Please wait while the formulary information is being retrieved.
Drug overview for FERRIPROX (deferiprone):
Generic name: deferiprone (de-FER-i-prone)
Drug class: Iron Chelating Agents
Therapeutic class: Antidotes and other Reversal Agents
Deferiprone is a chelating agent with affinity for ferric ions.
No enhanced Uses information available for this drug.
Generic name: deferiprone (de-FER-i-prone)
Drug class: Iron Chelating Agents
Therapeutic class: Antidotes and other Reversal Agents
Deferiprone is a chelating agent with affinity for ferric ions.
No enhanced Uses information available for this drug.
DRUG IMAGES
No Image Available
The following indications for FERRIPROX (deferiprone) have been approved by the FDA:
Indications:
Chronic iron overload due to repeated blood transfusions
Professional Synonyms:
Secondary iron overload from multiple blood transfusions
Transfusion hemosiderosis
Transfusion-induced iron overload
Transfusional hemosiderosis
Transfusional iron overload
Indications:
Chronic iron overload due to repeated blood transfusions
Professional Synonyms:
Secondary iron overload from multiple blood transfusions
Transfusion hemosiderosis
Transfusion-induced iron overload
Transfusional hemosiderosis
Transfusional iron overload
The following dosing information is available for FERRIPROX (deferiprone):
Dosing of deferiprone is based on actual body weight.
Deferiprone is administered orally as tablets or oral solution. Deferiprone oral tablets are administered orally 2 or 3 times daily depending on the formulation. For the 2-times-daily formulation (1000 mg twice-a-day tablet), administer the first dose in the morning and second dose in the evening, approximately 12 hours apart.
For the 3-times-daily formulations (1000 mg three-times-a-day tablet or 500 mg tablet), administer the first dose in the morning, second dose at mid-day, and third dose in the evening. Deferiprone oral solution is administered 3 times daily with the first dose in the morning, second dose at mid-day, and third dose in the evening. Use the provided measuring cup to measure the prescribed dose.
For specific instructions on use of the oral solution, consult the manufacturer's labeling. Administration with meals may help reduce nausea associated with the drug. Store deferiprone tablets and oral solution at 20-25oC (excursions permitted to 15-30oC).
Store the 3-times-daily 1000-mg tablet formulation in the original bottle, closed tightly to protect from moisture. Store the oral solution in the original bottle and carton to protect from light; after first opening the bottle, discard any unused portion after 35 days.
For the 3-times-daily formulations (1000 mg three-times-a-day tablet or 500 mg tablet), administer the first dose in the morning, second dose at mid-day, and third dose in the evening. Deferiprone oral solution is administered 3 times daily with the first dose in the morning, second dose at mid-day, and third dose in the evening. Use the provided measuring cup to measure the prescribed dose.
For specific instructions on use of the oral solution, consult the manufacturer's labeling. Administration with meals may help reduce nausea associated with the drug. Store deferiprone tablets and oral solution at 20-25oC (excursions permitted to 15-30oC).
Store the 3-times-daily 1000-mg tablet formulation in the original bottle, closed tightly to protect from moisture. Store the oral solution in the original bottle and carton to protect from light; after first opening the bottle, discard any unused portion after 35 days.
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| FERRIPROX 500 MG TABLET | Maintenance | Adults take 25 mg/kg by oral route 3 times per day ; round dose to nearest 250 mg (half-tablet) |
| FERRIPROX 100 MG/ML SOLUTION | Maintenance | Adults take 25 mg/kg by oral route 3 times per day round dose to nearest 2.5 mL (250 mg) |
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| DEFERIPRONE 500 MG TABLET | Maintenance | Adults take 25 mg/kg by oral route 3 times per day ; round dose to nearest 250 mg (half-tablet) |
The following drug interaction information is available for FERRIPROX (deferiprone):
There are 0 contraindications.
