deferasirox (Rx)

Brand and Other Names:Exjade, Jadenu, more...Jadenu Sprinkle
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Dosing & Uses

AdultPediatric

Dosing Forms & Strengths

tablet for oral suspension (Exjade)

  • 125mg
  • 250mg
  • 500mg

oral tablet (Jadenu)

  • 90mg
  • 180mg
  • 360mg

oral granules (Jadenu Sprinkle)

  • 90mg
  • 180mg
  • 360mg

Transfusional Hemosiderosis

Indicated for treatment of chronic iron overload caused by blood transfusion

Exjade: 20 mg/kg PO qDay; may increase by 5-10 mg increments based on serum ferritin; if not controlled on 30 mg/kg/day (ie, serum ferritin persistently >2500 mcg/L), may increase up to 40 mg/kg qDay  

Jadenu: 14 mg/kg PO qDay (calculate dose to the nearest whole tablet); adjust dose in 3.5-7 mg/kg according to response and goals; if not adequately controlled with doses of 21 mg/kg (serum ferritin levels persistently >2500 mcg/L), doses of up to 28 mg/kg may be considered; do not exceed 28 mg/kg

Converting from Exjade to Jadenu

  • The dose of Jadenu should be about 30% lower, rounded to the nearest whole tablet
  • Dosage comparisons between Exjade and Jadenu are listed below
  • Starting dose: 20 mg/kg/day (Exjade); 14 mg/kg/day (Jadenu)
  • Titration increments: 5-10 mg/kg (Exjade); 3.5-7 mg/kg (Jadenu)
  • Maximum dose: 40 mg/kg/day (Exjade); 28 mg/kg/day (Jadenu)

Nontransfusion-Dependent Thalassemia

Indicated for treatment of chronic iron overload caused by nontransfusion-dependent thalassemia syndromes and with a liver iron (Fe) concentration (LIC) of at least 5 mg Fe per gram of dry weight (dw) and a serum ferritin >300 mcg/L

This indication is based on achievement of an LIC <5 mg Fe/g dw; improvement in survival or disease-related symptoms has not been established

Exjade: 10 mg/kg PO qDay (calculate dose to nearest tablet size); if LIC >15 mg Fe/g dw after 4 weeks, consider increasing dose by 5-10 mg/kg up to 20 mg/kg/day

Jadenu: 7 mg/kg PO qDay (calculate dose to nearest whole tablet); if LIC >7 mg Fe/g dw after 6 months, increase dose by 3.5-7 mg/kg up to 14 mg/kg/day; do not exceed 14 mg/kg/day

Converting from Exjade to Jadenu

  • The dose of Jadenu should be about 30% lower, rounded to the nearest whole tablet
  • Dosage comparisons between Exjade and Jadenu are listed below
  • Starting dose: 10 mg/kg/day (Exjade); 7 mg/kg/day (Jadenu)
  • Titration increments: 5-10 mg/kg (Exjade); 3.5-7 mg/kg (Jadenu)
  • Maximum dose: 20 mg/kg/day (Exjade); 14 mg/kg/day (Jadenu)

Dosage Modifications

Coadministration with potent UGT inducers or bile acid sequestrants

  • UGT inducers (eg, rifampin, phenytoin, phenobarbital, ritonavir) and bile acid sequestrants (eg, cholestyramine, colesevelam, colestipol) may decrease systemic exposure of deferasirox
  • Avoid coadministration
  • If unable to avoid coadministration, consider increasing initial deferasirox dose by 50% and monitor serum ferritin levels and clinical responses for further dose modifications

Renal impairment

  • Baseline renal impairment
    • CrCl 40-60 mL/min: Reduce starting dose by 50%
    • Serum Cr >2 xULN or CrCl <40 mL/min: Do not use
  • While taking for transfusional iron overload
    • Adults and adolescents (aged 16 yr or older): Reduce daily dose by 10 mg/kg if serum creatinine increases by >33% (on 2 consecutive visits) above pretreatment levels
    • Children aged 2-15 yr: Reduce the dose by 10 mg per kg if serum creatinine increases by >33% above the average baseline measurement and greater than the age appropriate upper limit of normal
    • Serum creatinine >2 x ULN or CrCl <40 mL/min (all patients): Contraindicated; discontinue if these measurements occur during treatment
  • While taking for nontransfusion-dependent thalassemia
    • Adults and adolescents (aged 16 yr or older): If serum creatinine increases by >33% (on 2 consecutive visits) above pretreatment levels, interrupt therapy if dose is 5 mg/kg, or reduce by 50% if dose is 10-20 mg/kg
    • Children aged 10-15 yr: Reduce the dose by 5 mg per kg if serum creatinine increases by >33% above the average baseline measurement and greater than the age appropriate upper limit of normal
    • Serum creatinine >2 x ULN or CrCl <40 mL/min (all patients): Contraindicated; discontinue if these measurement occur during treatment

