Exjade

Generic name: deferasirox
Drug class: Chelating agents

Medically reviewed by A Ras MD.

What is Exjade?

Exjade is a prescription medicine that is used to treat people 2 years of age and older who have an increased amount of iron in their blood for a long period of time (chronic), caused by repeated blood transfusions, certain people 10 years of age or older with thalassemia who have an increased amount of iron in their blood but who are not receiving regular blood transfusions

It is not known if Exjade is safe and effective when used with other medicines to treat an increased amount of iron in the blood.

It is not known if Exjade is safe and effective for treating children under 2 years of age who have an increased amount of iron in their blood for a long period of time (chronic) caused by repeated blood transfusions.

It is not known if Exjade is safe and effective for treating children under 10 years of age with thalassemia who have an increased amount of iron in their blood, but who are not receiving regular blood transfusions.

Description

Exjade (deferasirox) is an iron chelating agent. Exjade tablets for oral suspension contain 125 mg, 250 mg, or 500 mg deferasirox. Deferasirox is designated chemically as 4-[3,5-Bis (2-hydroxyphenyl)-1H-1,2,4-triazol-1-yl]-benzoic acid and its structural formula is:

Deferasirox is a white to slightly yellow powder. Its molecular formula is C21H15N3O4 and its molecular weight is 373.4 g/mol.

Inactive Ingredients: Crospovidone (NF), lactose monohydrate (NF), magnesium stearate (NF), microcrystalline cellulose (NF), povidone (K30) (NF), silicon dioxide (NF), and sodium lauryl sulphate (NF).

Mechanism of Action

Exjade (deferasirox) is an orally active chelator that is selective for iron (as Fe3+). It is a tridentate ligand that binds iron with high affinity in a 2:1 ratio. Although deferasirox has very low affinity for zinc and copper there are variable decreases in the serum concentration of these trace metals after the administration of deferasirox. The clinical significance of these decreases is uncertain.

What is the most important information I should know about Exjade?

Exjade can cause serious side effects, including:
Kidney problems. Exjade can cause sudden (acute) kidney problems, including kidney failure that may require treatment with dialysis, and may cause death. Deaths have happened mostly in people who also have other health problems and had a blood disorder that was in an advanced stage. Adults and children who already have kidney problems and are taking certain medicines with Exjade, may also have an increased risk of sudden kidney problems. Be sure to tell your healthcare provider about all the medicines you take during treatment with Exjade.
Your healthcare provider should do blood and urine tests to check your or your child’s kidney function before and during treatment with Exjade. Call your or your child’s healthcare provider right away if:

your child becomes sick with fever, vomiting, or diarrhea and cannot drink fluids normally during treatment with Exjade. Your child may be dehydrated. Your child’s healthcare provider may need to temporarily stop treatment with Exjade and treat your child for dehydration to help prevent kidney problems. Your child’s healthcare provider may monitor your child’s kidney function more closely.
you notice that you or your child are passing less urine than usual during treatment with Exjade.

Liver problems. Exjade can cause liver problems, including liver failure that can sometimes cause death. Liver problems with Exjade may be more common in people who are over 55 years of age but can also happen in children. Liver failure has happened more often in people with cirrhosis of the liver and failure of other organs. Liver failure has also happened along with kidney problems in certain children who become dehydrated. See “Kidney problems” above.

Your healthcare provider should do blood tests to check your liver function before you start and regularly during treatment with Exjade. Call your healthcare provider right away, if you develop any of the following signs and symptoms:

drowsiness
upper right stomach-area (abdomen) pain
yellowing or increased yellowing of your skin or eyes,
dark urine

Bleeding, ulcers, and tears of the stomach or intestine. Severe stomach and intestine bleeding (hemorrhage) that have caused death have happened in some people treated with Exjade, especially in elderly people who have advanced blood cancers or low platelet counts. Some people have also had ulcers of the stomach or intestine, sometimes with tears (perforation) that have caused death. In some people who have taken Exjade, including children and adolescents, irritation of the upper gastrointestinal tract, ulcers, and bleeding have happened, but did not cause death.

