[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Chelating agents](https://durgical.com/en/pharmacology/classes/chelating-agents/) › Deferasirox

# Deferasirox

## Chelating agents?

Chelating agents

An oral iron chelator for chronic iron overload from repeated transfusions. It works well but can harm the kidneys, liver and gut.

Updated Nov 12, 2026

## Quick facts

**Group**
[Chelating agents](https://durgical.com/en/pharmacology/classes/chelating-agents/)

**Target**
Ferric iron (Fe3+)

**Used for**
Chronic iron overload

**Key effects**
Diarrhoea · Rash · Rises in serum creatinine

**Monitor**
Serum ferritin monthly · Serum creatinine

**ATC**
V03AC03

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

Deferasirox is an oral chelator selective for ferric iron. It is a tridentate ligand: two molecules wrap one iron ion. The complex is excreted mainly in the faeces. Steady removal of iron lowers ferritin and the iron stored in the liver.

- Repeated transfusions load the body with iron
- Two deferasirox molecules wrap one ferric ion
- The iron complex leaves mainly in the faeces
- Ferritin and liver iron fall over months

## Indications

- Chronic iron overload from blood transfusions, for example in thalassaemia or sickle cell disease [Thalassemias (α and β) →](https://durgical.com/en/conditions/thalassemias/)
- Chronic iron overload in non-transfusion-dependent thalassaemia [Thalassemias (α and β) →](https://durgical.com/en/conditions/thalassemias/)

## Adverse effects

### Common

- Diarrhoea, nausea, vomiting and abdominal pain
- Rash
- Rises in serum creatinine and liver enzymes

### Serious (rare, important)

- Acute kidney injury and kidney failure (boxed warning)
- Hepatic failure (boxed warning)
- Gastrointestinal ulceration and haemorrhage (boxed warning)
- Neutropenia, agranulocytosis and thrombocytopenia
- Hearing loss, cataracts and retinal changes
- Severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS) and anaphylaxis

## Contraindications

- Reduced kidney function below the label's eGFR limit
- Poor performance status, high-risk myelodysplastic syndrome or advanced cancer
- Low platelet count
- Hypersensitivity to deferasirox

## Key interactions

**Aluminium-containing antacids**
Not taken together

**Rifampicin, phenytoin, phenobarbital, ritonavir and bile acid sequestrants**
Lower deferasirox levels; avoided

**Repaglinide (CYP2C8) and theophylline (CYP1A2)**
Their levels rise; dose review and closer monitoring

**NSAIDs, corticosteroids, oral bisphosphonates and anticoagulants**
Higher risk of gastrointestinal ulcers and bleeding

**Hormonal contraceptives (CYP3A4)**
May become less effective; non-hormonal contraception is advised

## What is monitored

- Serum ferritin monthly, to guide treatment and avoid over-chelation
- Serum creatinine, eGFR, urinalysis and electrolytes
- Liver enzymes and bilirubin: often in the first month, then at least monthly
- Blood counts
- Hearing and eye examinations before treatment and periodically

## Administration and safety

- Given by mouth at the same time each day, on an empty stomach or with a light meal
- Treatment is paused or adjusted when kidney or liver tests worsen
- Not restarted after a serious allergic or skin reaction

## Pregnancy and breastfeeding

Human data are lacking and animal studies showed harm to offspring; it is used only if the benefit justifies the risk.

## Nursing care

- Check kidney and liver results before each new supply
- Ask about black stools, vomiting blood or abdominal pain
- Teach the patient to report rash, fever, sore throat or changes in hearing and vision
- Keep hydration up, especially during vomiting or diarrhoea

## Pharmacokinetics

**Absorption**
Oral; taken on an empty stomach or with a light, low-fat meal

**Elimination**
The iron complex is excreted mainly in the faeces

## Memory aid

deferaSIROX is the oral iron eater, but watch its three victims: Kidney, Liver, Gut.

## Test yourself

Think of the answer, then tap the question to see it.

## What are the three boxed-warning risks of deferasirox?

Kidney failure, liver failure and gastrointestinal haemorrhage.

## How is the deferasirox-iron complex mainly excreted?

In the faeces.

## Which laboratory value is followed monthly to guide deferasirox treatment?

Serum ferritin, together with kidney and liver tests.

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[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 2

- [Deferoxamine](https://durgical.com/en/pharmacology/deferoxamine/)
- [Deferiprone](https://durgical.com/en/pharmacology/deferiprone/)

## Related conditions 1

- [Thalassemias (α and β)](https://durgical.com/en/conditions/thalassemias/)

[← Back to the class: Chelating agents](https://durgical.com/en/pharmacology/classes/chelating-agents/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - DEFERASIROX- deferasirox tablet, film coated](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=65453013-c360-4835-8358-2a278a4a32db) (DailyMed (U.S. National Library of Medicine), 2026); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/) (World Health Organization, 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=V03AC03) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/deferasirox/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/deferasirox/