Ferriprox (Deferiprone)
Iron chelating agent for the treatment of transfusional iron overload in thalassemia major
Ferriprox (deferiprone) is an oral iron chelating medication used to remove excess iron from the body in patients with thalassemia major who develop iron overload from repeated blood transfusions. It is prescribed when first-line chelation with deferoxamine is contraindicated or insufficient. Due to the risk of agranulocytosis, weekly blood count monitoring is mandatory throughout treatment.
Quick Facts
Key Takeaways
- Ferriprox (deferiprone) is an oral iron chelator that removes excess iron accumulated from repeated blood transfusions in thalassemia major patients.
- The most serious risk is agranulocytosis (severe drop in white blood cells), occurring in 1–2% of patients — weekly blood monitoring is mandatory.
- Taken three times daily at a dose of 25 mg/kg body weight, with a maximum daily dose of 100 mg/kg.
- Contraindicated during pregnancy and breastfeeding due to teratogenic risk; effective contraception is required.
- Reddish-brown discoloration of urine is a harmless and very common effect that indicates the medication is working.
What Is Ferriprox and What Is It Used For?
Ferriprox belongs to a class of medications known as iron chelating agents (also called iron chelators). These drugs work by binding to excess iron in the body and forming a complex that can then be excreted, primarily through the urine. The active substance, deferiprone, chelates iron in a 3:1 molar ratio, meaning three molecules of deferiprone bind to one iron ion, creating a stable, soluble complex that the kidneys can filter out.
Iron overload is a serious and potentially life-threatening condition that develops in patients who require regular blood transfusions. Each unit of transfused red blood cells delivers approximately 200–250 mg of iron, and the human body has no physiological mechanism to actively excrete large amounts of iron. Over time, without chelation therapy, excess iron accumulates in vital organs including the heart, liver, and endocrine glands, leading to organ damage and failure. Cardiac iron overload remains the leading cause of death in patients with transfusion-dependent thalassemia.
Thalassemia major (also known as transfusion-dependent thalassemia or Cooley’s anemia) is a hereditary blood disorder characterized by severely reduced or absent production of hemoglobin, the oxygen-carrying protein in red blood cells. Patients with thalassemia major typically require lifelong blood transfusions every 2–4 weeks to maintain adequate hemoglobin levels. While these transfusions are essential for survival, they inevitably lead to progressive iron accumulation.
Ferriprox is specifically indicated for the treatment of iron overload in patients with thalassemia major when standard chelation therapy with deferoxamine (Desferal) is contraindicated (for example, due to allergic reactions or severe side effects) or when deferoxamine therapy alone is inadequate in controlling iron levels. It can be used as monotherapy or, in some cases, in combination with deferoxamine under specialist supervision.
One of the distinguishing features of deferiprone compared to other iron chelators is its particular effectiveness at removing iron from the heart. Several clinical studies have demonstrated that deferiprone is more effective than deferoxamine at reducing myocardial (heart) iron content, which is clinically significant given that cardiac iron overload is the primary cause of mortality in thalassemia major. The Thalassaemia International Federation (TIF) recognizes deferiprone as an important option in the management of cardiac iron overload.
What Should You Know Before Taking Ferriprox?
Contraindications
Certain conditions and circumstances make Ferriprox unsuitable for use. Understanding these contraindications is critical for patient safety. Do not take Ferriprox if:
- You are allergic to deferiprone or any of the other ingredients in the tablet (microcrystalline cellulose, magnesium stearate, colloidal anhydrous silica, hypromellose, macrogol, titanium dioxide).
- You have had repeated episodes of neutropenia (low white blood cell count, specifically neutrophils).
- You have had agranulocytosis (a dangerously low neutrophil count) at any time previously.
- You are currently taking any medication known to cause neutropenia or agranulocytosis, such as certain chemotherapy agents, clozapine, or carbimazole.
- You are pregnant or breastfeeding.