There are 11 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Deferiprone/Selected Myelosuppressive Agents SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis may increase the frequency or risk for severe toxicity.(1) CLINICAL EFFECTS: Concurrent use of deferiprone and myelosuppressive agents may result in severe neutropenia or agranulocytosis, which may be fatal. PREDISPOSING FACTORS: Agranulocytosis may be less common in patients receiving deferiprone for thalassemia, and more common in patients treated for other systemic iron overload conditions (e.g. myelodysplastic syndromes, sickle cell disease).(2,3) Inadequate monitoring appears to increase the risk for severe outcomes. Manufacturer post market surveillance found that in all fatal cases of agranulocytosis reported between 1999 and 2005, data on weekly white blood count (WBC) monitoring was missing. In three fatal cases, deferiprone was continued for two to seven days after the detection of neutropenia or agranulocytosis.(2) PATIENT MANAGEMENT: If possible, discontinue one of the drugs associated with risk for neutropenia or agranulocytosis. If alternative therapy is not available, documentation and adherence to the deferiprone monitoring protocol is essential. Baseline absolute neutrophil count (ANC) must be at least 1,500/uL prior to starting deferiprone. Monitor ANC weekly during therapy. If infection develops, interrupt deferiprone therapy and monitor ANC more frequently. If ANC is less than 1,500/uL but greater than 500/uL, discontinue deferiprone and any other drugs possibly associated with neutropenia. Initiate ANC and platelet counts daily until recovery (i.e. ANC at least 1,500/uL). If ANC is less than 500/uL, discontinue deferiprone, evaluate patient and hospitalize if appropriate. Do not resume deferiprone unless potential benefits outweigh potential risks.(1) DISCUSSION: Drugs linked to this monograph have an FDA Boxed Warning for risk of neutropenia, agranulocytosis, or pancytopenia, or have > 5% risk for neutropenia and/or warnings describing risk for myelosuppression in manufacturer prescribing information.(1-25) In pooled clinical studies submitted to the FDA, 6.1% of deferiprone patients met criteria for neutropenia and 1.7% of patients developed agranulocytosis.(1) The time to onset of agranulocytosis was highly variable with a range of 65 days to 9.2 years (median, 161 days).(3) |
2,3-DIMERCAPTOSUCCINIC ACID, ABECMA, ABELCET, ABRAXANE, ABRILADA(CF), ABRILADA(CF) PEN, ABRILADA(CF) PEN (2 PACK), ACTEMRA, ACTEMRA ACTPEN, ACTIMMUNE, ADALIMUMAB-AACF(CF), ADALIMUMAB-AACF(CF) (2 PK), ADALIMUMAB-AACF(CF) PEN (2 PK), ADALIMUMAB-AACF(CF) PEN CROHNS, ADALIMUMAB-AACF(CF) PEN PS-UV, ADALIMUMAB-AATY(CF) (2 PACK), ADALIMUMAB-AATY(CF) (2 PK), ADALIMUMAB-AATY(CF) AI CROHNS, ADALIMUMAB-AATY(CF) AUTOINJ(2), ADALIMUMAB-AATY(CF) AUTOINJECT, ADALIMUMAB-ADAZ(CF), ADALIMUMAB-ADAZ(CF) PEN, ADALIMUMAB-ADBM(CF), ADALIMUMAB-ADBM(CF) PEN, ADALIMUMAB-ADBM(CF) PEN CROHNS, ADALIMUMAB-ADBM(CF) PEN PS-UV, ADALIMUMAB-ADBM(CF)PEN, ADALIMUMAB-FKJP(CF), ADALIMUMAB-FKJP(CF) PEN, ADALIMUMAB-RYVK(CF), ADALIMUMAB-RYVK(CF) AUTOINJECT, ADCETRIS, ADRIAMYCIN, ADRUCIL, AFINITOR, AFINITOR DISPERZ, AKEEGA, ALFERON N, ALIMTA, ALIQOPA, ALKERAN, ALUNBRIG, ALYMSYS, AMBISOME, AMJEVITA(CF), AMJEVITA(CF) AUTOINJECTOR, AMPHOTERICIN B, AMPHOTERICIN B LIPOSOME, AMTAGVI, ANASTROZOLE, ANCOBON, APONVIE, APREPITANT, ARAVA, ARIMIDEX, ARRANON, ARSENIC TRIOXIDE, ARZERRA, ASTAGRAF XL, ATGAM, AUBAGIO, AUCATZYL, AUGTYRO, AURANOFIN, AVASTIN, AVONEX, AVONEX (4 PACK), AVONEX PEN, AVONEX PEN (4 PACK), AVSOLA, AXTLE, AYVAKIT, AZACITIDINE, AZASAN, AZATHIOPRINE, AZATHIOPRINE SODIUM, AZULFIDINE, BALVERSA, BAVENCIO, BELRAPZO, BENDAMUSTINE HCL, BENDEKA, BESPONSA, BESREMI, BETASERON, BEXAROTENE, BICNU, BLINCYTO, BORTEZOMIB, BORUZU, BOSULIF, BRAFTOVI, BREYANZI, BREYANZI CD4 COMPONENT, BREYANZI CD8 COMPONENT, BRIUMVI, BRUKINSA, BUSULFAN, BUSULFEX, CAELYX, CALQUENCE, CAMPATH, CAMPTOSAR, CAPECITABINE, CARBAMAZEPINE, CARBAMAZEPINE