Exjade

Exjade,

a trademark for deferasirox.

---

deferasirox

Exjade

Pharmacologic class: Iron-chelating agent

Therapeutic class: Antidote

Pregnancy risk category B

Action

Binds selectively to iron

Availability

Tablets for oral suspension: 125 mg, 250 mg, 500 mg

⊘Indications and dosages

➣ Chronic iron overload caused by blood transfusions

Adults and children ages 2 and older: Initially, 20 mg/kg (calculated to nearest whole tablet) P.O. daily on empty stomach at least 30 minutes before a meal, preferably at same time each day. Don't exceed 30 mg/kg daily.

Dosage adjustment

• Serum creatinine elevation
• Severe, persistent liver enzyme elevations

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:
• serum creatinine elevation, liver enzyme elevation, severe rash
• pregnant or breastfeeding patients.

Administration

☞ Make sure patient doesn't swallow tablets whole.
• Disperse tablets completely in water, orange juice, or apple juice; have patient consume suspension immediately. If residue remains, resuspend it in small amount of liquid and have patient swallow it. Disperse doses lower than 1 g in 3.5 oz liquid; disperse doses higher than 1 g in 7 oz liquid.
• Adjust dosage every 3 to 6 months in increments of 5 to 10 mg/kg based on ferritin levels, treatment goals, and response.

Route	Onset	Peak	Duration
P.O.	Unknown	1.5-4 hr	Unknown

Adverse reactions

CNS: headache, fatigue, dizziness

EENT: cataract, retinal disorder, increased intraocular pressure, ear infection, hearing loss, rhinitis, nasopharyngitis, pharyngolaryngeal pain, pharyngitis, acute tonsillitis

GI: nausea, vomiting, diarrhea, abdominal pain

Musculoskeletal: arthralgia, back pain

Respiratory: cough, respiratory tract infection, bronchitis

Skin: rash, urticaria

Other: fever, influenza

Interactions

Drug-drug. Aluminum-containing antacids: possible binding with antacid

Drug-diagnostic tests. Liver function tests, serum creatinine: increased

Drug-food. Any food: increased deferasirox bioavailability

Patient monitoring

• Perform baseline auditory and ophthalmic testing; repeat every 12 months.
• Monitor serum ferritin levels monthly.
• Monitor renal and hepatic function frequently.

Patient teaching

• Instruct patient to place tablets in water, orange juice, or apple juice and stir until completely dissolved. Tell him not to chew or swallow them.
• Advise patient not to take aluminum-containing antacids during therapy.
• Tell patient drug may cause vision and hearing disturbances, necessitating routine ophthalmic and auditory testing.
• Caution patient to avoid driving and other hazardous activities until drug effects are known.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.