Deferasirox 90mg Tablets

Manufacturer ZYDUS Active Ingredient Deferasirox Tablets(de FER a sir ox) Pronunciation de-FER-a-sir-ox
WARNING: This drug may cause kidney problems. Some people have needed dialysis. Sometimes, these kidney problems have been deadly. The risk of kidney problems may be higher if you already have kidney problems or other health problems. You will need to have your kidney function checked as you have been told by your doctor. If you have questions, talk with your doctor.If you are dehydrated or are taking any drugs that can raise the chance of kidney problems, talk with your doctor. There are many drugs that can raise the chance of kidney problems. Ask your doctor or pharmacist if you are not sure.This drug may cause liver problems. Sometimes, this has been deadly. The risk of liver problems may be higher if you are older than 55 years or if you already have liver problems or other health problems. You will need to have your liver function checked as you have been told by your doctor. If you have questions, talk with your doctor.If you have kidney or liver problems, talk with your doctor. This drug may need to be avoided or the dose may need to be changed with certain types of kidney or liver problems.This drug may raise the chance of severe and sometimes deadly stomach or bowel problems like ulcers or bleeding. The risk is greater in older people, and in people who have had stomach or bowel ulcers or bleeding before. These problems may occur without warning signs. @ COMMON USES: It is used to get rid of iron when too much is in the body.
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Drug Class
Iron Chelator
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Pharmacologic Class
Iron Chelating Agent
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Pregnancy Category
Not available
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FDA Approved
Mar 2015
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DEA Schedule
Not Controlled

Overview

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What is this medicine?

Deferasirox is a medicine used to remove extra iron from your body. Too much iron can build up from frequent blood transfusions or certain blood disorders, and it can harm your organs. This medicine helps your body get rid of that extra iron.
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How to Use This Medicine

Taking Your Medication

To take this medication correctly, follow your doctor's instructions and read all the information provided. Take the medication on an empty stomach or with a light meal. Swallow the tablet whole with water or another liquid. If you have difficulty swallowing tablets, you can crush the tablet and mix it with a small amount of soft food. However, be sure to take the mixture immediately and do not store it for later use.

Important Note: If you need to crush the 90 mg tablet, consult with your doctor or pharmacist first, as certain types of tablet crushers should not be used.

Take your medication at the same time every day, as directed by your doctor or healthcare provider. Continue taking the medication even if you feel well, unless your doctor instructs you to stop.

Storing and Disposing of Your Medication

Store your medication at room temperature in a dry place, away from the bathroom. Keep all medications in a safe location, out of the reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your pharmacist. If you have questions about disposing of your medication, consult with your pharmacist, who can also inform you about potential drug take-back programs in your area.

What to Do If You Miss a Dose

If you miss a dose, take it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and resume your regular schedule. Do not take two doses at the same time or take extra doses.
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Lifestyle & Tips

  • Take the tablet whole, do not chew or crush it. It can be taken with or without a light meal.
  • Stay well-hydrated while taking this medication.
  • Avoid taking aluminum-containing antacids (like Maalox, Mylanta) with deferasirox, as they can interfere with its absorption.
  • Report any new or worsening side effects to your doctor immediately.
  • Attend all scheduled blood tests and eye/ear exams, as these are crucial for monitoring your treatment and detecting potential side effects early.

Dosing & Administration

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Adult Dosing

Standard Dose: Initial dose for transfusional iron overload: 14 mg/kg once daily. Initial dose for non-transfusional thalassemia syndromes (NTTS) with iron overload: 7 mg/kg once daily. Doses are for Jadenu film-coated tablets.
Dose Range: 7 - 28 mg

Condition-Specific Dosing:

transfusionalIronOverload: Initial: 14 mg/kg once daily. May increase to 21 mg/kg, then 28 mg/kg based on serum ferritin trends and tolerability. Max: 28 mg/kg/day.
nonTransfusionalThalassemiaSyndromes: Initial: 7 mg/kg once daily. May increase to 14 mg/kg based on serum ferritin trends and tolerability. Max: 14 mg/kg/day.
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Pediatric Dosing

Neonatal: Not established (contraindicated in patients <2 years of age).
Infant: Not established (contraindicated in patients <2 years of age).
Child: â‰Ĩ2 years: Same dosing as adults based on indication (transfusional or non-transfusional iron overload). Monitor growth and development.
Adolescent: Same dosing as adults based on indication.
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Dose Adjustments

Renal Impairment:

Mild: CrCl 40-60 mL/min: Consider initial dose reduction by 7 mg/kg. Monitor renal function closely.
Moderate: CrCl 20-39 mL/min: Initial dose reduction by 7 mg/kg. Monitor renal function closely. Avoid if CrCl < 20 mL/min.
Severe: CrCl < 20 mL/min: Contraindicated.
Dialysis: Not recommended in patients with end-stage renal disease or CrCl < 10 mL/min.