ER, CARBATROL, CARBIMAZOLE, CARBOPLATIN, CARMUSTINE, CARVYKTI, CELLCEPT, CHEMET, CHLORAMBUCIL, CIDOFOVIR, CINVANTI, CISPLATIN, CLADRIBINE, CLOFARABINE, COLUMVI, COPIKTRA, COSMEGEN, CUPRIMINE, CYCLOPHOSPHAMIDE, CYCLOPHOSPHAMIDE MONOHYDRATE, CYLTEZO(CF), CYLTEZO(CF) PEN, CYLTEZO(CF) PEN CROHN'S-UC-HS, CYLTEZO(CF) PEN PSORIASIS-UV, CYTARABINE, D-PENAMINE, DACARBAZINE, DACTINOMYCIN, DANYELZA, DANZITEN, DARAPRIM, DARZALEX, DARZALEX FASPRO, DASATINIB, DAUNORUBICIN HCL, DAURISMO, DECITABINE, DEPEN, DEXRAZOXANE, DMSA, DOCETAXEL, DOCIVYX, DOXIL, DOXORUBICIN HCL, DOXORUBICIN HCL LIPOSOME, DROXIA, EFLORNITHINE HCL, ELAHERE, ELLENCE, ELREXFIO, EMEND, ENHERTU, ENSPRYNG, ENVARSUS XR, EPIRUBICIN HCL, EPITOL, EPKINLY, EQUETRO, ERIBULIN MESYLATE, ETOPOPHOS, ETOPOSIDE, EVEROLIMUS, EVOMELA, FARYDAK, FLUCYTOSINE, FLUDARABINE PHOSPHATE, FLUOROURACIL, FOCINVEZ, FOLOTYN, FOSAPREPITANT DIMEGLUMINE, FOSCARNET SODIUM, FOSCAVIR, FRINDOVYX, FYARRO, GANCICLOVIR SODIUM, GAVRETO, GAZYVA, GEMCITABINE HCL, GLEEVEC, GLEOSTINE, GLIADEL, GRAFAPEX, HADLIMA, HADLIMA PUSHTOUCH, HADLIMA(CF), HADLIMA(CF) PUSHTOUCH, HALAVEN, HEPZATO, HERCEPTIN, HERCEPTIN HYLECTA, HERCESSI, HERZUMA, HULIO(CF), HULIO(CF) PEN, HUMIRA, HUMIRA PEN, HUMIRA(CF), HUMIRA(CF) PEN, HUMIRA(CF) PEN CROHN'S-UC-HS, HUMIRA(CF) PEN PSOR-UV-ADOL HS, HYCAMTIN, HYDREA, HYDROXYUREA, HYRIMOZ, HYRIMOZ PEN, HYRIMOZ(CF), HYRIMOZ(CF) PEDIATRIC CROHN'S, HYRIMOZ(CF) PEN, HYRIMOZ(CF) PEN CROHN-UC START, HYRIMOZ(CF) PEN PSORIASIS, IBRANCE, ICLUSIG, IDAMYCIN PFS, IDARUBICIN HCL, IFEX, IFOSFAMIDE, ILARIS, IMATINIB MESYLATE, IMBRUVICA, IMDELLTRA, IMFINZI, IMKELDI, IMLYGIC, IMURAN, INFLECTRA, INFLIXIMAB, INFUGEM, INQOVI, INREBIC, IRINOTECAN HCL, ISTODAX, IVRA, IWILFIN, IXEMPRA, JAKAFI, JAYPIRCA, JEMPERLI, JEVTANA, JOENJA, JYLAMVO, KADCYLA, KANJINTI, KEMOPLAT, KESIMPTA PEN, KEVZARA, KEYTRUDA, KISQALI, KRAZATI, KYMRIAH, KYPROLIS, LAMIVUDINE-ZIDOVUDINE, LEFLUNICLO, LEFLUNOMIDE, LEMTRADA, LENALIDOMIDE, LEUKERAN, LEVAMISOLE HCL, LINEZOLID, LINEZOLID-0.9% NACL, LINEZOLID-D5W, LONSURF, LOQTORZI, LUNSUMIO, LUTATHERA, LYNPARZA, MATULANE, MAVENCLAD, MECHLORETHAMINE HCL, MEKINIST, MEKTOVI, MELPHALAN HCL, MERCAPTOPURINE, METHIMAZOLE, METHOTREXATE, METHOTREXATE SODIUM, MITOMYCIN, MITOXANTRONE HCL, MONJUVI, MUTAMYCIN, MVASI, MYCOPHENOLATE MOFETIL, MYCOPHENOLIC ACID, MYFORTIC, MYHIBBIN, MYLERAN, MYLOTARG, NEBUPENT, NELARABINE, NEPHROSCAN, NEXAVAR, NILOTINIB HCL, NIPENT, NULOJIX, OCREVUS, OCREVUS ZUNOVO, OGIVRI, OJJAARA, ONIVYDE, ONTRUZANT, ONUREG, OPDIVO, OPDIVO QVANTIG, OPDUALAG, OTREXUP, OXALIPLATIN, PACLITAXEL, PACLITAXEL PROTEIN-BOUND, PARAPLATIN, PAZOPANIB HCL, PEGASYS, PEMETREXED, PEMETREXED DISODIUM, PEMFEXY, PEMRYDI RTU, PENICILLAMINE, PENICILLAMINE(D-), PENTAM 300, PENTAMIDINE ISETHIONATE, PERJETA, PHESGO, PLEGRIDY, PLEGRIDY PEN, PLUVICTO, POLIVY, POMALYST, POTELIGEO, PRALATREXATE, PROCARBAZINE HCL, PROGRAF, PURIXAN, PYRIMETHAMINE, QUALAQUIN, QUININE HCL, QUININE SULFATE, RASUVO, REBIF, REBIF REBIDOSE, REMICADE, RENFLEXIS, RETHYMIC, RETROVIR, REVLIMID, REVUFORJ, REZUROCK, RIABNI, RIBAVIRIN, RIDAURA, RITUXAN, RITUXAN HYCELA, ROMIDEPSIN, ROTOP-DMSA, ROZLYTREK, RUBRACA, RUXIENCE, RYDAPT, RYTELO, SARCLISA, SCEMBLIX, SIKLOS, SIMLANDI(CF), SIMLANDI(CF) AUTOINJECTOR, SIMULECT, SIROLIMUS, SORAFENIB, SPRYCEL, SUCCIMER DMSA, SULFASALAZINE, SULFASALAZINE DR, SUNITINIB MALATE, SUTENT, SYLVANT, TABLOID, TACROLIMUS, TACROLIMUS XL, TAGRISSO, TALVEY, TALZENNA, TARGRETIN, TASIGNA, TAVALISSE, TECARTUS, TECELRA, TECENTRIQ, TECENTRIQ HYBREZA, TECVAYLI, TEGRETOL, TEGRETOL XR, TEMODAR, TEMOZOLOMIDE, TEMSIROLIMUS, TEPADINA, TERBINAFINE HCL, TERIFLUNOMIDE, TESTOSTERONE-ANASTROZOLE, TEVIMBRA, THIOGUANINE, THIOTEPA, THYMOGLOBULIN, TOFIDENCE, TOPOTECAN HCL, TORISEL, TORPENZ, TRAMETINIB, TRAZIMERA, TREANDA, TREXALL, TRIFLURIDINE, TRISENOX, TRODELVY, TRUQAP, TRUXIMA, TYENNE, TYENNE AUTOINJECTOR, TYSABRI, TZIELD, UNITUXIN, UPLIZNA, VALCYTE, VALGANCICLOVIR HCL, VANFLYTA, VEGZELMA, VELCADE, VENCLEXTA, VENCLEXTA STARTING PACK, VERZENIO, VIDAZA, VINBLASTINE SULFATE, VINCASAR PFS, VINCRISTINE SULFATE, VINORELBINE TARTRATE, VITRAKVI, VIVIMUSTA, VOTRIENT, VYXEOS, XALKORI, XATMEP, XELODA, XOFIGO, XPOVIO, XROMI, YESCARTA, YONDELIS, YUFLYMA(CF) (2 PACK), YUFLYMA(CF) AI CROHN'S-UC-HS, YUFLYMA(CF) AUTOINJECT (2 PCK), YUFLYMA(CF) AUTOINJECTOR, YUSIMRY(CF) PEN, ZALTRAP, ZEJULA, ZEPZELCA, ZEVALIN, ZIDOVUDINE, ZIRABEV, ZOKINVY, ZORTRESS, ZYDELIG, ZYMFENTRA, ZYMFENTRA (2 PACK), ZYMFENTRA PEN (2 PACK), ZYNLONTA, ZYNYZ, ZYVOX |