Hepatic impairment

  • Mild (Child-Pugh A): No dose adjustment required
  • Moderate (Child-Pugh B): Decrease initial dose by 50%
  • Severe (Child-Pugh C): Avoid use

Dosing considerations

Transfusional Hemosiderosis

  • Before initiating, obtain serum ferritin level, baseline serum creatinine (in duplicate) and determine creatinine clearance, serum transaminases, bilirubin, and baseline auditory and ophthalmic examinations
  • Measure serum ferritin qMonth

Nontransfusion-Dependent Thalassemia

  • Before initiating, obtain LIC by liver biopsy or other approved method, serum ferritin level (based on at least 2 measurements 1 month apart), baseline serum creatinine (in duplicate) and determine creatinine clearance, serum transaminases, bilirubin, and baseline auditory and ophthalmic examinations
  • Monitor serum ferritin monthly; interrupt treatment if serum ferritin <300 mcg/L and obtain an LIC to determine whether the LIC has fallen to <3 mg Fe/g dw
  • Measure LIC q6Months
  • If the LIC remains >7 mg Fe/g dw after 6 months, increase dose to a maximum of 20 mg/kg/day; do not exceed 20 mg/kg/day
  • If after 6 months of therapy, the LIC is 3-7 mg Fe/g dw, continue treatment with deferasirox at no more than 10 mg/kg/day
  • When the LIC is <3 mg Fe/g dw, interrupt treatment and continue to monitor LIC
  • Monitor blood counts, hepatic function, and renal function

Limitation of use

  • Safety and efficacy when administered with other iron chelation therapy have not been established

Dosing Forms & Strengths

tablet for oral suspension (Exjade)

  • 125mg
  • 250mg
  • 500mg

oral tablet (Jadenu)

  • 90mg
  • 180mg
  • 360mg

oral granules (Jadenu Sprinkle)

  • 90mg
  • 180mg
  • 360mg

Transfusional Hemosiderosis

Indicated for treatment of chronic iron overload caused by blood transfusion

<2 years: Safety and efficacy not established

Exjade: 20 mg/kg PO qDay; may increase by 5-10 mg increments based on serum ferritin; if not controlled on 30 mg/kg/day (ie, serum ferritin persistently >2500 mcg/L), may increase up to 40 mg/kg qDay  

Jadenu: 14 mg/kg PO qDay (calculate dose to the nearest whole tablet); adjust dose in 3.5-7 mg/kg according to response and goals; if not adequately controlled with doses of 21 mg/kg (serum ferritin levels persistently >2500 mcg/L), doses of up to 28 mg/kg may be considered; do not exceed 28 mg/kg

Converting from Exjade to Jadenu

  • The dose of Jadenu should be about 30% lower, rounded to the nearest whole tablet
  • Dosage comparisons between Exjade and Jadenu are listed below
  • Starting dose: 20 mg/kg/day (Exjade); 14 mg/kg/day (Jadenu)
  • Titration increments: 5-10 mg/kg (Exjade); 3.5-7 mg/kg (Jadenu)
  • Maximum dose: 40 mg/kg/day (Exjade); 28 mg/kg/day (Jadenu)

Dosing considerations

  • Before initiating, obtain serum ferritin level, baseline serum creatinine (in duplicate) and determine creatinine clearance, serum transaminases, bilirubin, and baseline auditory and ophthalmic examinations
  • Measure serum ferritin qMonth

Nontransfusion-Dependent Thalassemia

Indicated for treatment of chronic iron overload caused by nontransfusion-dependent thalassemia syndromes and with a liver iron (Fe) concentration (LIC) of at least 5 mg Fe per gram of dry weight (dw) and a serum ferritin >300 mcg/L

This indication is based on achievement of an LIC <5 mg Fe/g dw; improvement in survival or disease-related symptoms has not been established

<10 years: Safety and efficacy not established

Exjade: 10 mg/kg PO qDay (calculate dose to nearest tablet size); if LIC >15 mg Fe/g dw after 4 weeks, consider increasing dose by 5-10 mg/kg up to 20 mg/kg/day

