| Frequent adverse events with DFX and their management | ||
|---|---|---|
| Toxicity | Adjustment | |
| Renal impairment | ||
| At initiation | ||
| eGFR >60mL/min/1.73m2 | No dose adjustment | |
| eGFR 40-60mL/min/1.73m2 | Decrease dose by 50% | |
| eGFR <40mL/min/1.73m2 | Contraindicated | |
| During treatment | ||
| Creatinine increase 33% above baseline | Repeat in 1 week, if still elevated reduce dose by 10mg/kg/day (Exjade) or 7mg/kg/day (Jadenu) | |
| eGFR <40mL/min/1.73m2 | Discontinue | |
| Hepatic impairment | ||
| At initiation | ||
| Mild (Child-Pugh class A) | No dose adjustment, monitor closely | |
| Moderate (Child-Pugh class B) | Decrease dose by 50%, monitor closely | |
| Severe (Child-Pugh class C) | Avoid use | |
| During treatment | ||
| Severe/persistent increases in transaminases/bilirubin | Dose reduction or dose interruption | |
| GI intolerance | ||
| Nausea & vomitting |
✔ Use anti-emetics ✔ Switch to pre-prandial dosing ✔ Reduce dose or interrupt treatment |
|
| Diarrhea |
✔ Hydration ✔ Loperamide ✔ Lactacid if indicated ✔ Dose at night ✔ Use water to disperse tablets ✔ Reduce dose or interrupt treatment |
|
| Abdominal pain |
✔ Switch to pre-prandial dosing ✔ For upper abdominal pain, use anti-acids ✔ Consider spasmolytic drugs ✔ Reduce dose or interrupt treatment |
|
| DFX, deferasirox; eGFR; estimated glomerular filtration rate; GI, gastrointestinal; kg, kilogram; m2, square meters; min, minute; mg, milligram; mL, millilitre | ||