Transfusional Fe overload Initially 20 mg/kg daily. Adjust dose if necessary in steps of 5-10 mg/kg every 3-6 mth.
Patient receiving >14 mL/kg/mth of packed RBC (approx >4 u/mth for adult) & for whom objective is reduction of Fe overload May consider initial daily dose of 30 mg/kg.
Patient receiving <7 mL/kg/mth of packed RBC (approx <2 u/mth for adult) & for whom the objective is maintenance of body Fe level May consider initial daily dose of 10 mg/kg.
Patient already well-managed on treatment w/ deferoxamine May consider starting dose that is numerically ½ that of the deferoxamine dose.
Patient not adequately controlled w/ 30 mg/kg (eg, serum ferritin level persistently >2,500 mcg/L & not showing a decreasing trend over time) May consider dose up to 40 mg/kg.
Patient whose serum ferritin level has reached the target (usually between 500 & 1,000 mcg/L) Reduce dose in steps of 5-10 mg/kg.
NTDT syndrome Initially 10 mg/kg daily. Consider increasing in increments of 5-10 mg/kg if LIC ≥7 mg Fe/g dw, or serum ferritin is consistently >2,000 mcg/L & not showing a downward trend, & drug is tolerated well.
Patient in whom LIC was not assessed & serum ferritin is ≤2,000 mcg/L Not to exceed 10 mg/kg.
Patient in whom dose was increased to >10 mg/kg Reduce dose to 10 mg/kg or less when LIC is <7 mg Fe/g dw or serum ferritin is ≤2,000 mcg/L.
Moderate hepatic impairment (Child-Pugh B) Reduce starting dose by approx 50%.
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