| Clozapine/Selected Myelosuppressive Agents SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Clozapine and other myelosuppressive agents may be associated with neutropenia or agranulocytosis.(2) CLINICAL EFFECTS: Moderate neutropenia, even if due to combination therapy, may require abrupt discontinuation of clozapine resulting in decompensation of the patient's psychiatric disorder (e.g. schizophrenia). The disease treated by the myelosuppressive agent may be compromised if myelosuppression requires dose reduction, delay, or discontinuation of the myelosuppressive agent. Undetected severe neutropenia or agranulocytosis may be fatal. PREDISPOSING FACTORS: Low white blood counts prior to initiation of the myelosuppressive agent may increase risk for clinically significant neutropenia. PATIENT MANAGEMENT: If a patient stabilized on clozapine therapy requires treatment with a myelosuppressive agent, the clozapine prescriber should consult with prescriber of the myelosuppressive agent (e.g. oncologist) to discuss treatment and monitoring options.(2) More frequent ANC monitoring or treatment alternatives secondary to neutropenic episodes may need to be considered. Clozapine is only available through a restricted distribution system which requires documentation of the absolute neutrophil count (ANC) prior to dispensing.(1-2) For most clozapine patients, clozapine treatment must be interrupted for a suspected clozapine-induced ANC < 1000 cells/microliter. For patients with benign ethnic neutropenia (BEN), treatment must be interrupted for suspected clozapine-induced neutropenia < 500 cells/microliter.(2) DISCUSSION: Clozapine is only available through a restricted distribution system which requires documentation of the ANC prior to dispensing.(1) Agents linked to this interaction generally have > 5% risk for neutropenia and/or warnings describing risk for myelosuppression in manufacturer prescribing information.(3-26) |
CLOZAPINE, CLOZAPINE ODT, CLOZARIL, VERSACLOZ |
| Ponesimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ponesimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of ponesimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection, cryptococcal infection, or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The ponesimod US prescribing information states ponesimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Caution should be used during concomitant administration because of the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects. Initiating treatment with ponesimod after alemtuzumab is not recommended. However, ponesimod can generally be started immediately after discontinuation of beta interferon or glatiramer acetate.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections, cryptococcal meningitis, disseminated cryptococcal infections, and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1) |
PONVORY |
| Sodium Iodide I 131/Myelosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Sodium iodide I 131 can cause depression of the hematopoetic system. Myelosuppressives and immunomodulators also suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of sodium iodide I 131 with agents that cause bone marrow depression, including myelosuppressives or immunomodulators, may result in an enhanced risk of hematologic disorders, including anemia, blood dyscrasias, bone marrow depression, leukopenia, and thrombocytopenia. Bone marrow depression may increase the risk of serious infections and bleeding.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of sodium iodide I 131 states that concurrent use with bone marrow depressants may enhance the depression of the hematopoetic system caused by large doses of sodium iodide I 131.