Jadenu: 7 mg/kg PO qDay (calculate dose to nearest whole tablet); if LIC >7 mg Fe/g dw after 6 months, increase dose by 3.5-7 mg/kg up to 14 mg/kg/day; do not exceed 14 mg/kg/day

Converting from Exjade to Jadenu

  • The dose of Jadenu should be about 30% lower, rounded to the nearest whole tablet
  • Dosage comparisons between Exjade and Jadenu are listed below
  • Starting dose: 10 mg/kg/day (Exjade); 7 mg/kg/day (Jadenu)
  • Titration increments: 5-10 mg/kg (Exjade); 3.5-7 mg/kg (Jadenu)
  • Maximum dose: 20 mg/kg/day (Exjade); 14 mg/kg/day (Jadenu)

Dosing considerations

  • Before initiating, obtain LIC by liver biopsy or other approved method, serum ferritin level (based on at least 2 measurements 1 month apart), baseline serum creatinine (in duplicate) and determine creatinine clearance, serum transaminases, bilirubin, and baseline auditory and ophthalmic examinations
  • Monitor serum ferritin monthly; interrupt treatment if serum ferritin <300 mcg/L and obtain an LIC to determine whether the LIC has fallen to <3 mg Fe/g dw
  • Measure LIC q6Months
  • If the LIC remains >7 mg Fe/g dw after 6 months, increase dose to a maximum of 20 mg/kg/day; do not exceed 20 mg/kg/day
  • If after 6 months of therapy, the LIC is 3-7 mg Fe/g dw, continue treatment with deferasirox at no more than 10 mg/kg/day
  • When the LIC is <3 mg Fe/g dw, interrupt treatment and continue to monitor LIC
  • Monitor blood counts, hepatic function, and renal function

Dosage Modifications

Coadministration with potent UGT inducers or bile acid sequestrants

  • UGT inducers (eg, rifampin, phenytoin, phenobarbital, ritonavir) and bile acid sequestrants (eg, cholestyramine, colesevelam, colestipol) may decrease systemic exposure of deferasirox
  • Avoid coadministration
  • If unable to avoid coadministration, consider increasing initial deferasirox dose by 50% and monitor serum ferritin levels and clinical responses for further dose modifications

Renal impairment

  • Baseline renal impairment
    • CrCl 40-60 mL/min: Reduce starting dose by 50%
    • Serum Cr >2 xULN or CrCl <40 mL/min: Do not use
  • While taking for transfusional iron overload
    • Adults and adolescents (aged 16 yr or older): Reduce daily dose by 10 mg/kg if serum creatinine increases by >33% (on 2 consecutive visits) above pretreatment levels
    • Children aged 2-15 yr: Reduce the dose by 10 mg per kg if serum creatinine increases by >33% above the average baseline measurement and greater than the age appropriate upper limit of normal
    • Serum creatinine >2 x ULN or CrCl <40 mL/min (all patients): Contraindicated; discontinue if these measurements occur during treatment
  • While taking for nontransfusion-dependent thalassemia
    • Adults and adolescents (aged 16 yr or older): If serum creatinine increases by >33% (on 2 consecutive visits) above pretreatment levels, interrupt therapy if dose is 5 mg/kg, or reduce by 50% if dose is 10-20 mg/kg
    • Children aged 10-15 yr: Reduce the dose by 5 mg per kg if serum creatinine increases by >33% above the average baseline measurement and greater than the age appropriate upper limit of normal
    • Serum creatinine >2 x ULN or CrCl <40 mL/min (all patients): Contraindicated; discontinue if these measurement occur during treatment

Hepatic impairment

  • Mild (Child-Pugh A): No dose adjustment required
  • Moderate (Child-Pugh B): Decrease initial dose by 50%
  • Severe (Child-Pugh C): Avoid use
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Interactions

Interaction Checker

and deferasirox

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      Serious - Use Alternative

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            Adverse Effects

            >10%

            Serum creatinine increase (dose related; 7-38%)

            Abdominal pain (21-28%)

            Nausea (11-23%)

            Vomiting (10-21%)

            Diarrhea (12-20%)

            Proteinuria (19%)

            Pyrexia (19%)

            Headache (16%)

            Cough (14%)

            Nasopharyngitis (13%)

            Pharyngolaryngeal pain (11%)

            Influenza (11%)

            Rash (8-11%)

            1-10%

            Respiratory tract infection (10%)

            Bronchitis (9%)

            ALT increased (2-8%)

            Arthralgia, back pain (6-7%)

            Acute tonsillitis (6%)