Warnings and Precautions
The most serious adverse reaction associated with Ferriprox is a severe decrease in white blood cells (neutrophils), a condition known as agranulocytosis. This has occurred in 1–2 out of every 100 patients treated with Ferriprox in clinical studies. Since white blood cells are essential for fighting infection, a low neutrophil count places you at risk of developing a serious and potentially life-threatening infection.
To monitor for neutropenia and agranulocytosis, your doctor will require regular blood tests (complete blood count with differential) as frequently as every week throughout the duration of your treatment with Ferriprox. It is critically important that you attend these appointments without fail. A patient safety card is included with the medication packaging to remind you of this requirement.
If you develop any symptoms of infection while taking Ferriprox — including fever, sore throat, or flu-like symptoms — you must contact your doctor immediately, without waiting for your next scheduled blood test. Your white blood cell count must be checked within 24 hours to rule out agranulocytosis. If agranulocytosis is confirmed, Ferriprox must be stopped immediately and appropriate medical treatment initiated.
Your doctor may recommend additional monitoring if you are HIV-positive or if you have severely impaired liver or kidney function, as these conditions may affect the metabolism and safety profile of the medication. Periodic assessment of serum ferritin levels and potentially liver biopsies will be performed to evaluate the degree of iron overload and the effectiveness of chelation therapy.
Neurological adverse effects, including tremors, gait disturbance, double vision, involuntary muscle contractions, and coordination problems, have been reported in children who were prescribed doses exceeding the recommended maximum of 100 mg/kg/day over prolonged periods. These symptoms were also observed at standard doses in some children. In all reported cases, the neurological symptoms resolved after Ferriprox was discontinued.
Pregnancy and Breastfeeding
Ferriprox has the potential to cause serious harm to an unborn baby and is contraindicated during pregnancy. Animal studies have demonstrated teratogenic effects, meaning the drug can cause birth defects. Ferriprox should only be used during pregnancy if there is absolutely no alternative and the potential benefit justifies the risk to the fetus.
Both female and male patients of reproductive age must take precautions to prevent pregnancy during treatment:
- Women of childbearing potential: Must use effective contraception during Ferriprox treatment and for at least 6 months after the last dose.
- Men: Must use effective contraception during treatment and for at least 3 months after the last dose.
If you become pregnant while taking Ferriprox, contact your doctor immediately. Ferriprox must not be taken while breastfeeding, as it is unknown whether deferiprone passes into breast milk. Your doctor will discuss the risks and advise on the appropriate course of action.
How Does Ferriprox Interact with Other Drugs?
Drug interactions are an important consideration when taking Ferriprox. Certain medications can increase the risk of serious side effects or reduce the effectiveness of deferiprone. Always inform your doctor and pharmacist about all medications you are taking, including prescription drugs, over-the-counter medicines, and dietary supplements.
Major Interactions
The most critical drug interactions involve medications that can independently lower white blood cell counts. The combination of such drugs with Ferriprox significantly increases the risk of developing life-threatening agranulocytosis.
| Interacting Drug | Risk Level | Clinical Effect | Action Required |
|---|---|---|---|
| Clozapine | Contraindicated | Additive risk of agranulocytosis | Do not use together |
| Chemotherapy agents (myelosuppressive) | Contraindicated | Additive bone marrow suppression | Do not use together |
| Carbimazole / Methimazole | Contraindicated | Additive risk of neutropenia | Do not use together |
| Metamizole (Dipyrone) | Contraindicated | Additive risk of agranulocytosis | Do not use together |
Other Important Interactions
Several other substances can affect the way Ferriprox works or may alter its absorption and effectiveness. While not strictly contraindicated, these require careful management.
| Substance | Type of Interaction | Recommendation |
|---|---|---|
| Aluminium-based antacids | Reduced deferiprone absorption due to chelation of aluminium | Avoid concurrent use; separate doses by at least 4 hours |
| Vitamin C (Ascorbic acid) | May alter iron mobilization and increase cardiac toxicity | Consult physician before use; limit to low doses if permitted |
| Polyvalent cation supplements (zinc, calcium, iron) | May form complexes that reduce deferiprone bioavailability | Separate administration by at least 4 hours |
| UGT1A6 inhibitors (e.g., probenecid) | May reduce glucuronidation of deferiprone, altering metabolism | Monitor closely; dose adjustment may be needed |
Because deferiprone is primarily metabolized by glucuronidation via the enzyme UGT1A6 in the liver, drugs that significantly inhibit or induce this pathway could affect deferiprone blood levels. Always discuss any new medications with your treating hematologist before starting them.
