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Brand name: Ferriprox
Drug class: Heavy Metal Antagonists
VA class: AD300
Chemical name: 3-Hydroxy-1,2-dimethylpyridin-4-one
Molecular formula: C7H9NO2
CAS number: 30652-11-0

Medically reviewed by on Feb 7, 2022. Written by ASHP.


  • Risk of agranulocytosis, which may be preceded by neutropenia and may result in serious infection or death. (See Cytopenias under Cautions.)

  • Measure ANC prior to and weekly during therapy; interrupt therapy if neutropenia occurs.

  • If infection occurs, interrupt therapy and monitor ANC more frequently.

  • Instruct patient to temporarily discontinue deferiprone and contact clinician immediately if symptoms suggestive of infection occur.


Heavy metal antagonist; chelates iron.

Uses for Deferiprone

Chronic Iron Overload

Treatment of chronic iron overload resulting from multiple transfusions in patients with thalassemia syndromes when current chelation therapy is inadequate.

Current indication based on the drug's effects on markers of iron overload (e.g., serum ferritin concentrations); long-term safety and clinical benefit, including efficacy in prolonging survival or improving disease-related symptoms or function, not established.

Safety and efficacy for the treatment of chronic iron overload in patients with other types of chronic anemia not established.

Designated an orphan drug by FDA for the treatment of iron overload in patients with hematologic disorders requiring chronic transfusion therapy.

Also has been used in combination with deferoxamine [off-label], either as alternating sequential therapy or simultaneously, for the treatment of iron overload in patients with thalassemia. Further study needed to confirm efficacy.

Deferiprone Dosage and Administration


Restricted Distribution Program

  • Patients must obtain deferiprone through the Ferriprox Total Care program available from Centric Health Resources. Prescriber and patient both must complete enrollment forms; following verification of prescription information and review of healthcare benefits, a 30-day supply of deferiprone will be shipped directly to the patient. To enroll in this program, the prescriber or patient should call 866-758-7071.


Oral Administration

Administer orally 3 times daily. Administration with meals may help reduce nausea.



Chronic Iron Overload

Initial dosage: 25 mg/kg 3 times daily (75 mg/kg per day). Round calculated dosage to the nearest 250 mg (one-half of a 500-mg tablet).

May adjust dosage up to 33 mg/kg 3 times daily (99 mg/kg per day) based on individual patient response and therapeutic goals.

Monitor serum ferritin concentration every 2–3 months to assess effects on body iron stores. If serum ferritin concentration is decreased consistently to <500 mcg/L, consider temporary interruption of therapy.

Prescribing Limits


Chronic Iron Overload

Maximum 33 mg/kg 3 times daily (99 mg/kg per day).

Special Populations

Hepatic Impairment

Not studied conclusively in patients with hepatic impairment; no specific dosage recommendations available.

Renal Impairment

Not studied specifically in patients with renal impairment; no specific dosage recommendations available.

Geriatric Patients

Select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.

Cautions for Deferiprone


  • Known hypersensitivity to deferiprone or any ingredient in the formulation.




Risk of agranulocytosis, which may be preceded by neutropenia; may result in potentially life-threatening infections. Agranulocytosis reported in 1.7% of patients in clinical trials; agranulocytosis and neutropenia usually resolve upon drug discontinuance.

Measure ANC before initiating deferiprone and every week during therapy. If neutropenia (ANC <1500/mm3) develops, temporarily discontinue deferiprone and any other drugs that may cause neutropenia. Obtain CBC, including WBC count corrected for the presence of nucleated RBCs, ANC, and platelet count, daily until neutropenia resolves (ANC ≥1500/mm3). If agranulocytosis (ANC <500/mm3) develops, discontinue deferiprone and initiate appropriate clinical treatment, including hospitalization if necessary.

In patients who have experienced neutropenia or agranulocytosis, do not resume deferiprone therapy unless potential benefit outweighs potential risk.

If infection occurs, interrupt deferiprone therapy and monitor ANC more frequently.

Other Warnings/Precautions

Fetal/Neonatal Morbidity and Mortality

May cause fetal harm; embryofetal lethality and teratogenicity demonstrated in animals. If used during pregnancy or if the patient becomes pregnant, apprise of potential fetal hazard.

Sensitivity Reactions

Hypersensitivity reactions (e.g., Henoch-Schönlein purpura, urticaria, periorbital edema with skin rash) reported.

Prolongation of QT Interval

Effect on QT interval not studied thoroughly to date. Torsades de pointes reported in a patient with a history of QT-interval prolongation who was receiving deferiprone.

Use with caution in patients who may be at increased risk for QT-interval prolongation (e.g., patients with CHF, bradycardia, cardiac hypertrophy, hypokalemia, or hypomagnesemia and those receiving diuretics).

Hepatic Effects

Increased serum transaminase concentrations, sometimes resulting in drug discontinuance, reported. Monitor serum ALT concentrations monthly; consider interrupting therapy if transaminase concentrations are persistently increased.

Early reports that deferiprone may worsen liver fibrosis not confirmed in subsequent clinical trials.