Hepatic Impairment:

Mild: Child-Pugh A: No initial dose adjustment needed.
Moderate: Child-Pugh B: Initial dose reduction by 7 mg/kg. Monitor hepatic function closely. Max dose 14 mg/kg/day.
Severe: Child-Pugh C: Contraindicated.

Pharmacology

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Mechanism of Action

Deferasirox is an orally active chelator that is highly selective for iron. It forms a stable 2:1 complex with iron, effectively removing excess iron from the body. The iron-deferasirox complex is then excreted primarily via the feces.
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Pharmacokinetics

Absorption:

Bioavailability: Relative bioavailability of Jadenu film-coated tablets is 136% compared to Exjade dispersible tablets.
Tmax: 2-4 hours
FoodEffect: Jadenu film-coated tablets can be taken with or without a light meal. High-fat meals increase AUC and Cmax.

Distribution:

Vd: 14 L
ProteinBinding: >99% (primarily to serum albumin)
CnssPenetration: Limited

Elimination:

HalfLife: 8-16 hours
Clearance: Not available (primarily hepatic metabolism and biliary excretion)
ExcretionRoute: Fecal (84%), Renal (8%)
Unchanged: Not available
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Pharmacodynamics

OnsetOfAction: Not precisely defined, but iron chelation begins shortly after administration.
PeakEffect: Reduction in iron burden is gradual, typically observed over months of treatment.
DurationOfAction: Once daily dosing maintains therapeutic levels for continuous chelation.

Safety & Warnings

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BLACK BOX WARNING

Renal Failure: Deferasirox can cause acute renal failure, sometimes requiring dialysis and with fatal outcomes. Monitor serum creatinine and eGFR weekly for the first month and monthly thereafter. Reduce dose or interrupt treatment for increases in serum creatinine. Hepatic Failure: Deferasirox can cause hepatic failure, sometimes fatal. Monitor liver transaminases and bilirubin weekly for the first month and monthly thereafter. Interrupt treatment for persistent or progressive increases in liver transaminases. Gastrointestinal Hemorrhage: Gastrointestinal hemorrhage, sometimes fatal, has occurred, especially in elderly patients with underlying hematologic malignancies and/or low platelet counts. Monitor for signs and symptoms of GI bleeding.
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Side Effects

Urgent Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:

Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Signs of kidney problems: inability to urinate, changes in urine output, blood in the urine, or sudden weight gain.
Signs of liver problems: dark urine, fatigue, decreased appetite, stomach upset or pain, light-colored stools, vomiting, or yellowing of the skin or eyes.
Signs of bowel problems: black, tarry, or bloody stools, fever, mucus in the stools, vomiting blood or coffee ground-like material, severe stomach pain, constipation, or diarrhea.
Changes in hearing or vision.
Chest pain or pressure, rapid heartbeat, or fainting.
Flu-like symptoms.
Rashes, which may require discontinuation of the medication. If you develop a rash, contact your doctor promptly to determine the best course of action.
Severe skin reactions, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and other serious conditions, which can be life-threatening. Seek immediate medical attention if you experience red, swollen, blistered, or peeling skin; red or irritated eyes; sores in the mouth, throat, nose, eyes, genitals, or skin; fever; chills; body aches; shortness of breath; or swollen glands.
Blood cell disorders, which can increase the risk of severe bleeding or infections. Contact your doctor right away if you experience signs of infection, such as fever, chills, severe sore throat, ear or sinus pain, cough, increased or discolored sputum, painful urination, mouth sores, or a wound that won't heal; bruising or bleeding; or excessive fatigue or weakness.

Other Possible Side Effects

Like all medications, this drug can cause side effects, although many people may not experience any or may only have mild symptoms. If you encounter any of the following side effects or any other symptoms that concern you or persist, contact your doctor:

* Diarrhea, stomach pain, upset stomach, or vomiting.

This is not an exhaustive list of potential side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
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Seek Immediate Medical Attention If You Experience:

  • Severe stomach pain, black or bloody stools, vomiting blood (signs of GI bleeding)
  • Significant decrease in urine output, swelling in legs/ankles (signs of kidney problems)
  • Yellowing of skin or eyes, dark urine, severe nausea/vomiting (signs of liver problems)
  • Sudden decrease in hearing or vision changes (blurred vision, difficulty seeing)
  • Severe skin rash, blistering, or peeling skin
  • Unexplained fever, sore throat, or unusual bruising/bleeding (signs of blood problems)
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Before Using This Medicine

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
Certain health conditions, including:
+ Cancer
+ Blood or bone marrow disorders, such as low platelet count or high-risk myelodysplastic syndrome (MDS)
+ Kidney disease
+ Liver disease
Any instances of dehydration, which can be caused by:
+ Inability to eat or drink normally
+ Diarrhea
+ Vomiting
+ Other illnesses that may lead to dehydration
Use of similar medications. If you are unsure, consult your doctor or pharmacist.
Concurrent use of the following medications:
+ Cholestyramine
+ Colesevelam
+ Colestipol
+ Phenobarbital
+ Phenytoin
+ Rifampicin
+ Ritonavir
+ Theophylline
+ Tizanidine
Breast-feeding. Note that you should not breast-feed while taking this medication.

