Which iron chelator is better: desferrioxamine or deferiprone?
Desferrioxamine (DesferalTM, Novartis) is a time tested iron chelator. It has to be given by S/C infusion by a pump over 5-7 hours at least 5 days in a week. The dose is 25-50 mg/kg/day. A higher dose increases risk of Desferal induced toxicity. The desferal therapeutic index or Porter index is defined as mean daily dose of desferrioxamine in mg/kg, divided by serum ferritin in mg/L, calculated every 6 months should not exceed 0.025, to minimize sensorineural hearing loss. The main disadvantage of desferral is that it requires injection. Deferiprone (KelferTM, Cipla) is given at a dose of 50-75 mg/kg. The toxicity includes gastrointestinal problems, musculoskeletal pains, arthropathy and agranulocytosis. How-ever, it has been successfully used in many Indian centers. However, combination therapy is best for patients with very high serum ferritin levels. It provides more effective iron chelation due to ‘shuttle effect’ of deferiprone. It removes the tissue iron esp. cardiac iron to the
