Exjade (Deferasirox) belongs to the class of medications known as iron chelators. It is used to treat the iron overload that occurs when Anemia is treated with frequent blood transfusions. It is used in adults and children 6 years and older. It is also used in children 2 to 5 years old for whom deferoxamine is not providing an adequate response. It works by binding to excess iron in the blood and removing it from the body (mainly through the stools), thereby relieving the iron overload caused by blood transfusions. It can also be used to treat chronic iron overload in people 10 years of age and older who have thalassemia and do not require regular blood transfusions.

Your doctor may have suggested Exjade (Deferasirox) for conditions other than those listed in these drug information articles. As well, some forms of Exjade (Deferasirox) may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking Exjade (Deferasirox), speak to your doctor. Do not stop taking Exjade (Deferasirox) without consulting your doctor.

Do not give Exjade (Deferasirox) to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take Exjade (Deferasirox) if their doctor has not prescribed it.

The usual recommended starting dose of Exjade (Deferasirox) is 10 mg to 30 mg per kilogram of body weight per day, depending on the individual. Your doctor will determine the exact dosage that is appropriate for your circumstances.

Exjade (Deferasirox) should be taken once daily at about the same time each day. It should be taken on an empty stomach and at least 30 minutes before the first meal of the day. The tablets must be mixed with water, apple, or orange juice (100 mL of liquid for doses of less than 1 g, and 200 mL for doses of 1 g or more). Drop the tablet into the liquid and stir until the tablet dissolves completely. Drink all the liquid, then add a little water or juice to what is left in the glass and drink that as well. Do not chew or crush the tablets, or swallow them whole.

Do not use milk or carbonated beverages such as soda pop to dissolve the tablets. Milk slows down dissolution and carbonated beverages will foam up.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take Exjade (Deferasirox) exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Exjade (Deferasirox) at room temperature, protect it from light and moisture, and keep it out of the reach of children. Leave the medication in its original package until it is time to take a dose.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes Exjade (Deferasirox). If you are concerned about side effects, discuss the risks and benefits of Exjade (Deferasirox) with your doctor.

The following side effects have been reported by at least 1% of people taking Exjade (Deferasirox). Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• bloating
• Constipation
• Diarrhea
• dizziness
• Fever
• hair loss
• headache
• heartburn
• nausea
• skin colour changes
• skin rash
• sore throat
• stomach pain
• tiredness
• trouble sleeping
• vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• anxiety
• blurred or cloudy eyesight
• reduced hearing
• heartburn or abdominal pain (ulcers) particularly after eating or taking the drug
• partial vision loss
• increased frequency of flu-like symptoms or infections
• signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
• signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
• signs of kidney problems (e.g., increased urination at night, decreased urine production, blood in the urine)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• swelling of the arms or legs

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of gastrointestinal (stomach or intestines) bleeding, such as vomiting blood and/or black stools
• signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
• signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
• symptoms of a Anaphylaxis (severe allergic reaction) (Hives; skin rash; itchy skin; trouble breathing; swelling of the face, lips, tongue, or throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking Exjade (Deferasirox).

125 mg
Each off-white, round, flat, bevelled-edged, dispersible tablet, imprinted with "J 125" on one side and "NVR" on the other, contains 125 mg of Exjade (Deferasirox). Nonmedicinal ingredients: lactose monohydrate, crospovidone, povidone (K30), sodium lauryl sulphate, microcrystalline cellulose, colloidal silicon dioxide, and magnesium stearate.

250 mg
Each off-white, round, flat, bevelled-edged, dispersible tablet, imprinted with "J 250" on one side and "NVR" on the other, contains 250 mg of Exjade (Deferasirox). Nonmedicinal ingredients: lactose monohydrate, crospovidone, povidone (K30), sodium lauryl sulphate, microcrystalline cellulose, colloidal silicon dioxide, and magnesium stearate.

500 mg
Each off-white, round, flat, bevelled-edged, dispersible tablet, imprinted with "J 500" on one side and "NVR" on the other, contains 500 mg of Exjade (Deferasirox). Nonmedicinal ingredients: lactose monohydrate, crospovidone, povidone (K30), sodium lauryl sulphate, microcrystalline cellulose, colloidal silicon dioxide, and magnesium stearate.

