| Management |
Caution is advised if deferasirox is used in combination with other potentially nephrotoxic agents (e.g., aminoglycosides polypeptide, glycopeptide, and polymyxin antibiotics amphotericin B adefovir cidofovir tenofovir foscarnet cisplatin gallium nitrate lithium mesalamine certain immunosuppressants intravenous bisphosphonates intravenous pentamidine high intravenous dosages of methotrexate high dosages and/or chronic use of nonsteroidal anti-inflammatory agents). 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. |