Effects on Zinc

Decreased plasma zinc concentrations reported. Monitor serum zinc concentrations and administer zinc supplements if necessary.

Specific Populations


Category D. (See Fetal/Neonatal Morbidity and Mortality under Cautions.)


Not known whether deferiprone is distributed into milk. Discontinue nursing or the drug.

Pediatric Use

Safety and efficacy not established.

Geriatric Use

Safety and efficacy not established. (See Geriatric Patients under Dosage and Administration.)

Hepatic Impairment

Not studied conclusively.

Renal Impairment

Not studied specifically.

Common Adverse Effects

Chromaturia, nausea, vomiting, abdominal pain/discomfort, arthralgia, increased ALT, decreased neutrophil count, neutropenia.

Interactions for Deferiprone

Metabolized principally by uridine diphosphate-glucuronosyltransferase (UGT) 1A6.

Drugs Affecting UGT Enzymes

UGT1A6 inhibitors: Potential pharmacokinetic interaction (decreased glucuronidation of deferiprone). Clinical importance not established. Closely monitor for adverse deferiprone effects; reduce dosage or interrupt deferiprone therapy if necessary.

Drugs Associated with Neutropenia or Agranulocytosis

Increased risk of neutropenia and agranulocytosis. Avoid concomitant use; if this is not possible, closely monitor ANC.

Specific Drugs




Antacids, aluminum-containing

Deferiprone may bind to aluminum

Allow ≥4 hours between administration of deferiprone and aluminum-containing antacids


Possible decreased glucuronidation of deferiprone

Closely monitor for adverse effects; reduce dosage or interrupt deferiprone therapy if necessary

Iron, multivitamins, and mineral supplements

Deferiprone may bind to polyvalent cations (e.g., iron, aluminum, zinc)

Allow ≥4 hours between administration of deferiprone and preparations containing iron, aluminum, or zinc

Phenylbutazone (no longer commercially available in US)

Decreases deferiprone glucuronidation by up to 78%

Closely monitor for adverse effects; reduce dosage or interrupt deferiprone therapy if necessary


Possible decreased glucuronidation of deferiprone

Closely monitor for adverse effects; reduce dosage or interrupt deferiprone therapy if necessary

Silymarin (milk thistle)

Possible decreased glucuronidation of deferiprone

Closely monitor for adverse effects; reduce dosage or interrupt deferiprone therapy if necessary

Deferiprone Pharmacokinetics



Well absorbed following oral administration, with peak plasma concentration usually attained within 1 hour after a single dose in fasting state and up to 2 hours after a single dose in fed state.


Food decreases rate and extent of absorption; magnitude of effect does not warrant fasting administration.

Special Populations

Pharmacokinetics not specifically studied in children or geriatric patients.



Not known whether deferiprone is distributed into milk.

Plasma Protein Binding




Extensively metabolized, primarily by UGT1A6. Major metabolite, the 3-O-glucuronide, lacks iron-binding capability.

Elimination Route

Excreted in urine (75–90% within 24 hours following oral administration) mainly as metabolite.


1.9 hours.

Special Populations

No data currently available in children, geriatric patients, or patients with renal or hepatic impairment.





20–25°C (may be exposed to 15–30°C).


  • Chelates iron by binding ferric ions and forming a stable complex.

  • Has a high binding affinity for iron in a 3:1 ratio (3 deferiprone molecules binding 1 iron atom) and a lower binding affinity for other metals, including copper, aluminum, and zinc.

Advice to Patients

  • Importance of providing patient a copy of manufacturer's patient information (medication guide).

  • Risk of blood disorders, which can result in potentially life-threatening infections. Importance of immediately discontinuing the drug and informing clinicians if symptoms of infection (e.g., fever, sore throat, mouth sores, flu-like symptoms) occur. Importance of regular monitoring of blood cell counts.

  • Importance of taking deferiprone in 3 divided doses (morning, midday, and evening). Importance of taking a missed dose as soon as it is remembered unless it is almost time for the next dose; do not take a double dose to make up for a missed dose. Contact clinicians if a higher dosage than prescribed is taken.

  • Importance of allowing ≥4 hours between taking deferiprone and taking any antacids or mineral supplements that contain iron, aluminum, or zinc.

  • Risk of nausea, which may be decreased by taking deferiprone with food.

  • Possibility of reddish/brown discoloration of the urine, which is not harmful.

  • Importance of seeking immediate medical attention in case of palpitations, dizziness, lightheadedness, syncope, or seizures.

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. Advise women not to become pregnant or breast-feed while receiving deferiprone.

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and herbal or dietary supplements, as well as any concomitant illnesses.

  • Importance of informing patients of other important precautionary information. (See Cautions.)


Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Distribution of deferiprone is restricted. (See Restricted Distribution Program under Dosage and Administration.)



Dosage Forms


Brand Names



Tablets, film-coated

500 mg

Ferriprox (scored)


AHFS DI Essentials™. © Copyright 2023, Selected Revisions February 15, 2013. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration.

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