What Is the Correct Dosage of Ferriprox?
Ferriprox dosing is weight-based and individualized. Your doctor will calculate the appropriate dose based on your body weight and adjust it according to your serum ferritin levels and clinical response. It is essential to follow your doctor’s instructions precisely and to take the medication as prescribed.
Adults
Standard Adult Dosage
Dose: 25 mg/kg body weight, three times daily
Total daily dose: 75 mg/kg
Maximum daily dose: 100 mg/kg (should not be exceeded)
Administration: First dose in the morning, second at midday, third in the evening
With or without food: Can be taken either way; taking with meals may help you remember
| Body Weight | Dose per Administration | Tablets per Dose | Total Daily Dose |
|---|---|---|---|
| 40 kg | 1,000 mg | 2 tablets | 3,000 mg (6 tablets) |
| 50 kg | 1,250 mg | 2.5 tablets | 3,750 mg (7.5 tablets) |
| 60 kg | 1,500 mg | 3 tablets | 4,500 mg (9 tablets) |
| 70 kg | 1,750 mg | 3.5 tablets | 5,250 mg (10.5 tablets) |
| 80 kg | 2,000 mg | 4 tablets | 6,000 mg (12 tablets) |
The 500 mg tablet has a score line allowing it to be divided into two equal halves, which facilitates dose adjustments for patients whose calculated dose does not correspond to whole tablets.
Children
Pediatric Dosage
The dosing principle for children is the same as for adults: 25 mg/kg three times daily (75 mg/kg total daily dose), with a strict maximum of 100 mg/kg/day. However, it is critical to note that neurological adverse effects have been reported in children, particularly those receiving doses exceeding the recommended maximum over extended periods. Close monitoring by a pediatric hematologist is essential.
Elderly Patients
Elderly Dosage
There is limited clinical experience with Ferriprox in elderly patients. The standard weight-based dosing applies, but doctors may exercise additional caution given the potential for age-related renal or hepatic impairment. More frequent monitoring of blood counts and organ function may be warranted.
Missed Dose
Ferriprox is most effective when taken consistently without missing doses. If you forget to take a dose:
- Take it as soon as you remember, and take the next dose at the usual time.
- If you have missed more than one dose, do not take a double dose to make up for missed doses — simply continue with your regular schedule.
- Do not change your daily dose without speaking to your doctor.
Overdose
There are no reported cases of acute overdose with Ferriprox. However, if you accidentally take more than your prescribed dose, contact your doctor or poison control center immediately. In the event of a significant overdose, supportive care and monitoring of blood counts and organ function would be appropriate. There is no specific antidote for deferiprone overdose.
What Are the Side Effects of Ferriprox?
Like all medicines, Ferriprox can cause side effects, although not everybody gets them. Understanding the potential side effects and their frequency helps you recognize problems early and know when to seek medical attention. The side effects are categorized below by how commonly they occur.
Very Common
- Abdominal pain — stomach discomfort or cramping, particularly in the early weeks of treatment
- Nausea — feeling sick, often improved by taking the medication with food
- Vomiting — may be reduced by taking Ferriprox with meals
- Reddish/brown urine discoloration — this is a harmless effect caused by the excretion of the iron-deferiprone complex and is not a cause for concern
Common
- Agranulocytosis and neutropenia — low white blood cell count (see critical warning above)
- Headache
- Diarrhea
- Increased liver enzymes (ALT, AST) — detected through routine blood tests
- Fatigue — feeling unusually tired
- Increased appetite
Reported (Frequency Not Known)
- Allergic reactions including skin rash or hives (urticaria)
- Joint pain and swelling — ranging from mild pain in one or more joints to significant functional impairment; in most cases, symptoms resolved while continuing treatment
- Neurological disturbances (reported mainly in children) — tremors, gait disturbance, double vision, involuntary muscle contractions, coordination problems. These have been observed particularly in children receiving more than the recommended maximum dose over prolonged periods
If you experience nausea or vomiting, taking Ferriprox with food can significantly help reduce these symptoms. Many patients find that gastrointestinal side effects are most pronounced during the first few weeks of treatment and tend to diminish over time as the body adjusts to the medication. If symptoms persist or are severe, speak with your doctor — do not stop taking the medication without medical advice.
