Deferasirox (Exjade)

Oral chelating agent for the use in hemoglobinopathy, and myelodysplastic associated hemosiderosis.

Neutral iron balance achieved with 20 mg/kg/day dose and reduction in iron load achieved at 30 mg/kg/day dosage.

5-10 mg/kg/day doses are not sufficient to prevent increased liver iron concentration.

Dosing should be started at 20 mg per kilogram body weight, and the drug should be given on a daily basis on an empty stomach aup up upt least 30 minutes before eating, and preferably the same time each day.

Common side effects include rash in about 10% of cases, and transient gastrointestinal symptoms in 10-5% of cases.

Mild increases in creatinine can occur (38%) but rarely cause discontinuance of the drug.

Cases of renal failure, and even fatalities have been reported: patients have had multiple comorbidities and had advanced stages of their hematologic disorders.

Serum creatinine should be monitored before initiating therapy and monthly thereafter.

Dose reductions, int2242uption, or discontinuance of the drug should be considered for elevations in serum creatinine.

Intermittent proteinuria occurs in greater than 18.5% of patients.

Hepatic impairment including hepatic failure has been reported and liver function tests should be performed prior to treatment and every 2 weeks during the first month then monthly thereafter.

Blood counts should be monitored closely, as reports of pancytopenia occurring in some patients.

For adults, the daily dose should be reduced by 10 mg per kilogram if there is a greater than 33% increase in serum creatinine seen at two consecutive visits.

Hepatic failure can occur, particularly in individuals over the age of 55 years and with comorbidities of cirrhosis and multiorgan failure.

Associated with pyrexia (18.9%), headache (15.9%), abdominal pain (13.9%), cough (13.9%), nasopharyngitis (13.2%), diarrhea (11.8%), influenza (10.8%), nausea (10.5%), pharyngolaryngeal pain (10.5%) and vomiting (10.1%).

Auditory and ocular disturbances have been reported, and auditory and ophthalmic testing should be performed before starting treatment and annually thereafter.

Because of gastrointestinal irritation its use with uclerogenic agents were drugs would hemorrhagic potential requires caution.

Fatal gastrointestinal hemorrhage has been reported, especially in elderly patients in those who have advanced hematologic malignancies and/or low platelet counts.

The use of this drug is considered when patients have received transfusions of approximately 100 mL per kilogram of packed red blood cells or about 20 units for a 40 kg patient and to have consistent f2242itin levels of greater than 1000 mcg per liter.

Studies have revealed of this agent effectively reduces liver iron concentration (LIC) in relation to the dose administered with a 74% success rate in reducing LIC at a dose of 30 mg per kilogram per day and a 37% success rate in reducing LIC dose of 20 mg per kilogram per day.

The drugs elimination half-life is 8 to 16 hours, providing once daily oral dosing.

This drug is contraindicated with a creatinine clearance of less than 40 mL per minute and with a creatinine greater than 2 times the age-appropriate upper limit of normal.

The drug is contraindicated in patients with a poor performance status and high-risk myelodysplastic syndromes, and platelet counts of less than 50,000.

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