Complications of Combined Treatment with Deferiprone and Desferrioxamine in Thalassemic Patients

Although successful iron chelation with deferiprone is associated with significant complications, patient’s compliance with medication regimens is of a high priority. The present study did evaluate the complications and compliance of domestically-manufactured deferiprone combined with desferrioxamine for iron chelation therapy. A total of 32 major beta thalassemic patients with cardiomyopathy were enrolled in the study and were monitored clinically and paraclinically. Upon every visit, the patients were prescribed only the number of tablets deemed necessary. The side effects observed as nausea (25%), vomiting (12%), neutropenia (12%), thrombocytopenia (6%), and joint pain (3%) without agranulocytosis or increased liver enzymes to more than twice the normal values. Deferiprone was discontinued in 30% of patients because of severe refractory gastrointestinal complaints (12%), recurrent neutropenia (6%), recurrent thrombocytopenia (6%), severe arthropathy (3%), or interferon therapy (3%). None of the patients, except one, remembered taking full number of the prescribed tablets. Twenty seven patients used 35% to 92% of the prescribed tablets. Poor compliance with deferiprone due to patient’s neglect to take the drug 3 times a day for a prolonged period was the main problem in this regimen. Although thrombocytopenia was more common compared with those of previous reports, other complications were seen with equal or lower frequencies. This study shows that a lower daily dose is the most favorable property of an oral iron chelator for prolonged usage.