Your risk of severe bleeding (hemorrhage) may be increased if you take Exjade along with other medicines that can cause ulcers or bleeding, such as:

nonsteroidal anti-inflammatory drugs (NSAIDs)
corticosteroids
certain osteoporosis medicines called oral bisphosphonates
blood thinner medicines

Before you start taking Exjade, tell your healthcare provider if you are taking one of these medicines. Ask your healthcare provider if you are not sure. If you develop an ulcer of the stomach or intestine, or severe bleeding, your healthcare provider may stop Exjade.

Elderly people may be at a higher risk of developing serious side effects and death due to serious side effects with Exjade. Your healthcare provider may need to monitor you more closely during treatment with Exjade.

Tell your healthcare provider if you get heartburn during treatment with Exjade.
Get emergency medical help right away if you vomit blood or pass black or bloody stools, or if you have severe stomach-area (abdomen) pain during treatment with Exjade.

See “What are the possible side effects of Exjade?” for more information about side effects.

Who should not take Exjade?

Do not take Exjade if you:

have certain kidney problems
have high-risk myelodysplastic syndrome (MDS)
have advanced cancer
have a low platelet count
are allergic to deferasirox or any of the ingredients in Exjade. See the end of this leaflet for a list of the ingredients in Exjade.

Ask your healthcare provider if you are not sure if you have any of the medical conditions listed above.

What should I tell my healthcare provider before taking Exjade?

Before taking Exjade, tell your healthcare provider about all of your medical conditions, including if you:

have kidney problems
have liver problems
have advanced cancer. See “Who should not take Exjade?” above.
have a blood disorder that may increase your risk for bleeding
are pregnant or plan to become pregnant. It is not known if Exjade can harm your unborn baby. Hormonal forms of birth control may not be as effective if used during treatment with Exjade. You could become pregnant. Talk to your healthcare provider about other birth control options that you can use during this time. Tell your healthcare provider right away if you become pregnant during treatment with Exjade.
are breastfeeding or plan to breastfeed. It is not known if Exjade passes into your breast milk and can harm your baby. You and your healthcare provider should decide if you will take Exjade or breastfeed. You should not do both.

Tell your healthcare provider about all the medicines you take, including prescription medicines, over-the-counter medicines, vitamins, and herbal supplements. Some medicines may affect how Exjade works, and Exjade may affect how other medicines work. Also, your risk of sudden kidney problems or severe bleeding may be increased if you take Exjade with certain medicines. See “What is the most important information I should know about Exjade?”

Avoid taking the following medicines during treatment with Exjade:
- antacid products (medicines used to treat heartburn) that contain aluminum
- theophylline
- certain medicines to lower your cholesterol, called bile acid sequestrants.

Ask your healthcare provider if you are not sure if you take one of these medicines.

Know the medicines you take. Keep a list of them to show your healthcare provider or pharmacist when you get a new medicine.

How should I take Exjade?