Do not take Exjade (Deferasirox) if you:

• are allergic to Exjade (Deferasirox) or any ingredients of Exjade (Deferasirox)
• have a low platelet count (less than 50×109/L)
• have myelodysplastic syndrome (MDS)
• have rapidly worsening disease and are not likely to be helped with chelation therapy
• have severe kidney impairment (creatinine clearance less than 60 mL per minute)

There may be an interaction between Exjade (Deferasirox) and any of the following:

• Abiraterone
• acetylsalicylic acid (Aspirin)
• alpha-blockers (e.g., Alfuzosin, Doxazosin, Tamsulosin)
• antacids containing aluminum (e.g., aluminum hydroxide)
• anti-cancer medications (e.g., Doxorubicin, Paclitaxel, Vincristine, Vinorelbine)
• anticoagulant medications (e.g., Apixaban, dabigatran, Edoxaban, Rivaroxaban, Warfarin)
• anti-psychotics (e.g., Aripiprazole, Clozapine, Haloperidol, Olanzapine, Quetiapine, Risperidone)
• Amiodarone
• Aprepitant
• "azole" antifungals (e.g., itraconazole, ketoconazole, Voriconazole)
• benzodiazepines (e.g., Clonazepam, Diazepam, Lorazepam)
• Bisoprolol
• birth control pills
• bisphosphonates (e.g., Alendronate, etidronate, Risedronate)
• Buprenorphine
• Buspirone
• caffeine
• Calcitriol
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• Celecoxib
• Cholestyramine
• chloroquine
• clozapine
• Cobicistat
• Colesevelam
• Colestipol
• conivaptan
• corticosteroids (e.g., Hydrocortisone, Prednisone)
• Cyclosporine
• Dabrafenib
• Dapsone
• Darifenacin
• dasabuvir
• Dasatinib
• Desloratadine
• Disopyramide
• Duloxetine
• Eliglustat
• Enzalutamide
• Eplerenone
• estrogens
• Everolimus
• Flibanserin
• Flutamide
• "gliptin" Diabetes medications (DPP-IV inhibitors; e.g., Linagliptin, Saxagliptin, Sitagliptin)
• Heparin and low-molecular weight heparins (e.g., Dalteparin, Tinzaparin)
• Hepatitis C antivirals (e.g., asunaprevir, daclatasvir, dasabuvir, grazoprevir, ombitasvir, paritaprevir)
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• Lomitapide
• Losartan
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• maraviroc
• Mefloquine
• melatonin
• Methadone
• mifepristone
• mefloquine
• methadone
• Mirtazapine
• nitrates (e.g., isosorbide dinitrate, isosorbide mononitrate)
• nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., Diclofenac, ibuprofen, Naproxen)
• Ondansetron
• other iron chelators
• Pentoxifylline
• progestins (e.g., Dienogest, Levonorgestrel, medroxyprogesterone, Norethindrone)
• Phenytoin
• Pioglitazone
• Primaquine
• progestins (e.g., dienogest, levonorgestrel, medroxyprogesterone, norethindrone)
• Propranolol
• protein kinase inhibitors (e.g., Bosutinib, Ibrutinib, imatinib, Lapatinib, Nilotinib)
• proton pump inhibitors (e.g., Lansoprazole, Omeprazole)
• Pseudoephedrine
• quinidine
• quinine
• Rasagiline
• Repaglinide
• rifabutin
• rifampin
• Riociguat
• rivaroxaban
• Roflumilast
• Romidepsin
• Ropinirole
• seizure medications (e.g., Carbamazepine, Phenobarbital, phenytoin)
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Paroxetine, Sertraline)
• Sildenafil
• Sirolimus
• Solifenacin
• "statin" anti-cholesterol medications (e.g., Atorvastatin, Lovastatin, Simvastatin)
• suvorexant
• Tacrolimus
• Tamoxifen
• Tetracycline
• Theophylline
• Ticagrelor
• Ticlopidine
• Tizanidine
• Tofacitinib
• Tolterodine
• Tolvaptan
• Tramadol
• Trazodone
• Ulipristal
• Zolpidem
• Zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Exjade (Deferasirox). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Exjade (Deferasirox).

