take Deferasirox Glenmark once daily at approximately the same time each day with water. The film-coated tablets can be taken on an empty stomach or with a light meal. For patients who cannot swallow tablets whole, they may be crushed and sprinkled on soft food such as yogurt or applesauce. The food should be consumed immediately and completely — do not store it for later use. Consistency with timing helps maintain effective iron chelation.
Regular monitoring is essential throughout treatment with Deferasirox Glenmark. This includes blood tests for serum ferritin (to track iron burden), serum creatinine (kidney function), and liver transaminases (liver function). Urine tests for protein are also required. Vision and hearing assessments should be performed annually. Your doctor may also order MRI scans to measure liver iron concentration. These results guide dose adjustments and help detect potential complications early.
Deferasirox Glenmark is not recommended during pregnancy unless absolutely necessary and the potential benefit justifies the risk. Animal studies have shown reproductive toxicity. Women using hormonal contraceptives should use an additional or alternative method (such as condoms), as deferasirox may reduce the effectiveness of hormonal birth control. Breastfeeding is also not recommended during treatment. Always discuss family planning with your doctor if you are taking this medication.
Film-coated tablets (such as Deferasirox Glenmark) are swallowed whole with water or crushed and sprinkled on soft food. Dispersible tablets are dissolved in water or juice before being consumed. The two formulations have different bioavailability, meaning the doses are not directly interchangeable. Film-coated tablets generally have improved absorption and better gastrointestinal tolerability. If switching between formulations, your doctor will recalculate the appropriate dose to ensure effective treatment continues.
If you miss a dose, take it as soon as you remember on the same day. Take your next dose at the usual scheduled time. Do not take a double dose the following day to compensate for the missed one. If you have any concerns about missed doses or your dosing schedule, consult your doctor or pharmacist for advice.
References
This article is based on the following peer-reviewed sources and international medical guidelines:
- European Medicines Agency (EMA). Deferasirox — Summary of Product Characteristics. www.ema.europa.eu. Accessed January 2026.
- Cappellini MD, Cohen A, Piga A, et al. A Phase 3 Study of Deferasirox (ICL670), a Once-Daily Oral Iron Chelator, in Patients with Beta-Thalassemia. Blood. 2006;107(9):3455-3462. doi:10.1182/blood-2005-08-3430
- Cappellini MD, Porter J, El-Beshlawy A, et al. Tailoring iron chelation by iron intake and serum ferritin: the prospective EPIC study of deferasirox in 1744 patients with transfusion-dependent anemias. Haematologica. 2010;95(4):557-566.
- Taher AT, Porter JB, Viprakasit V, et al. Deferasirox effectively reduces iron overload in non-transfusion-dependent thalassemia (NTDT) patients: 1-year results from the THALASSA study. Blood. 2012;120(5):970-977.
- Brittenham GM. Iron-Chelating Therapy for Transfusional Iron Overload. N Engl J Med. 2011;364(2):146-156. doi:10.1056/NEJMct1004810
- World Health Organization (WHO). Model List of Essential Medicines. 23rd List, 2023. www.who.int.
- U.S. Food and Drug Administration (FDA). Exjade (deferasirox) Prescribing Information. www.fda.gov. Accessed January 2026.
- National Institute for Health and Care Excellence (NICE). Managing blood transfusion-related iron overload. www.nice.org.uk.
- Thalassaemia International Federation. Guidelines for the Management of Transfusion Dependent Thalassaemia (TDT). 4th Edition, 2021.
Medical Editorial Team
This article has been reviewed by the iMedic Medical Review Board, comprising board-certified physicians specializing in hematology, clinical pharmacology, and internal medicine. All medical claims are supported by peer-reviewed evidence from international guidelines (EMA, FDA, WHO) and the GRADE evidence framework.
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