(1) Sodium iodide I 131 causes a dose-dependent bone marrow suppression, including neutropenia or thrombocytopenia, in the 3 to 5 weeks following administration. Patients may be at increased risk of infections or bleeding during this time. Monitor complete blood counts within one month of therapy. If results indicate leukopenia or thrombocytopenia, dosimetry should be used to determine a safe sodium iodide I 131 activity.(1) DISCUSSION: Hematologic disorders including death have been reported with sodium iodide I 131. The most common hematologic disorders reported include anemia, blood dyscrasias, bone marrow depression, leukopenia, and thrombocytopenia.(1) |
HICON, SODIUM IODIDE I-131 |
| Fingolimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Fingolimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1-3) CLINICAL EFFECTS: Concurrent use of fingolimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1-3) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: Recommendations for fingolimod regarding this interaction differ between regulatory approving agencies. The fingolimod US prescribing information states: - Antineoplastic, immune-modulating, or immunosuppressive therapies, (including corticosteroids) are expected to increase the risk of immunosuppression, and the risk of additive immune system effects must be considered if these therapies are coadministered with fingolimod. When switching from drugs with prolonged immune effects, such as natalizumab, teriflunomide or mitoxantrone, the duration and mode of action of these drugs must be considered to avoid unintended additive immunosuppressive effects when initiating fingolimod.(1) The fingolimod Canadian prescribing information states: - Concurrent use with immunosuppressive or immunomodulatory agents is contraindicated due to the risk of additive immune system effects. However, co-administration of a short course of corticosteroids (up to 5 days) did not increase the overall rate of infection in patients participating Phase III clinical trials.(2) The fingolimod UK specific product characteristics states: - Fingolimod is contraindicated in patients currently receiving immunosuppressive therapies or those immunocompromised by prior therapies. When switching patients from another disease modifying therapy to Gilenya, the half-life and mode of action of the other therapy must be considered in order to avoid an additive immune effect whilst at the same time minimizing the risk of disease activation.(3) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1-3) |
FINGOLIMOD, GILENYA, TASCENSO ODT |
| Ozanimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ozanimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of ozanimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The ozanimod US prescribing information state this information regarding this interaction: -Ozanimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Caution should be used during concomitant administration because of the risk of additive immune effects during therapy and in the week following administration. When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects. Initiating treatment with ozanimod after alemtuzumab is not recommended. However, ozanimod can generally be started immediately after discontinuation of beta interferon or glatiramer acetate.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1) |
ZEPOSIA |
| Siponimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Siponimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of siponimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The siponimod US prescribing information state this information regarding this interaction: -Siponimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Caution should be used during concomitant administration because of the risk of additive immune effects during therapy and in the week following administration. When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects. Initiating treatment with siponimod after alemtuzumab is not recommended. However, siponimod can generally be started immediately after discontinuation of beta interferon or glatiramer acetate.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1) |