This list is not exhaustive, and it is crucial to inform your doctor and pharmacist about all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you may have. This will help ensure your safety while taking this medication. Do not initiate, discontinue, or modify the dosage of any medication without first consulting your doctor.
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Precautions & Cautions

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Until you understand how this drug affects you, avoid driving and other activities that require alertness.

Regular monitoring is crucial; therefore, follow your doctor's instructions for scheduled blood work, lab tests, eye exams, and hearing tests.

To avoid potential interactions, do not take antacids containing aluminum while using this medication.

If you are 55 years or older, exercise caution when taking this drug, as you may be more susceptible to side effects. Similarly, when administering this medication to children, use it with caution, as they may have a higher risk of experiencing certain side effects. If your child's weight changes while taking this medication, consult your doctor, as their dose may need to be adjusted.

When using this medication, be aware that birth control pills and other hormone-based contraceptives may be less effective in preventing pregnancy. To minimize this risk, consider using an additional form of birth control, such as a condom, while taking this drug.

If you are pregnant or planning to become pregnant, inform your doctor, as it is necessary to discuss the potential benefits and risks of using this medication during pregnancy.
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Overdose Information

Overdose Symptoms:

  • Abdominal pain
  • Diarrhea
  • Nausea
  • Vomiting
  • Headache
  • Dizziness
  • Elevated liver transaminases
  • Renal impairment

What to Do:

In case of suspected overdose, contact a poison control center or emergency room immediately. Call 1-800-222-1222 for the Poison Control Center. Treatment is supportive.

Drug Interactions

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Contraindicated Interactions

  • Aluminum-containing antacids (e.g., aluminum hydroxide, aluminum carbonate) - due to potential for increased deferasirox exposure and aluminum toxicity.
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Major Interactions

  • UGT inducers (e.g., rifampin, phenytoin, phenobarbital, ritonavir) - may decrease deferasirox exposure, requiring dose increase.
  • UGT inhibitors (e.g., fluconazole) - may increase deferasirox exposure, requiring dose reduction.
  • CYP2C8 inhibitors (e.g., gemfibrozil) - may increase deferasirox exposure, requiring dose reduction.
  • Bile acid sequestrants (e.g., cholestyramine) - may decrease deferasirox exposure.
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Moderate Interactions

  • CYP3A4 substrates (e.g., midazolam, cyclosporine, simvastatin) - deferasirox is a weak CYP3A4 inducer, may decrease exposure of co-administered drugs.
  • CYP2C8 substrates (e.g., repaglinide) - deferasirox is a weak CYP2C8 inhibitor, may increase exposure of co-administered drugs.
  • Oral contraceptives (hormonal) - deferasirox may decrease efficacy, consider alternative or additional contraception.
  • Vitamin K antagonists (e.g., warfarin) - increased risk of bleeding, monitor INR closely.
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Minor Interactions

  • Not specifically listed as minor interactions with clinical significance requiring dose adjustment.

Monitoring

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Baseline Monitoring

Serum ferritin

Rationale: To establish baseline iron burden and guide initial dosing.

Timing: Prior to initiation of therapy.

Serum creatinine and estimated Glomerular Filtration Rate (eGFR)

Rationale: To assess renal function, guide dosing, and identify patients at risk for renal impairment.

Timing: Prior to initiation of therapy.

Liver transaminases (ALT, AST) and serum bilirubin

Rationale: To assess hepatic function and identify patients at risk for hepatic impairment.

Timing: Prior to initiation of therapy.

Complete Blood Count (CBC)

Rationale: To assess hematological status and monitor for cytopenias.

Timing: Prior to initiation of therapy.

Audiometry

Rationale: To establish baseline hearing function.

Timing: Prior to initiation of therapy.

Ophthalmologic examination (slit lamp and fundoscopy)

Rationale: To establish baseline vision and monitor for ocular toxicity.

Timing: Prior to initiation of therapy.

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Routine Monitoring

Serum ferritin

Frequency: Monthly

Target: Goal is typically <1000 mcg/L, but individualized based on clinical response.

Action Threshold: Increase dose if ferritin >2500 mcg/L and well-tolerated; consider dose reduction if ferritin <500 mcg/L.

