Deferasirox

CLINICAL USE

Treatment of iron overload

DOSE IN NORMAL RENAL FUNCTION

10–30 mg/kg once daily rounded to the nearest whole tablet

PHARMACOKINETICS

Molecular weight :373.4

%Protein binding :99

%Excreted unchanged in urine : 8

Volume of distribution (L/kg) :14 litres

half-life – normal/ESRD (hrs) :8–16

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Avoid. See ‘Other Information’

10 to 20 : Avoid. See ‘Other Information’

<10 : Avoid. See ‘Other Information’

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unlikely to be dialysed. Avoid

HD :Dialysed. Avoid

HDF/high flux :Dialysed. Avoid

CAV/VVHD :Unlikely to be dialysed. Avoid

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsAluminium-containing antacids: avoid concomitant useOther nephrotoxic agents: avoid concomitant therapy

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

–

Comments

Take on an empty stomach Disperse in a glass of water, orange or apple juice

OTHER INFORMATION

Increased risk of potentially fatal renal failure and cytopenias in patients with other comorbidities who also had an advanced haematological condition. www.medscape.com/viewarticle/557118During clinical trials, increases in serum creatinine of >33% on 2 consecutive occasions (sometimes above the upper limit of the normal range) occurred in about 36% of patients. These were dose-dependent. Cases of acute renal failure have been reported following post-marketing use of deferasiroxPatients with pre-existing renal conditions and patients who are receiving medicinal products that depress renal function may be more at risk of complicationsTests for proteinuria should be performed monthly. Other markers of renal tubular function may also be monitored (e.g. glycosuria in non-diabetics and low levels of serum potassium, phosphate, magnesium or urate, phosphaturia, aminoaciduria)If, despite dose reduction and interruption, the serum creatinine remains significantly elevated and there is also persistent abnormality in another marker of renal function (e.g. proteinuria, Fanconi’s Syndrome), the patient should be referred to a renal specialist, and further specialised investigations (such as renal biopsy) may be considered

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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