MAYZENT |
| Betibeglogene Autotemcel/Myelosuppressive Iron Chelators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Treatment with betibeglogene autotemcel requires hematopoietic stem cell (HSC) mobilization which can suppress the immune system. CLINICAL EFFECTS: Myelosuppressive iron chelators may result in increased risk of serious infections. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Avoid myelosuppressive iron chelators for six months after betibeglogene autotemcel infusion. If iron chelation is needed, consider administration of non-myelosuppressive iron chelators.(1) DISCUSSION: In clinical trials, 100% of 41 patients experienced Grade 3 or 4 neutropenia from Day 1 to Month 24.(1) |
ZYNTEGLO |
| Etrasimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Etrasimod causes reversible sequestration of lymphocytes in lymphoid tissues, resulting in a mean 55% decrease in peripheral blood lymphocyte count at 52 weeks.(1) Other immunosuppressives and immune-modulators also suppress the immune system. CLINICAL EFFECTS: Concurrent use of etrasimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious and fatal infections, such as disseminated herpetic infection, cryptococcal infection, or progressive multifocal leukoencephalopathy (PML).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications increases the risk of adverse effects. PATIENT MANAGEMENT: The etrasimod US prescribing information states etrasimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Concomitant administration of these therapies with etrasimod should be avoided because of the risk of additive immune effects during therapy and in the weeks following administration. Etrasimod's effect on peripheral lymphocytes may persist for up to 5 weeks after discontinuation.(1) When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections, cryptococcal meningitis, disseminated cryptococcal infections, and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients treated with other sphingosine-1 phosphate receptor modulators.(1) |
VELSIPITY |
| Lovotibeglogene Autotemcel/Myelosuppressive Iron Chelators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Treatment with lovotibeglogene autotemcel requires hematopoietic stem cell (HSC) mobilization which can suppress the immune system. CLINICAL EFFECTS: Myelosuppressive iron chelators may result in increased risk of serious infections. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Iron chelators should be discontinued 7 days prior to initiation of mobilization or conditioning. Avoid myelosuppressive iron chelators for six months after lovotibeglogene autotemcel infusion. Avoid non-myelosuppressive iron chelators for three months after lovotibeglogene autotemcel infusion. If iron chelation is needed, consider phlebotomy in lieu of iron chelation when appropriate.(1) DISCUSSION: In preparation for infusion of lovotibeglogene autotemcel, iron chelation should be discontinued 7 days prior to initiation of mobilization or conditioning.(1) In clinical trials, 60% of 45 patients experienced Grade 3 or 4 neutropenia from Day 1 to Month 24.(1) |
LYFGENIA |
| Exagamglogene Autotemcel/Myelosuppressive Iron Chelators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Treatment with exagamglogene autotemcel requires hematopoietic stem cell (HSC) mobilization which can suppress the immune system. CLINICAL EFFECTS: Myelosuppressive iron chelators may result in increased risk of serious infections. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Iron chelators should be discontinued 7 days prior to initiation of mobilization or conditioning. Avoid myelosuppressive iron chelators for six months after exagamglogene autotemcel infusion. Avoid non-myelosuppressive iron chelators for three months after exagamglogene autotemcel infusion. If iron chelation is needed, consider phlebotomy in lieu of iron chelation when appropriate.(1) DISCUSSION: In preparation for infusion of exagamglogene autotemcel, iron chelation should be discontinued 7 days prior to initiation of mobilization or conditioning.(1) In clinical trials, 100% of 44 patients experienced Grade 3 or 4 neutropenia from Day 1 to Month 24.(1) |
