Drug General Information (ID: DDI5JWKCIP)
Drug Name			Pamidronic acid		Drug Info		Deferasirox		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiinflammatory Agents				Chelating Agents
Structure

Mechanism of Pamidronic acid-Deferasirox Interaction (Severity Level: Major)
Increased risk of GI mucosal injury/bleeding risk Click to Show/Hide Mechanism Graph
Drug Name		Pamidronic acid				Deferasirox
Mechanism 1		GI mucosal injury/bleeding risk				GI mucosal injury/bleeding risk
Key Mechanism Factor 1
		Factor Name		Gastrointestinal toxicity
		Factor Description		The risk and severity of gastrointestinal toxicity, including inflammation, bleeding, ulceration, and perforation, increases when drugs with gastrointestinal mucosal irritant effects are combined.
Mechanism Description		Increased risk of GI mucosal injury/bleeding risk by the combination of Pamidronic acid and Deferasirox
Increased risk of nephrotoxicity Click to Show/Hide Mechanism Graph
Drug Name		Pamidronic acid				Deferasirox
Mechanism 2		Nephrotoxicity				Nephrotoxicity
Key Mechanism Factor 2
		Factor Name		Nephrotoxicity
		Factor Description		The combination of drugs that can induce nephrotoxicity may increase the risk of kidney injury. When kidney injury occurs, the inability to remove excess urine and waste from the body can lead to high levels of urea nitrogen, creatinine, and electrolytes (such as potassium and magnesium) in the blood.
Mechanism Description		Increased risk of nephrotoxicity by the combination of Pamidronic acid and Deferasirox

Recommended Action
Management		Caution is advised if deferasirox is used in combination with drugs that have known ulcerogenic potential, including oral bisphosphonates. Patients should be advised to contact their physician if they develop potential signs and symptoms of gastrointestinal injury such as abdominal pain, bloating, dizziness, lightheadedness, vomiting blood, anorexia, and/or black, tarry stools. Caution is advised if deferasirox is used in combination with other potentially nephrotoxic agents, including intravenous bisphosphonates. Serum creatinine and/or creatinine clearance should be closely monitored (e.g., prior to initiation of deferasirox therapy, then weekly during the first month after initiation or modification of therapy and monthly thereafter), especially in the elderly and patients with preexisting renal impairment, comorbid conditions, dehydration, or severe infections. Dosage reduction, interruption, or discontinuation should be considered in the presence of creatinine elevations. A progressive increase in serum creatinine beyond the age-appropriate upper limit of normal may warrant an interruption of therapy. Once the creatinine has returned to within the normal range, therapy may be reinitiated at a lower dose followed by a gradual dose escalation according to the product labeling, provided the clinical benefit is expected to outweigh potential risks.

References
1	Product Information. Exjade (deferasirox). Novartis Pharmaceuticals, East Hanover, NJ.
2	Rafat C, Fakhouri F, Ribeil JA, Delarue R, Le Quintrec M "Fanconi Syndrome Due to Deferasirox." Am J Kidney Dis (2009):. [PMID: 19493602]