Blood counts: Exjade (Deferasirox) can decrease the number of neutrophils (a type of white blood cell that helps fight infection), red blood cells (which carry oxygen), and platelets (which help your blood to clot).

Your doctor will do blood tests regularly to monitor the number of specific types of blood cells, in your blood.

Dizziness: Exjade (Deferasirox) may cause dizziness. Do not drive, operate machinery, or perform other potentially hazardous tasks until you have determined how Exjade (Deferasirox) affects you.

Hearing problems: Exjade (Deferasirox) may cause hearing problems such as decreased hearing or difficulty hearing high-pitched sounds. Your doctor may recommend you have hearing tests before and throughout treatment. If you notice changes in your hearing, contact your doctor as soon as possible.

Heart failure: Exjade (Deferasirox) is not recommended for people with heart failure due to iron overload. If you have heart failure caused by iron overload, discuss with your doctor how Exjade (Deferasirox) may affect your medical condition, how your medical condition or medications may affect the dosing and effectiveness of Exjade (Deferasirox), and whether any special monitoring is needed.

Kidney function: Exjade (Deferasirox) may cause serious kidney problems, including kidney failure. If you have reduced kidney function or Kidney Disease, discuss with your doctor how Exjade (Deferasirox) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Exjade (Deferasirox), and whether any special monitoring is needed.

Your doctor may recommend you have your kidney function tested regularly throughout treatment. This can be done with blood tests.

Liver function: Exjade (Deferasirox) is not recommended for people with severe liver impairment. Exjade (Deferasirox) may cause serious liver problems, including liver failure. If you have reduced liver function or liver disease, discuss with your doctor how Exjade (Deferasirox) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Exjade (Deferasirox), and whether any special monitoring is needed.

Your doctor may recommend you have your liver function tested regularly throughout treatment. This can be done with blood tests.

Laboratory tests: Your doctor may recommend regular blood tests to monitor your response to Exjade (Deferasirox), the effect the medication has on your liver and kidney, and to monitor your blood cell levels.

Lactose intolerance: Exjade (Deferasirox) contains lactose. It is not recommended for people with hereditary galactose intolerance, glucose-galactose malabsorption, or severe lactase deficiency.

If you have poor lactose tolerance, discuss with your doctor how Exjade (Deferasirox) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Exjade (Deferasirox), and whether any special monitoring is needed.

Skin rash: Exjade (Deferasirox) may cause a skin rash. Mild-to-moderate rashes often resolve without treatment and do not require any changes in Exjade (Deferasirox) therapy. Severe rashes may require a change in dose, or treatment may need to be stopped, as recommended by your doctor. If you notice symptoms including a rash, itching, blistering, or peeling skin, contact your doctor right away.

Stomach problems: Exjade (Deferasirox) can irritate the lining of the stomach and cause indigestion, or in more serious situations, bleeding in the stomach and digestive system. This is more likely to happen when you are also taking other medications that irritate the stomach, such as anti-inflammatory pain relievers (e.g., acetylsalicylic acid or Ibuprofen).

If you have stomach problems, have a history of stomach problems, or are taking any medications that can irritate the stomach, discuss with your doctor how Exjade (Deferasirox) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Exjade (Deferasirox), and whether any special monitoring is needed.

Vision problems: Changes to your vision or eyes, such as cloudy vision or Cataracts, may occur with the use of Exjade (Deferasirox). Your doctor may recommend you have eye tests before and throughout treatment. If you notice changes in your vision, contact your doctor as soon as possible.

Pregnancy: Exjade (Deferasirox) should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Exjade (Deferasirox), contact your doctor immediately.

Breast-feeding: It is not known if Exjade (Deferasirox) passes into breast milk. If you are a breast-feeding mother and are taking Exjade (Deferasirox), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of Exjade (Deferasirox) have not been established for children less than 2 years of age. There is limited data on the use of Exjade (Deferasirox) by children aged 2 to 5 years.

Seniors: Seniors are at an increased risk of experiencing side effects related to the kidneys, liver, and heart. If you are a senior, your doctor should closely monitor your condition while you are taking Exjade (Deferasirox).