CASGEVY |
There are 1 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Deferiprone/Aluminum, Iron, Zinc SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Deferiprone chelates polyvalent cations such as aluminum, iron, and zinc.(1) CLINICAL EFFECTS: Deferiprone chelation with oral aluminum, iron or zinc containing products in the gastrointestinal tract may decrease the amount of free deferiprone available for systemic iron chelation. Zinc supplements prescribed to counteract deferiprone-induced zinc deficiency may not be effective if taken near time of deferiprone administration. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer recommends at least a four hour interval between deferiprone dose and administration of aluminum, iron or zinc containing medications or supplements.(1) Avoid use of iron-containing vitamins or nutritional supplements in patients who require chelation therapy for iron overload. DISCUSSION: The US manufacturer has not studied this interaction. The recommendation to separate deferiprone and polyvalent cation doses by at least four hours is based upon the deferiprone mechanism of action.(1) |
ACCRUFER, ALUMINUM HYDROXIDE, ATTAPULGITE, AUROVELA 24 FE, AUROVELA FE, AURYXIA, AVIDOXY DK, BALCOLTRA, BLISOVI 24 FE, BLISOVI FE, CHARLOTTE 24 FE, FEIRZA, FERRIC CITRATE, FINZALA, GALZIN, GEMMILY, HAILEY 24 FE, HAILEY FE, JOYEAUX, JUNEL FE, JUNEL FE 24, KAITLIB FE, KAOLIN, LARIN 24 FE, LARIN FE, LAYOLIS FE, LEVONORG-ETH ESTRAD-FE BISGLYC, LO LOESTRIN FE, LOESTRIN FE, MERZEE, MIBELAS 24 FE, MICROGESTIN FE, MINZOYA, NORETHIN-ETH ESTRA-FERROUS FUM, NORETHINDRONE-E.ESTRADIOL-IRON, TARINA 24 FE, TARINA FE, TARINA FE 1-20 EQ, TAYTULLA, TILIA FE, TRI-LEGEST FE, VELPHORO, WILZIN, WYMZYA FE, XARAH FE, XELRIA FE, ZINC ACETATE, ZINC CHLORIDE, ZINC OXIDE, ZINC SULFATE, ZINC UNDECYLENATE |
The following contraindication information is available for FERRIPROX (deferiprone):
Drug contraindication overview.
Known hypersensitivity to the drug or any ingredient in the formulation. Hypersensitivity reactions (Henoch-Schonlein purpura, urticaria, and periorbital edema with skin rash) have been reported.
Known hypersensitivity to the drug or any ingredient in the formulation. Hypersensitivity reactions (Henoch-Schonlein purpura, urticaria, and periorbital edema with skin rash) have been reported.
There are 1 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Lactation |
There are 2 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Neutropenic disorder |
| Pregnancy |
There are 1 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Zinc deficiency |
The following adverse reaction information is available for FERRIPROX (deferiprone):
Adverse reaction overview.
Adverse effects reported in >6% of patients with thalassemia receiving deferiprone include nausea, vomiting, abdominal pain, arthralgia, increased ALT concentrations, and neutropenia. Adverse effects reported in >6% of patients with sickle cell disease or other anemias receiving deferiprone include pyrexia, abdominal pain, bone pain, headache, vomiting, pain in extremity, sickle cell anemia with crisis, back pain, increased ALT concentrations, increased AST concentrations, arthralgia, oropharyngeal pain, nasopharyngitis, decreased neutrophil count, cough, and nausea.
Adverse effects reported in >6% of patients with thalassemia receiving deferiprone include nausea, vomiting, abdominal pain, arthralgia, increased ALT concentrations, and neutropenia. Adverse effects reported in >6% of patients with sickle cell disease or other anemias receiving deferiprone include pyrexia, abdominal pain, bone pain, headache, vomiting, pain in extremity, sickle cell anemia with crisis, back pain, increased ALT concentrations, increased AST concentrations, arthralgia, oropharyngeal pain, nasopharyngitis, decreased neutrophil count, cough, and nausea.