Take Exjade exactly as your healthcare provider tells you to.
Do not change your dose of Exjade or stop taking it unless your healthcare provider tells you to.
Take Exjade1 time every day, preferably at the same time every day.
Take Exjade on an empty stomach at least 30 minutes before eating food.
Do not to chew Exjade tablets or swallow them whole.
Place the prescribed number of Exjade tablets in a cup with water, orange juice, or apple juice. Stir to disperse the tablets in the liquid.
- If your prescribed dose of Exjade is less than 1 gram, use 3.5 ounces of liquid to disperse the tablets.
- If your prescribed dose of Exjade is 1 gram or more, use 7 ounces of liquid to disperse the tablets.
Completely disperse the tablets until it becomes a fine suspension, then drink the suspension right away.
Do not disperse Exjade tablets in carbonated drinks or milk.
After drinking the suspension, add a small amount of water, orange juice, or apple juice to the cup to disperse any remaining medicine, and then drink it.
Do not take Exjade with aluminum-containing antacid products. See “What should I tell my healthcare provider before taking Exjade?”
Tell your healthcare provider if you or your child gain or lose any weight. Your or your child’s dose of Exjade may need to be adjusted.
If you take the diabetes medicine repaglinide during treatment with Exjade, you may need to test your blood sugar (glucose) levels more often. Follow your healthcare provider’s instructions about how often to test your blood sugar during this time.
Your healthcare provider should do blood and urine tests before, and during treatment to check how you respond to Exjade, and to monitor you for side effects. Your healthcare provider may change your dose, temporarily or permanently stop Exjade if you have certain side effects.
In people who have thalassemia, your healthcare provider will check the amount of iron in your liver before and during treatment with Exjade.
If you or your child take too much Exjade, call your healthcare provider right away or go to the nearest hospital emergency room. Symptoms that can happen if you take too much Exjade include: stomach-area (abdominal) pain, diarrhea, nausea, and vomiting.

What should I avoid while taking Exjade?

Exjade may cause dizziness. Avoid driving or operating machinery until you know how Exjade affects you. Do not drive or operate machinery if Exjade makes you dizzy.

What are the possible side effects of Exjade?

Exjade can cause serious side effects, including:

See “What is the most important information I should know about Exjade?”
Effects on your bone marrow. Exjade can affect your bone marrow and cause you to have low white blood cell count which can be serious, decreased platelets, or worsening of your anemia, and may lead to death. Your risk for effects on your bone marrow may be increased if you already have other blood disorders. Your healthcare provider will do blood tests to monitor your blood cell counts for these problems.
Serious allergic reactions. Exjade may cause serious allergic reactions, which usually start within the first month of treatment. Get medical help right away if you develop any of the following symptoms of a serious allergic reaction including:
- difficulty in breathing or swallowing
- chest pain
- rapid heartbeat
- feeling faint
- swelling of the face, lips, mouth, tongue or throat
- severe itching of the skin with a red rash or raised bumps
- hives
Skin rash and severe skin reactions. Skin rashes are common with Exjade. If you get a more severe rash, your healthcare provider may temporarily stop Exjade.Severe skin reactions can also happen with Exjade and can be life-threatening or lead to death. Get medical help right away if you develop any one or more of the following signs and symptoms of a severe skin reaction, including:
- rash or red skin
- blisters on your lips, or around your mouth or eyes
- mouth sores
- skin peeling
- high fever or flu-like symptoms
- enlarged lymph nodes
Hearing and vision problems. Exjade can cause decreased hearing and changes in your vision including cataracts, increased pressure in your eye, and problems with your retinas. Your healthcare provider should do hearing and vision tests before you start and then regularly during treatment. Your healthcare provider may decrease your dose or stop Exjade if you develop hearing or vision problems.

Tell your healthcare provider if you develop any changes in your vision or hearing during treatment with Exjade.

The most common side effects in anyone who takes Exjade include: diarrhea and nausea.

Other common side effects in people with too much iron in their blood due to repeated blood transfusions include: vomiting, stomach-area (abdomen) pain, and an abnormal kidney function blood test.

These are not all the possible side effects of Exjade.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General information about the safe and effective use of Exjade

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use Exjade for a condition for which it was not prescribed. Do not give Exjade to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about Exjade that is written for health professionals.

How should I store Exjade?

Store Exjade at room temperature between 68°F to 77°F (20°C to 25°C).
Keep the bottle closed tightly and away from moisture.

Keep Exjade and all medicines out of the reach of children.

What are the ingredients in Exjade?

Active ingredient: deferasirox
Inactive ingredients: Crospovidone, lactose monohydrate, magnesium stearate, microcrystalline cellulose, povidone (K30), silicone dioxide, and sodium lauryl sulphate.