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Deferasirox Brand Names- Exjade | JADENU
What is Deferasirox
Deferasirox is a first in class, tridentate, oral, iron-chelating agent used in the treatment of chronic iron overload secondary to multiple RBC transfusions (i.e., transfusional iron overload) and non-transfusion dependent thalassemia syndromes.
Iron overload is a serious complication caused by frequent blood transfusions in patients with blood transfusion-dependent anemias, such as ß-thalassemia, sickle cell disease, other rare anemias, and myeloproliferative disorders.
Deferasirox has been developed as an alternative to deferoxamine, the standard treatment of chronic iron overload, which is administered parenterally.
In patients with chronic iron toxicity, chelation treatments are effective for rapid iron removal, maintenance of low iron stores, prevention of heart and other organ damage caused by iron overload, and ultimately improved survival.
A large number of patients that require iron chelation therapy with deferoxamine often do not receive adequate therapy due to noncompliance.
Because deferasirox is administered orally once daily, it will likely be a more acceptable regimen for chronic use, thus enhancing the management of chronic iron toxicity.
Additionally, the quality of life of patients who require lifelong iron-chelating therapy may be considerably improved.
Despite the benefits, health care providers are urged to consider the risks versus benefits of prescribing deferasirox.
To highlight these risks, the product labeling contains a Black Box Warning regarding potential for renal failure, hepatic failure, and gastrointestinal hemorrhages. In some cases these adverse events have resulted in fatalities, particularly in elderly and pediatric patients.
Indications
- iron toxicity
- transfusional iron overload
For the treatment of chronic iron toxicity secondary to transfusional iron overload or non-transfusion-dependent thalassemia syndromes
for the initiation of therapy for chronic iron toxicity secondary to transfusional iron overload (transfusional hemisiderosis)
Side Effects
- abdominal pain
- agranulocytosis
- alopecia
- anaphylactoid reactions
- angioedema
- anxiety
- cataracts
- cholelithiasis
- diarrhea
- dizziness
- Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
- edema
- elevated hepatic enzymes
- erythema multiforme
- esophagitis
- Fanconi syndrome
- fatigue
- fever
- gastritis
- GI bleeding
- GI perforation
- glycosuria
- hearing loss
- hematuria
- hepatic failure
- hepatitis
- hepatotoxicity
- hypokalemia
- insomnia
- interstitial nephritis
- maculopapular rash
- nausea
- nephrotoxicity
- neutropenia
- optic neuritis
- pancreatitis
- peptic ulcer
- proteinuria
- purpura
- rash
- renal failure (unspecified)
- Stevens-Johnson syndrome
- thrombocytopenia
- toxic epidermal necrolysis
- urticaria
- vasculitis
- visual impairment
- vomiting
Monitoring Parameters
- audiometry
- CBC with differential
- ferritin
- LFTs
- ophthalmologic exam
- serum creatinine/BUN
- serum electrolytes
- urinalysis
Contraindications
- agranulocytosis
- anemia
- angioedema
- anticoagulant therapy
- bone marrow suppression
- breast-feeding
- cataracts
- children
- corticosteroid therapy
- diarrhea
- driving or operating machinery
- geriatric
- GI bleeding
- GI perforation
- glaucoma
- hearing impairment
- hepatic decompensation
- hepatic disease
- hepatitis
- hepatotoxicity
- hypovolemia
- infants
- myelodysplastic syndrome (MDS)
- neonates
- neoplastic disease
- nephrotoxicity
- neutropenia
- peptic ulcer disease
- pregnancy
- proteinuria
- renal disease
- renal failure
- renal impairment
- serious hypersensitivity reactions or anaphylaxis
- serious rash
- thrombocytopenia
- visual disturbance
- vomiting
Interactions
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Alclometasone
- Alendronate
- Alendronate; Cholecalciferol
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aluminum Hydroxide
- Aluminum Hydroxide; Magnesium Carbonate
- Aluminum Hydroxide; Magnesium Hydroxide
- Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
- Aluminum Hydroxide; Magnesium Trisilicate