There are 34 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Neutropenic disorder |
Infection Skin rash |
| Rare/Very Rare |
|---|
|
Abnormal hepatic function tests Acute respiratory distress syndrome Agranulocytosis Anaphylaxis Atrial fibrillation Bruxism Enterocolitis Furunculosis Gastrointestinal ulcer Heart failure Hematuria Hepatomegaly Hyperbilirubinemia Hypersensitivity drug reaction Hypertension Hypotension IgA vasculitis Increased alanine transaminase Intracerebral hemorrhage Jaundice Metabolic acidosis Multiple organ failure Pancreatitis Pancytopenia Parotitis Pulmonary thromboembolism Rectal bleeding Retinal disorder Seizure disorder Thrombocytosis Urticaria |
There are 27 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Acute abdominal pain Arthralgia Nausea Urine discoloration Vomiting |
Anorexia Back pain Diarrhea Dyspepsia Headache disorder Increased appetite Weight gain |
| Rare/Very Rare |
|---|
|
Chills Depression Diplopia Drowsy Epistaxis Fever Glycosuria Hemoptysis Hyperhidrosis Obsessive-compulsive disorder Papilledema Periorbital edema Peripheral edema Pharyngitis Zinc deficiency |
The following precautions are available for FERRIPROX (deferiprone):
Safety and efficacy of deferiprone for the treatment of transfusional iron overload due to thalassemia syndromes have been established in pediatric patients. Evidence of efficacy and safety for this indication are derived from clinical trials in adult patients with thalassemia and pediatric patients with sickle cell disease, respectively. Safety and efficacy of deferiprone for the treatment of transfusional iron overload due to sickle cell disease or other anemias have been established in 86 pediatric patients 3-16 years of age in an adequate and well-controlled study.
A US registry established from December 2011-2019 includes 125 patients 4 to <17 years of age with sickle cell disease who received deferiprone. The adverse reactions (including agranulocytosis) observed in the registry are similar to those reported in recent clinical studies. Safety and efficacy of deferiprone tablets have not been established in pediatric patients <8 years of age. Safety and efficacy of deferiprone oral solution have not been established in pediatric patients <3 years of age.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
A US registry established from December 2011-2019 includes 125 patients 4 to <17 years of age with sickle cell disease who received deferiprone. The adverse reactions (including agranulocytosis) observed in the registry are similar to those reported in recent clinical studies. Safety and efficacy of deferiprone tablets have not been established in pediatric patients <8 years of age. Safety and efficacy of deferiprone oral solution have not been established in pediatric patients <3 years of age.
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
There are limited data regarding use of deferiprone in pregnant women to inform a drug-associated risk of major birth defects and miscarriage. However, based on evidence of genotoxicity and findings from animal reproduction studies, deferiprone can cause fetal harm. Animal studies showed embryo-fetal mortality, structural malformations, and alterations to growth after administration of oral deferiprone to pregnant rabbits and rats during the period of organogenesis at doses 49% and 33%, respectively, of the maximum recommended human dose. Pregnant women and females of reproductive potential should be apprised of the potential drug-associated risk to the fetus.
It is not known whether deferiprone is distributed into human milk; the effects of the drug on the breast-fed infant or on the production of milk are also unknown. Animal studies of deferiprone have found potential for tumorigenicity in the breast-fed child. Because of the potential for adverse reactions in breast-fed infants, women should be advised not to breast-feed while receiving deferiprone and for >=2 weeks after the last dose.
The manufacturer makes no specific dosage recommendations for geriatric patients. Clinical studies of deferiprone did not include sufficient numbers of patients >65 years of age to determine whether or not geriatric subjects respond differently than younger subjects. Other reported clinical experience has not identified differences in responses between elderly and younger patients.
The following prioritized warning is available for FERRIPROX (deferiprone):
WARNING: This medication may rarely cause a very serious low white blood cell count, which increases your risk of serious, possibly fatal infections. To lower your risk, your doctor will check your blood counts with a blood test before treatment and regularly during treatment. Get medical help right away if you develop any signs of infection such as sore throat that doesn't go away, fever, chills, or flu-like symptoms.
WARNING: This medication may rarely cause a very serious low white blood cell count, which increases your risk of serious, possibly fatal infections. To lower your risk, your doctor will check your blood counts with a blood test before treatment and regularly during treatment. Get medical help right away if you develop any signs of infection such as sore throat that doesn't go away, fever, chills, or flu-like symptoms.
The following icd codes are available for FERRIPROX (deferiprone)'s list of indications:
| Chronic iron overload due to repeated blood transfusions | |
| E83.111 | Hemochromatosis due to repeated red blood cell transfusions |
Formulary Reference Tool