It is important to report any suspected side effects to your healthcare provider, even if they are not listed above. Post-marketing surveillance depends on patient and clinician reporting to continuously evaluate the benefit-risk profile of the medication. You can also report side effects directly to your national medicines regulatory authority.
How Should You Store Ferriprox?
Proper storage of medications is essential to maintain their effectiveness and safety throughout the treatment period. Follow these guidelines for storing Ferriprox:
- Temperature: Store at no more than 30°C (86°F). Avoid exposing the tablets to excessive heat or direct sunlight.
- Container: Keep the tablets in the original bottle with the cap tightly closed to protect from moisture.
- Children: Keep this medicine out of the sight and reach of children at all times.
- Expiry date: Do not use Ferriprox after the expiry date (EXP) printed on the label and carton. The expiry date refers to the last day of that month.
- Disposal: Do not throw unused medicines into household waste or down the drain. Ask your pharmacist how to dispose of medicines you no longer need. These measures help protect the environment.
Ferriprox is supplied in bottles of 100 film-coated tablets. The tablets are white to off-white, capsule-shaped, and marked with “APO” and “500” on one side. Each tablet measures approximately 7.1 mm × 17.5 mm × 6.8 mm and has a score line for splitting into two equal halves.
What Does Ferriprox Contain?
Understanding the full composition of your medication can be important, particularly if you have known allergies or sensitivities to pharmaceutical excipients. Ferriprox contains the following ingredients:
Active Ingredient
Deferiprone 500 mg per tablet. Deferiprone (chemical name: 3-hydroxy-1,2-dimethylpyridin-4(1H)-one) is a synthetic iron chelator with a molecular weight of 139.15 g/mol. It is a bidentate ligand that forms a 3:1 complex with ferric iron (Fe3+).
Inactive Ingredients (Excipients)
Tablet core:
- Microcrystalline cellulose — a commonly used filler and binder in pharmaceutical tablets
- Magnesium stearate — a lubricant that facilitates tablet manufacturing
- Colloidal anhydrous silica — a glidant that improves powder flow during production
Film coating:
- Hypromellose (hydroxypropyl methylcellulose) — forms the film coating
- Macrogol (polyethylene glycol) — a plasticizer for the coating
- Titanium dioxide (E171) — a white colorant
Ferriprox does not contain lactose, gluten, or sucrose. The marketing authorization is held by Chiesi Farmaceutici S.p.A., Parma, Italy. If you have any concerns about any of the ingredients, discuss them with your doctor or pharmacist before starting treatment.
Frequently Asked Questions About Ferriprox
Ferriprox (deferiprone) is an oral iron chelating medication used to treat iron overload caused by repeated blood transfusions in patients with thalassemia major. It works by binding excess iron in the body and facilitating its excretion through urine. It is typically prescribed when first-line chelation therapy with deferoxamine is contraindicated or inadequate. Deferiprone is particularly effective at removing iron from the heart, making it especially valuable in managing cardiac iron overload.
The most serious side effect is agranulocytosis, a severe reduction in white blood cells (neutrophils) that has occurred in 1–2% of patients in clinical trials. This condition can lead to life-threatening infections. Symptoms to watch for include fever, sore throat, and flu-like symptoms. If you experience any of these, contact your doctor immediately — your blood count must be checked within 24 hours. Weekly blood monitoring is mandatory throughout treatment to detect this condition early.