Serum creatinine and eGFR

Frequency: Weekly for the first month, then monthly thereafter.

Target: Within normal limits or stable baseline.

Action Threshold: If increase >33% above baseline on 2 consecutive measurements, or if CrCl falls below 20 mL/min, interrupt or discontinue therapy. Consider dose reduction if increase >33% above baseline and within normal range.

Liver transaminases (ALT, AST) and serum bilirubin

Frequency: Weekly for the first month, then monthly thereafter.

Target: Within normal limits or stable baseline.

Action Threshold: If transaminases increase >5 times ULN, interrupt therapy. If increase >2 times ULN and persistent, consider dose reduction or interruption.

Complete Blood Count (CBC)

Frequency: Monthly

Target: Within normal limits.

Action Threshold: Monitor for neutropenia, thrombocytopenia, or worsening anemia. Consider dose interruption if severe cytopenias develop.

Audiometry

Frequency: Annually

Target: Stable hearing.

Action Threshold: If hearing impairment develops, consider dose reduction or interruption.

Ophthalmologic examination (slit lamp and fundoscopy)

Frequency: Annually

Target: Stable vision.

Action Threshold: If visual disturbances develop, consider dose reduction or interruption.

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Symptom Monitoring

  • Gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain)
  • Skin rash
  • Changes in urine output or color
  • Yellowing of skin or eyes (jaundice)
  • Unusual bleeding or bruising
  • Vision changes (blurred vision, decreased acuity)
  • Hearing changes (decreased hearing, tinnitus)
  • Fatigue, weakness, or malaise (signs of organ dysfunction)

Special Patient Groups

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Pregnancy

Based on animal data, deferasirox may cause fetal harm. There are no adequate and well-controlled studies in pregnant women. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Trimester-Specific Risks:

First Trimester: Animal studies showed skeletal malformations and reduced fetal weight at doses higher than clinical exposure.
Second Trimester: Not specifically detailed, but general risk of fetal harm applies throughout pregnancy.
Third Trimester: Not specifically detailed, but general risk of fetal harm applies throughout pregnancy.
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Lactation

It is not known whether deferasirox is excreted in human milk. Due to the potential for serious adverse reactions in breastfed infants, advise women not to breastfeed during treatment with deferasirox.

Infant Risk: Unknown, but potential for serious adverse reactions.
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Pediatric Use

Approved for patients 2 years of age and older. Dosing is weight-based. Monitor growth and development, as iron overload and chelation therapy can impact these. Renal and hepatic function should be monitored closely, as children may be more susceptible to adverse effects.

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Geriatric Use

Increased incidence of adverse reactions, including renal failure, hepatic failure, and GI hemorrhage, has been reported in elderly patients (â‰Ĩ65 years). Use with caution and monitor closely, especially for renal, hepatic, and GI toxicities.

Clinical Information

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Clinical Pearls

  • Jadenu film-coated tablets offer improved patient convenience compared to Exjade dispersible tablets, as they can be swallowed whole and taken with or without a light meal.
  • Strict adherence to monitoring schedules (renal, hepatic, ferritin, vision, hearing) is critical due to the potential for serious adverse effects.
  • Patients should be educated on the importance of hydration to minimize the risk of renal toxicity.
  • Dose adjustments are frequently required based on serum ferritin trends, renal function, and tolerability.
  • For patients with significant GI irritation, taking the dose with a light meal may improve tolerability, but avoid high-fat meals.
  • Deferasirox is not indicated for iron overload in patients with myelodysplastic syndromes (MDS) who are not transfusion-dependent.
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Alternative Therapies

  • Deferoxamine (Desferal) - parenteral iron chelator
  • Deferiprone (Ferriprox) - oral iron chelator
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Cost & Coverage

Average Cost: Highly variable, typically several thousand USD per 30 tablets
Generic Available: Yes
Insurance Coverage: Tier 3 or 4 (Specialty Drug), often requires prior authorization.
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General Drug Facts

If your symptoms or health problems do not improve or worsen over time, it is essential to contact your doctor for further evaluation and guidance. To ensure your safety and the effectiveness of your treatment, never share your medication with others or take someone else's medication.

This medication is accompanied by a Medication Guide, which is a valuable resource that provides important information about its safe and effective use. It is crucial to read this guide carefully and review it again whenever your prescription is refilled. If you have any questions or concerns about this medication, do not hesitate to discuss them with your doctor, pharmacist, or other healthcare provider.

In the event of a suspected overdose, it is vital to seek immediate medical attention by calling your local poison control center or visiting the emergency room. When seeking help, be prepared to provide detailed information about the overdose, including the name of the medication taken, the amount consumed, and the time it occurred. This information will enable healthcare professionals to provide you with the most appropriate and timely care.