Recent Advances in Patient Treatment and Care (Track)


Azita Azarkeivan, Khashayar Karimian, Siamak Mirtorabi Mahabadi, Mojgan Shaiegan, Alireza Narenjian and Masoume Sadat Eslami

Thalassemia Clinic, Iranain Blood Tranfusion Organization, Tehran, Iran


Introduction: Iron overload is one of the serious side effects of chronic blood transfusion in thalassemia major. Use of iron chealation drugs is the solution for this problem. One of these drugs is deferiprone (L1) which is usually used as combination therapy with desferoxamin especially in high iron overload patients. Nausea and vomiting is the common side effects of L1 which sometimes gets so bad that the patient cannot tolerate the drug. We tried a new form of drug (Enteric coated; EC) with the aim of decreasing the gastric side effects. The studies of bioequivalency of the EC form was done by company and Ministry of Health (MOH) accepted this drug according to the scientific documents.

Methods: We started enteric coated for 100 patients and followed them for gastric side effects for six months. All of them were on combination therapy with L1 and desferal and could not tolerate L1 because of sever nausea and vomiting. Two of our patients moved to other cities and could not followed by this therapy. 98 patients remained on EC form of L1.

Results: 98 patients studied. 91 thalassemia major and 7 intermedia, 39 male, 59 female with mean age of 6.03 ± 25.16. 6768.4 % patients were on combination therapy because of high ferritin level and 31(31.6 %) because of cardiac iron overload in addition of high ferritin level. Dose of the drug was75 mg/kg. 61(62.2 %) patients had 6 tab /day and the others were on 8 tab/day.
4 patients could not continue the treatment, 3 because of recurrence of nausea and vomiting and one because of artheralgia. 94(95.9%) could tolerate the EC form and successfully continued the treatment.

Conclusion: Severe nausea and vomiting is one of side effects of L1 in treatment of iron chealation, and this is very important since the patients with high iron overload who indicated for combination therapy cannot tolerate this treatment and with discontinuation of the L1 the condition of the patients may be worsen.

The enteric form of L1 had good results for reduction of GI side effects of L1 because this form of drug is enteric coated and the drug is released in duodenum. We had 96 % success rate for reduction in this side effect and the patients could continue without any nausea and vomiting.