Weekly blood tests (complete blood count) are required to monitor your white blood cell levels, specifically the neutrophil count. This is essential to detect neutropenia or agranulocytosis early, before it leads to a serious infection. Your doctor will also perform periodic tests to monitor serum ferritin levels (to assess iron levels) and liver function. Missing blood tests is not acceptable while on Ferriprox therapy — always attend your scheduled monitoring appointments.
No. Ferriprox is contraindicated during pregnancy and breastfeeding due to the risk of serious harm to the developing baby. Animal studies have shown teratogenic effects. Women of childbearing potential must use effective contraception during treatment and for 6 months after the last dose. Men should also use effective contraception during treatment and for 3 months after the last dose. If you become pregnant while taking Ferriprox, stop the medication and contact your doctor immediately.
Reddish-brown discoloration of the urine is a very common and completely harmless side effect. It occurs because the iron-deferiprone complex is excreted through the kidneys, and this complex has a characteristic reddish-brown color. This is not blood in the urine and does not indicate kidney damage or any other medical problem. The color change is actually a reassuring sign that the medication is actively chelating iron and removing it from your body. If you are concerned, discuss it with your doctor for reassurance.
Yes. Ferriprox can be taken with or without food. However, many patients find it helpful to take Ferriprox with meals for two reasons: it can reduce gastrointestinal side effects such as nausea and vomiting, and it makes it easier to remember your three daily doses (with breakfast, lunch, and dinner). The absorption of deferiprone is not significantly affected by food.
References
This article is based on international medical guidelines and peer-reviewed research. All medical claims are supported by evidence level 1A, the highest quality of evidence based on systematic reviews and randomized controlled trials.
- European Medicines Agency (EMA). Summary of Product Characteristics — Ferriprox (deferiprone). EPAR. Available at: ema.europa.eu/ferriprox. Accessed December 2025.
- Thalassaemia International Federation (TIF). Guidelines for the Management of Transfusion Dependent Thalassaemia (TDT). 4th Edition. Nicosia: TIF; 2021.
- Fisher SA, Brunskill SJ, Doree C, et al. Oral deferiprone for iron chelation in people with thalassaemia. Cochrane Database of Systematic Reviews. 2013;(8):CD004839. doi:10.1002/14651858.CD004839.pub2.
- Pennell DJ, Berdoukas V, Karagiorga M, et al. Randomized controlled trial of deferiprone or deferoxamine in beta-thalassemia major patients with asymptomatic myocardial siderosis. Blood. 2006;107(9):3738–3744.
- World Health Organization. WHO Model List of Essential Medicines. 23rd List. Geneva: WHO; 2023.
- Cappellini MD, Cohen A, Porter J, et al. Guidelines for the Management of Transfusion Dependent Thalassaemia (TDT). 3rd Edition. Nicosia: Thalassaemia International Federation; 2014.
- Kontoghiorghes GJ, Kolnagou A, Peng CT, et al. Safety issues of iron chelation therapy in patients with normal range iron stores including thalassaemia, neurodegenerative, renal and infectious diseases. Expert Opinion on Drug Safety. 2010;9(2):201–206.
- Borgna-Pignatti C, Cappellini MD, De Stefano P, et al. Cardiac morbidity and mortality in deferoxamine- or deferiprone-treated patients with thalassemia major. Blood. 2006;107(9):3733–3737.
Editorial Team
This article has been developed and reviewed by the iMedic Medical Editorial Team, comprising licensed specialist physicians with expertise in hematology, internal medicine, and clinical pharmacology.
Written by specialist physicians with clinical experience in hematology and transfusion medicine. All content follows international evidence-based guidelines from the EMA, WHO, and TIF.
Independently reviewed by the iMedic Medical Review Board. Fact-checked against the current EMA Summary of Product Characteristics and TIF Guidelines for TDT management.
All information meets Evidence Level 1A, based on systematic reviews and randomized controlled trials. Following the GRADE evidence framework for assessing quality of evidence.
No pharmaceutical company sponsorship or commercial funding. All content is editorially independent with no conflicts of interest.