There is no mention at all of calcium in the Exjade prescribing information. It only says to take at least 30 minutes before eating. This is so it can move through the stomach without interacting with foods that may have some neutralizing effect on its effectiveness and this is only a precaution. I cannot find any precaution about taking calcium. I cannot find any evidence in any reports that Exjade chelates calcium in the body. Waiting 3 hours seems nearly impossible. That would almost necessitate skipping breakfast completely, and at the least would require that no calcium foods are taken with breakfast, which is not a sensible part of a balanced diet.
Here is a list of know interactions with Exjade.
http://www.hsa.gov.sg/publish/hsaportal/en/health_products_regulation/safety_information/safety-related_product/january-april_2008.htmlDeferasirox (Exjade®, Novartis) Special warnings: Although uncommon, elevations of transaminases > 10Xs the upper limit of the normal range, suggestive of hepatitis, have been observed in clinical trials. Most post-marketing reports of hepatic failure in patients treated with Exjade® involved those with significant co-morbidities including liver cirrhosis & multi-organ failure; fatal outcomes reported in some of them.
Upper GI ulceration & haemorrhage have been reported in patients, including children & adolescents, receiving Exjade®. Promptly initiate additional evaluation & treatment if a serious GI adverse event is suspected. Exercise caution in patients who are taking Exjade® in combination with drugs that are ulcerogenic, such as NSAIDs, corticosteroids or oral bisphosphonates & in patients receiving anticoagulants.
Risk of toxicity of Exjade® may be increased when inappropriately high doses are given in patients with a low iron burden or with serum ferritin levels that are only slightly elevated.
Interactions: Study has shown that the concomitant administration of Exjade® & midazolam, a CYP3A4 substrate, resulted in a decrease of midazolam exposure by 17%. Therefore, caution should be exercised when deferasirox is combined with substances metabolised through CYP3A4 e.g. ciclosporin, simvastatin, hormonal contraceptive agents.
Concomitant administration of Exjade® with drugs that have ulcerogenic potential, such as NSAIDs, corticosteroids or oral bisphosphonates & use of Exjade® in patients receiving anticoagulants may increase the risk of GI irritation.
ADRs: Optic neuritis, GI haemorrhage, gastric/duodenal ulcer, oesophagitis, renal tubulopathy (Fanconi's syndrome), hepatic failure.
Posology & method of administration: Decision to remove accumulated iron should be individualized based on anticipated clinical benefit & risks of chelation therapy.
Some notes I do want to make about this are that they mention liver enzyme levels of 10 times normal. We need to make note of this because people are overly concerned about levels that are barely above normal. Also, it is not a good choice to use Exjade in low ferritin conditions as what was recommended with Jos. As he reported, some dietary changes and IP6 made an immediate impact on his ferritin level. With transfusing thals, this is different because there is a constant source of new iron being added to the body, but for patients with minor incidental iron build up, Exjade should probably not be used, especially since we do know about the natural safe chelators like IP6 and green tea extract.
I would also appreciate if CF can clarify what they have been told about how long to wait after taking calcium before using Exjade and what is the reason.