Renal impairment deferasirox

In another patient thrombocytopenia due to deferasirox developed as part of a generalized delayed hypersensitivity reaction, in combination with a rash, fever, eosinophilia, renal impairment, and liver injury [13" ]. 

Dubourg L, Laurain C, Ranchin B, Pondarre C, Hadj-Aissa A, Siquado-Roussel D, et al. Deferasirox-induced renal impairment in children an increasing concern for pediatricians. Pediatr Nephrol November 2012 27(ll) 2115-22. 

Deravirdine (Rescnptor) [Antiretroviral/NNRTI] Uses HIV Infxn Action Nonnucleoside RT inhibitor Dose 400 mg PO tid Caution [C, ] CDC recommends HIV-infected mothers not to breast-feed (transmission risk) w/ renal/hepatic impair Contra Use w/ drugs dependent on CYP3A for clearance (Table VI-8) Disp Tabs SE Fat redistribution, immune reconstitution synd, HA, fatigue, rash, T transaminases, N/V/D Interactions T Effects W/ fluoxetine T effects OF benzodiazepines, cisapride, clarithromycin, dapsone, ergotamine, indinavir, lovastatin, midazolam, nifedipine, quinidine, ritonavir, simvastatin, terfena-dine, triazolam, warfarin effects W/ antacids, barbiturates, carbamazepine, cimetidine, famotidine, lansoprazole, nizatidine, phenobarbital, phenytoin, ranitidine, rifabutin, rifampin effects OF didanosine EMS Use of benzodiazepines and CCBs should be avoided may cause a widespread rash located on upper body and arms OD May cause an extension of nl SEs symptomatic and supportive Deferasirox (Exjade) [Iron Chelator] Uses Chronic iron overload d/t transfusion in pts >2 y Action Oral iron chelator Dose Initial 20 mg/kg... 

Urinary tract There is a paucity of information concerning kidney function in patients with P-thalassemia. A few previous reports gave a signal of a possible connection between deferasirox and renal tubular damage. The underlying mechanism of deferasirox nephrotoxicity is uncertain, but several possible mechaitisms have been suggested intrarenal hemodynamic changes (perhaps secondary to a reduced iron burden) nctional impairment of iron-bound proteins in proximal tubular cells intercellular accumulation of deferoxamine-iron complexes and increased iron absorption and decompartmentalization of chelated iron in the kidneys (and other tissues) [15 ]. 

While increases in serum creatinine due to deferasirox are usually benign, in one of 14 patients with excess iron storage due to myelodysplasia, deferasirox (dose not specified) had to be withdrawn after 1 month because of impaired renal function [23 ]. 

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