Exjade

1 What is Exjade?

Brand: Exjade, Jadenu

Generic: Deferasirox

Exjade is an oral iron chelator. The common dosage form of drug is as a tablet. It belongs to the therapeutic class of heavy metal chelator. Its main use is to remove chronic iron overload in patients who are receiving repeated blood transfusions for beta thalassemias and other chronic anemias. It is the first oral medication that has been approved in US for this purpose.

The half-life of the drug is between 8 to 16 hrs permitting once a day dosage. The drug is capable of removing iron from the cells as well as removing it from the body.

2 What to Know Before Using

Before using Exjade, the risks of using the medication are weighed against the benefits it does. The following considerations are made:

  • Allergies: Prior allergies to similar type of medicines or other drugs should be mentioned to the doctor. Also any other allergy to food, drug or preservatives should be made.
  • Children: Enough evidence on safety and efficacy in children under 10 years of age is lacking.
  • Older adults: Elderly are more likely to get unwanted heart, liver and kidney troubles by the use of drugs and they are also susceptible to interaction with multiple drugs that they may be taking for other health issues.
  • Pregnant women: No adequate studies are conducted for safety and efficacy in pregnant women.
  • Breast feeding: No adequate studies are present on efficacy and safety of use of drug while breast feeding and its impact on new born.
  • Interactions with following drugs have been noted:

        ‒ Aluminum Carbonate, Basic
        ‒ Aluminum Hydroxide
        ‒ Aluminum Oxide
        ‒ Aluminum Phosphate
        ‒ Cholestyramine
        ‒ Colesevelam
        ‒ Colestipol
        ‒ Dihydroxyaluminum Aminoacetate
        ‒ Dihydroxyaluminum Sodium Carbonate
        ‒ Duloxetine
        ‒ Enzalutamide
        ‒ Fosphenytoin
        ‒ Phenobarbital
        ‒ Phenytoin
        ‒ Rifampin
        ‒ Ritonavir
        ‒ Theophylline
        ‒ Tizanidine
        ‒ Warfarin

  • Interactions with certain kinds of food are also noted along with the influence of use of tobacco and alcohol.
  • Other medical problems: The presence of other medical problems may affect the use of this medicine like:

        ‒ Blood or bone marrow disorders
        ‒ Eye problems
        ‒ Hearing problems
        ‒ Kidney diseases
        ‒ Stomach problems like ulceration, gastritis, etc which may get worse.
        ‒ Advanced cancer
        ‒ Severe kidney troubles
        ‒ Liver diseases
        ‒ Thrombocytopenia
        ‒ Liver diseases like hepatitis

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3 Proper Usage

To use Exjade correctly, you must follow all instructions given by your doctor.

Swallow the whole tablet with water or liquids. If whole tablet cannot be taken, it needs to be crushed and mixed with soft foods before taking.

It’s best to take medicine at the same time each day on an empty stomach or with light meal. Dissolve the suspension form of tablet in apple juice, orange juice or water and mix well. Do not chew it or swallow it as a whole and also mix the suspension form properly before drinking.

Dosage

  • For chronic iron overload after blood transfusions:

For oral dosage form (tablets):

    • Adults and children 2 years of age and older—Dose is based on body weight and must be determined by your doctor. The starting dose is usually 14 milligrams (mg) per kilogram (kg) of body weight per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 28 mg per kg per day.
    • Children younger than 2 years of age—Use and dose must be determined by your doctor.

For oral dosage form (tablet for suspension):

    • Adults and children 2 years of age and older—Dose is based on body weight and must be determined by your doctor. The starting dose is usually 20 milligrams (mg) per kilogram (kg) of body weight per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 40 mg per kg per day.
    • Children younger than 2 years of age—Use and dose must be determined by your doctor.
  • For chronic iron overload in non-transfusion dependent thalassemia syndrome:

For oral dosage form (tablets):

  1. Adults and children 10 years of age and older—Dose is based on body weight and must be determined by your doctor. The starting dose is usually 7 milligrams (mg) per kilogram (kg) of body weight per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 14 mg per kg per day.
  2. Children younger than 10 years of age—Use and dose must be determined by your doctor.

For oral dosage form (tablet for suspension):

    • Adults and children 10 years of age and older—Dose is based on body weight and must be determined by your doctor. The starting dose is usually 10 milligrams (mg) per kilogram (kg) of body weight per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 20 mg per kg per day.
    • Children younger than 10 years of age—Use and dose must be determined by your doctor.

Storage

Store the medicine in a closed container at a room temperature away from heat, moisture and direct light but should not be allowed to freeze. Keep away from the reach of children. Do not use expired medication.

4 Precautions to Take

In using Exjade, you must be careful and take some precautions as advised by your doctor.

Proper monitoring of the effects of drug is essential. For this, regular visits to doctor may be necessary along with some blood and urine examinations to monitor the effects of drug.

The drug may cause visual or hearing problems. As soon as one notices these, report immediately to the doctor.

The drug causes a serious type of allergic reaction called as anaphylaxis. It can be life threatening and requires immediate attention. Call your doctor if you notice rash, itching, difficulty in breathing, trouble swallowing, and difficulty in breathing.

The drug decreases the blood count. So, proper precautions are necessary. Like the decrease in WBCs can cause frequent infections. So proper sanitary precautions are necessary. Also there may be decrease in platelet count that can lead to frequent bleeding so proper care to avoid sharp and rough surfaces is advised to prevent injury and consequent bleeding.

Check with your doctor right away if you have agitation, confusion, decreased urine output, lethargy, muscle twitching, rapid weight gain, seizures, or swelling of the face, ankles, or hands. These may be symptoms of a serious kidney problem.

Upper abdominal pain, pale urine, altered stools, itching, anorexia, nausea, vomiting may be signs of liver disease and should be reported.

Blistering, peeling, sores, ulcers, red skin lesions may be signs of severe skin lesions and need to be checked with doctor.

This medicine may cause some people to become dizzy. Do not drive, use machines, or do anything else that could be dangerous until you know how this medicine affects you.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements. Do not take this medicine with aluminum-containing antacids (Maalox®, Mylanta®).

5 Potential Side Effects

As with many medications, there are several potential side effects associated with Exjade.

The following side effects can occur and need to be notified to the doctor:

More common:

Rare:

  • Blindness
  • Blurred vision
  • Change in hearing
  • Change in vision
  • Pain or discomfort in the eye

Incidence not known:

  • Black, tarry stools
  • Bleeding gums
  • Blood in the urine or stools
  • Dark-colored urine
  • Decrease in urine amount
  • General feeling of tiredness or weakness
  • Hives or welts or skin rash
  • Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • Lethargy
  • Light-colored stools
  • Lower back or side pain
  • Pale skin
  • Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • Redness, soreness or itching of the skin
  • Sores, welting, or blisters
  • Stomach pain, continuing
  • Unusual bleeding or bruising
  • Vomiting of blood or material that looks like coffee grounds
  • Yellow eyes or skin
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