Desferal or Exjade

helloooooooo
to all thalassemia patiant, parants and doctors
wich on of thes tratmant is bater and safty for thalassemis major
pationt Ddesferal pump of Exjade tablet becos i have abroblem in my hart
and i'm taking the Exjade for 1.1/2 years and my freten butwen 700-500
shall i stoop Exjade i hear it's not good and it have saed efect
b.regards
bdra

DOSAGE AND ADMINISTRATION
The decision to remove accumulated iron should be individualized based on anticipated
clinical benefit and risks of Exjade therapy. In patients who are in need of iron chelation
therapy, it is recommended that therapy with Exjade® (deferasirox) be started when a
patient has evidence of chronic iron overload, such as the transfusion of approximately
100 mL/kg of packed red blood cells (approximately 20 units for a 40-kg patient) and a
serum ferritin consistently >1000 mcg/L.
Starting Dose
The recommended initial daily dose of Exjade is 20 mg/kg body weight.
Maintenance
After commencing initial therapy, it is recommended that serum ferritin be monitored
every month and the dose of Exjade adjusted if necessary every 3 to 6 months based on
serum ferritin trends. Dose adjustments should be made in steps of 5 or 10 mg/kg and
should be tailored to the individual patient’s response and therapeutic goals (maintenance
or reduction of body iron burden). [bgcolor=#ffff00]If the serum ferritin falls consistently below 500
mcg/L, consideration should be given to temporarily interrupting therapy with Exjade. [/bgcolor]Doses of Exjade should not exceed 30 mg/kg per day since there is limited experience
with doses above this level[/b]
Administration Instructions
Exjade should be taken once daily on an empty stomach at least 30 minutes before food,
preferably at the same time each day. Tablets should not be chewed or swallowed whole.
Exjade should not be taken with aluminum-containing antacid products. Doses (mg/kg
per day) should be calculated to the nearest whole tablet. Tablets should be completely
dispersed by stirring in water, orange juice, or apple juice until a fine suspension is
obtained. Doses of <1 g should be dispersed in 3.5 ounces of liquid and doses of ≥1 g in
7.0 ounces of liquid. After swallowing the suspension, any residue should be resuspended
in a small volume of liquid and swallowed.

Hi bdra ,
i hope it help you ... let me know if i miss anything ...

Best Regards
Take Care
Umair

What about the maintaince Dose which is 20mg/kilo? Should it be stopped too in spite of regular transfusions?

Andy, would you please shed some light on this

Manal

I do think this is a question for your doctor. I don't think a patient should stop chelating unless the doctor prescribes that. If your ferritin is quite low and most importantly, low iron levels are demonstrated through a scan of the liver and heart, then a reduction may be warranted. I would not recommend lowering or stopping the dose until your doctor says it should be done based on scan results.

Bdra,

I have been told that if ferritin is consistently below 600 that changes are often made with the Exjade (either held back for a while, or reduced) - but your doctor needs to make the decision.  Also, because ferritin is not an exact measure of iron it would be a good idea to have a scan (SQUID or ferriscan) to determine if your LIC is also below 600. 

Congratulations on getting your ferritin so low by the way, that is great to hear!!

Sharmin

Drug Interactions
The concomitant administration of Exjade and aluminum-containing antacid preparations
has not been formally studied. Although deferasirox has a lower affinity for aluminum
than for iron, Exjade should not be taken with aluminum-containing antacid preparations.
In healthy volunteers, Exjade had no effect on the pharmacokinetics of digoxin. The
effect of digoxin on Exjade pharmacokinetics has not been studied.
The concomitant administration of Exjade and vitamin C has not been formally studied.
Doses of vitamin C up to 200 mg were allowed in clinical studies without negative
consequences.
The interaction of Exjade with hydroxyurea has not been formally studied. No inhibition
of deferasirox metabolism by hydroxyurea is expected based on the results of an in vitro
study.
Exjade should not be combined with other iron chelator therapies, as safety of such
combinations has not been established.

Laboratory Tests
Serum ferritin should be measured monthly to assess response to therapy and to evaluate
for the possibility of overchelation of iron. If the serum ferritin falls consistently below
500 mcg/L, consideration should be given to temporarily interrupting therapy with
Exjade. (See DOSAGE AND ADMINISTRATION.)
[bgcolor=#fff500]In the clinical studies, the correlation coefficient between the serum ferritin and LIC was
0.63. Therefore, changes in serum ferritin levels may not always reliably reflect changes
in LIC.[/bgcolor]
Laboratory monitoring of renal and hepatic function should be performed. (See
WARNINGS.)

i hope its clearing up now ,,,

Umair

Hey buddies ,
here is a PDF document .. its all about exjade and its trials studies .you can find in it wat r ther safety measures to start, keep continue  and reasons why and when you should stop exjade please check this .... i hope you will find all wat you want to know ,in it ...

Umair

Thanks Umair so much

manal

A more recent version of this information, including updates, is available in the Documents section at http://www.thalassemiapatientsandfriends.com/index.php?topic=1928.msg16165#msg16165

Along with the discussion about Exjade, this information should also be remembered. Exjade reacts with aluminum so do not take Exjade with antacids containing aluminum (aluminum is a poison so it amazes me that it is an ingredient in medications in the first place). Antacids such as Amphojel, Gaviscon, Maalox, Mi-Acid, Mylanta, Rulox, and others. If you read about aluminum toxicity, you won't want to use them anyway.

Some things about aluminum that may interest thals.  http://www.emedicine.com/MED/topic113.htm

Aluminum also has a direct effect on hematopoiesis. Excess aluminum has been shown to induce microcytic anemia...Aluminum may cause anemia through decreased heme synthesis, decreased globulin synthesis, and increased hemolysis. Aluminum may also have a direct effect on iron metabolism: it influences absorption of iron via the intestine, it hinders iron's transport in the serum, and it displaces iron's binding to transferrin. Patients with anemia from aluminum toxicity often have increased reticulocyte counts, decreased mean corpuscular volume, and mean corpuscular hemoglobin.

Other organic manifestations of aluminum intoxication have been proposed, such as a slightly poorer immunologic response to infection, but the mechanism by which it exerts its effect is complex and multifactorial.

Aluminum is also found in many baking powders and baked goods.

This is very interesting Andy, i think also cooking in aluminum utensils adds to this toxicity. Unfortunetly, these utencils are widely used here

manal

In Pakistan too 

Zaini.