FAQs About Chelators Exjade & Deferiprone ...

Hi Buddies,
there are alot of posts regarding the Q & As about these Chelator ( Exjade & Deferiprone ) , on different boards of this forum  , i just want to togather FAQs about these chelators in one place , to make it easy to find " Frequantly Asked Question " under one thread ..
its based on General information ...

General info about Exjade .....

What is Exjade?
Exjade is a substance whose chemical name is Deferasirox, which binds iron and so is used to treat iron overload.
Can it be given to children?
The youngest age that has received this drug is 2 years, using the same starting dose (20mg) as for adults.
Are there any precautions to be considered before taking Exjade?
Before prescribing this treatment your doctor should be informed about any allergies to drugs, kidney conditions, liver disease, visual or hearing problems.
What is the dose?
Usually 20mg/kg/day are given to maintain iron balance in the body but 30mg/kg/day are required to reduce iron overload. In some patients and even higher dose may be needed, and trials are underway to test these doses.
How is it taken?
The medication is taken once a day, on an empty stomach, at least 30 minutes before food – preferably the same time each day. Each tablet is dissolved in water, orange juice or apple juice and the mixture is taken right away. Use half a cup if the dose is less than 1000mgs (1g) or a full cup (around 200ml) if the dose is more than 1000mgs. Any residue in the cup after taking the suspension should be resuspended in a small volume of water and swallowed.
How are the tablets stored?
Room temperature (15-30°C) avoiding very warm or moist environments.
What if a dose is missed?
Take it as soon as you remember, unless you remember very near your next scheduled dose, in which case take the medicine at the next scheduled time. Do not take an extra amount to make up for the missed dose.
What are the possible side effects?
Allergy manifesting as a rash (urticaria), swelling of face, lips, tongue or throat and in severe cases difficulty in breathing. Problems in vision and hearing. These are the most severe side effects and must be reported to the doctor promptly. Less serious effects are mild upsets with stomach pain, nausea, vomiting or diarrhoea; fever; skin rash; cough, runny or stuffy nose; headache and sinus pain. Most of these side effects are temporary, at the start of treatment and disappearing in time, without having to stop taking the medicine or reducing the dose.
Does this treatment need monitoring with lab tests?
Renal and liver function tests are monitored monthly during treatment because reactions in both kidneys and liver have been reported, even though these are rarely serious. Caution is especially needed in patients who already have impaired kidney or liver function, in whom it is best not to use this drug. Exjade is interrupted if S. Creatinine continues to rise above the upper limit of normal for age.
Are there interactions with other medicines? Should I avoid taking Exjade while taking other drugs?
At this time Deferasirox has not yet been tested in conjunction with other chelating agents. Combination therapy should be avoided until tests have been carried out by scientists. It is also recommended to avoid taking Exjade along with antacids which contain aluminium (these include Gaviscon, Maalox, Amphigel, Mi-Acid, Mylanta, Rulox and others). Doses of Vitamin C up to 200mg are well tolerated with Derasirox but there have been no formal studies with higher doses.
Can Deferasirox be used in pregnancy and breast feeding?
In animal studies there was no evidence of harm to the embryo. However, it is recommended to stop the drug in pregnancy and when breastfeeding

FAQs About Deferiprone :

• How many times a day should Deferiprone be taken?

Deferiprone is taken in three divided doses, morning, midday and evening.

• Is there an interaction with other medicines?

There have been no reports of drug interactions with other prescribed medicines. There is, however, a potential interaction with aluminium-based based antacids, since Deferiprone binds other metallic ions as well as iron. The concurrent use of Vitamin C has not been studied but it is potentially toxic and should be avoided.

• Why is it necessary to do a weekly blood count?

In a proportion of patients there is fall in the number of polymorphonuclear cells, the white blood cells responsible for the defence of the body against bacterial infections. This may be severe fall to below 500/cmm known as agranulocytosis: this occurs in about 1.2% of patients taking Deferiprone and it may lead to a serious infection. A less severe fall in the neutrophil count may also occur, between 500–1500/cmm, known as neutropenia. This may be indicate that agranulocytosis is imminent and may also predispose to infection. It is important to detect this fall in white cell count early since interruption of the drug will restore the neutrophil count and avoid any complications. This is the reason for the weekly blood counts.

• Is Deferiprone used in pregnancy and breastfeeding?

In animal studies it was demonstrated that this drug can cause damage to the early embryo (teratogenic). This has not been recorded in humans but because of the experience in animals it is unwise to use the drug in both pregnancy and breastfeeding. In fact it is strongly advised to avoid pregnancy while on this medication.

• Does Deferiprone predispose to Yersinia enterocolitica infection?

Experimental evidence from the Pasteur Institute of Paris, both in vitro and in a mouse model, indicate that this drug does not promote Yersinia growth and virulence. However, in a Canadian review of clinical infections in thalassaemia patients over 15 years, one patient was receiving Deferiprone, while 2 patients were not on any chelating agent and the rest of their cases (11) were taking Deferoxamine. For this reason it can be concluded that Deferiprone is less likely to predispose to Yersinia. In numerous studies on Deferiprone in thalassaemia, cases of Yersinia infection are not mentioned.

• Does Deferiprone protect the heart more than other agents?i

Comparisons have been made mainly with Deferoxamine. Recent publications confirm that Deferiprone is superior as a cardio-protective agent than Deferoxamine, probably because as a smaller molecule, it can remove intracellular iron from myocardial cells.

• Can Deferiprone be used in children?

Formal trials of safety and efficacy have not been conducted in children under the age of 10 years.

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