What is the suitable starting dose of Deferasirox (deferasirox) for a 24 kg child?

Deferasirox Dosing for a 24 kg Child

The suitable starting dose of deferasirox for a 24 kg child is 20 mg/kg/day, which equals 480 mg once daily. 1

Dosing Guidelines

• The FDA-approved starting dose for deferasirox in children 2 years and older with transfusional iron overload is 14 mg/kg body weight orally, once daily 1
• For patients who are not adequately controlled with the initial dose, doses can be increased to 21 mg/kg and up to 28 mg/kg (maximum recommended dose) 1
• The typical chronic dosing range for deferasirox is 20-40 mg/kg/day administered once daily 2
• Doses should be calculated to the nearest whole tablet, and changes in weight of pediatric patients over time must be taken into account when calculating the dose 1

Administration Instructions

• Deferasirox should be taken on an empty stomach or with a light meal (containing less than 7% fat content and approximately 250 calories) 1
• The medication should be administered at the same time each day for consistency 1
• For children who have difficulty swallowing whole tablets, deferasirox tablets may be crushed and mixed with soft foods (e.g., yogurt or apple sauce) immediately prior to use 1
• Do not administer with aluminum-containing antacid products 1

Monitoring Requirements

• Before starting therapy, evaluate:

  • Serum ferritin level 1
  • Baseline renal function (serum creatinine, eGFR, urinalysis) 1
  • Serum transaminases and bilirubin 1
  • Baseline auditory and ophthalmic examinations 1

• During therapy:

  • Monitor serum ferritin monthly and adjust dose every 3-6 months based on trends 1
  • Monitor blood counts, liver function, and renal function monthly 1
  • If serum ferritin falls below 1000 mcg/L at two consecutive visits, consider dose reduction 1
  • If serum ferritin falls below 500 mcg/L, interrupt therapy 1

Special Considerations

• Interrupt deferasirox for pediatric patients who have acute illnesses that can cause volume depletion (vomiting, diarrhea, decreased oral intake) 1
• Resume therapy based on assessments of renal function when oral intake and volume status normalize 1
• Deferasirox is excreted primarily through feces (≈90%) 2, 3
• The medication has a mean elimination half-life of 8-16 hours, allowing for once-daily dosing 2

Common Adverse Effects

• Mild to moderate transient gastrointestinal disturbances (nausea, vomiting, diarrhea, abdominal pain) 2
• Skin rash 2
• Increased alanine aminotransferase and serum creatinine levels 2
• Mild elevations in serum creatinine occur in approximately 33% of patients 2

Important Cautions

• Deferasirox can cause renal impairment, hepatic impairment, and gastrointestinal hemorrhage 1
• Higher plasma concentrations (>10 mcg/mL) have been associated with increased adverse events in pediatric patients 4
• The drug is contraindicated in patients with creatinine clearance <40 mL/min or serum creatinine greater than twice the age-appropriate normal threshold 2