In children and young adults with transfusion-dependent thalassemia (TDT), safety of amlodipine (L-type calcium channel blocker) was evident and a combination of amlodipine with chelation therapy seemed to be more effective in decreasing cardiac iron overload than chelation only in these patients.

• A double-blind placebo-controlled trial involved randomization of 64 eligible patients with TDT to receive either amlodipine and chelation (group A) or chelation alone (group B).

• Myocardial iron concentration (MIC) via T2* magnetic resonance imaging (MRI), liver iron concentration (LIC), left ventricular ejection fraction (LVEF), and serum ferritin were assessed at baseline and 12 months.

• Significant increase in mean cardiac T2* value, from 18.11 ± 8.47 to 22.15 ± 7.61 at 12 months, was seen in the amlodipine group, whereas controls showed a nonsignificant increase in cardiac T2* value from 19.50 ± 8.84 to 20.03 ± 9.07.

• In the amlodipine group, a significant decrease occurred in MRI-derived MIC, vs the control group (1.93 ± 1.61 to 1.29 ± 0.90).

• Alterations in the LVEF, MRI-derived LIC, and serum ferritin were not significant between the two groups.