- Amikacin
- Aminoglycosides
- Aminosalicylate sodium, Aminosalicylic acid
- Amiodarone
- Amlodipine
- Amlodipine; Atorvastatin
- Amlodipine; Benazepril
- Amlodipine; Celecoxib
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Antithrombin III
- Apalutamide
- Aprepitant, Fosaprepitant
- Argatroban
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Azelastine; Fluticasone
- Bedaquiline
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Benzhydrocodone; Acetaminophen
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Bismuth Subsalicylate
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Bivalirudin
- Bromocriptine
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Budesonide
- Budesonide; Formoterol
- Bupivacaine; Lidocaine
- Busulfan
- Calcium Carbonate; Risedronate
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Celecoxib
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Cholestyramine
- Choline Salicylate; Magnesium Salicylate
- Clobetasol
- Cobimetinib
- Colesevelam
- Colestipol
- Cyclosporine
- Dabigatran
- Daclatasvir
- Dalteparin
- Danaparoid
- Dapsone
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Deferiprone
- Deferoxamine
- Deflazacort
- Desirudin
- Dexamethasone
- Diclofenac
- Diclofenac; Misoprostol
- Diflunisal
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Doravirine
- Doravirine; Lamivudine; Tenofovir disoproxil fumarate
- Dronabinol
- Drospirenone
- Drospirenone; Estradiol
- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Edoxaban
- Elbasvir; Grazoprevir
- Enoxaparin
- Esomeprazole; Naproxen
- Estradiol; Levonorgestrel
- Estradiol; Norethindrone
- Estradiol; Norgestimate
- Ethinyl Estradiol
- Ethinyl Estradiol; Desogestrel
- Ethinyl Estradiol; Ethynodiol Diacetate
- Ethinyl Estradiol; Etonogestrel
- Ethinyl Estradiol; Levonorgestrel
- Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Ethinyl Estradiol; Norelgestromin
- Ethinyl Estradiol; Norethindrone
- Ethinyl Estradiol; Norethindrone Acetate
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Ethinyl Estradiol; Norgestimate
- Ethinyl Estradiol; Norgestrel
- Etodolac
- Etonogestrel
- Ezetimibe; Simvastatin
- Famotidine; Ibuprofen
- Fenoprofen
- Flurbiprofen
- Fluticasone
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Fluvastatin
- Fondaparinux
- food
- Fosphenytoin
- Gentamicin
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guanfacine
- Heparin
- Homatropine; Hydrocodone
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibandronate
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Indomethacin
- Iron
- Iron – Injectable Only
- Iron Salts
- Isavuconazonium
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Ivabradine
- Kanamycin
- Ketoprofen
- Ketorolac
- Lansoprazole; Naproxen
- Lepirudin
- Leuprolide; Norethindrone
- Levonorgestrel
- Lidocaine
- Loperamide
- Loperamide; Simethicone
- Lopinavir; Ritonavir
- Lumateperone
- Magnesium Salicylate
- Maraviroc
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Mestranol; Norethindrone
- Metformin; Repaglinide
- Methylprednisolone
- Midazolam
- Nabumetone
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Neratinib
- Niacin; Simvastatin
- Nisoldipine
- Non-Ionic Contrast Media
- Nonsteroidal antiinflammatory drugs
- Norethindrone
- Norgestrel
- Ombitasvir; Paritaprevir; Ritonavir
- Oxaprozin
- Oxycodone
- Paclitaxel
- Paromomycin
- Pentosan
- Perindopril; Amlodipine
- Phenobarbital
- Phenytoin
- Piroxicam
- Plazomicin
- Polysaccharide-Iron Complex
- Pomalidomide
- Praziquantel
- Prednisolone
- Prednisone
- Repaglinide
- Rifampin
- Riluzole
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- Ritonavir
- Rivaroxaban
- Rofecoxib
- Salicylates
- Salsalate
- Segesterone Acetate; Ethinyl Estradiol
- Selexipag
- Simvastatin
- Simvastatin; Sitagliptin
- Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate
- Sofosbuvir; Velpatasvir
- Sofosbuvir; Velpatasvir; Voxilaprevir
- Sonidegib
- Streptomycin
- Sufentanil
- Sulindac
- Tacrolimus
- Tinzaparin
- Tobramycin
- Tolmetin
- Trandolapril; Verapamil
- Triamcinolone
- Ubrogepant
- Ulipristal
- Valdecoxib
- Vancomycin
- Verapamil
- Warfarin
- Zolpidem