            Rhinitis (6%)

            Fatigue (6%)

            Ear infection (5%)

            Transaminitis (4%)

            Urticaria (4%)

            <1%

            Anaphylaxis

            Angioedema

            Cytopenias, including agranulocytosis, neutropenia and thrombocytopenia; leukocytoclastic vasculitis

            Postmarketing Reports

            Skin and subcutaneous tissue disorders: Leukocytoclastic vasculitis, urticaria, alopecia, Stevens-Johnson syndrome, toxic epidermal necrolysis

            Immune system disorders: Hypersensitivity reactions (including anaphylaxis and angioedema)

            Renal and urinary disorders: Acute kidney injury, including acute renal failure requiring dialysis, and renal tubular toxicity including Fanconi syndrome, renal tubular necrosis, tubulointerstitial nephritis

            Hepatobiliary disorders: Hepatic failure, acute pancreatitis with and without underlying biliary conditions

            Gastrointestinal disorders: GI perforation and hemorrhage

            Hematology: Hematuria

            Endocrine: Hypokalemia

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            Warnings

            Black Box Warnings

            Renal failure

            • Can cause acute renal failure and death, especially with comorbidities and advanced stages of hematologic disorders
            • Evaluate baseline renal function prior to starting or increasing dosing in all patients; therapy is contraindicated in adult and pediatric patients with eGFR <40 mL/min/1.73 m²
            • Measure serum creatinine and determine creatinine clearance in duplicate prior to treatment initiation; monitor renal function at least monthly thereafter
            • If baseline renal impairment or increased risk of acute renal failure exist, monitor renal function weekly for the first month, then at least monthly
            • Reduce starting dose in patients with pre-existing renal disease; during therapy, increase frequency of monitoring and modify dose for patients with an increased risk of renal impairment, including use of concomitant nephrotoxic drugs, and pediatric patients with volume depletion or overchelation
            • Consider dose reduction, interruption, or discontinuation based on increases in serum creatinine

            Hepatic failure

            • Can cause hepatic injury including hepatic failure and death
            • Obtain serum transaminases and bilirubin in all patients prior to initiating treatment, every 2 weeks during the first month, and at least monthly thereafter
            • Avoid with severe (Child-Pugh C) hepatic impairment and reduce the dose with moderate (Child Pugh B) hepatic impairment

            Gastrointestinal hemorrhage

            • Can cause gastrointestinal (GI) hemorrhages, which may be fatal, especially in elderly patients who have advanced hematologic malignancies and/or low platelet counts
            • Monitor and discontinue for suspected GI ulceration or hemorrhage

            Contraindications

            Hypersensitivity

            Estimated GFR <40 ml/min/1.73 m² or serum creatinine >2 x ULN

            Poor performance status and high-risk myelodysplastic syndromes or advanced malignancies

            Platelet counts <50 x10^9/L

            Cautions

            Coadministration with aluminum-containing antacids decreases absorption

            Concomitant cholestyramine (see Dosage Modifications)

            Risk of hepatic failure, some with fatal outcome; most occurred with age >55 yr and with comorbid conditions (eg, liver cirrhosis, multiorgan failure); (see Black Box Warnings)

            Consider dose reduction or closer monitoring of renal and hepatic function, and serum ferritin levels during periods when patients are receiving doses >25 mg/kg/day while their serum ferritin values were <1,000 mcg/L; use minimum effective dose to maintain low iron burden

            Frequency of auditory adverse events irrespective of causality may increase among pediatric patients who receive doses >25 mg/kg/day when serum ferritin is <1,000 mcg/L

            Acute liver injury and failure, including fatal outcomes, have occurred in pediatric; liver failure have occurred in association with acute kidney injury in pediatric patients at risk for overchelation during a volume depleting event; interrupt therapy when acute liver injury or acute kidney injury is suspected and during volume depletion; monitor liver and renal function more frequently in pediatric patients who are receiving doses in the 20-40 mg/kg/day range and when iron burden is approaching normal; use minimum effective dose to achieve and maintain a low iron burden

            Avoid use with severe (Child-Pugh C) hepatic impairment; closely monitor with mild or moderate hepatic impairment and decrease initial dose by 50%

            Consider discontinuation if auditory/ocular disturbances occur

            GI perforation and hemorrhage, including deaths reported, especially in elderly patients who had advanced hematologic malignancies and/or low platelet counts; nonfatal upper GI irritation, ulceration and hemorrhage reported; monitor for signs and symptoms of GI ulceration and hemorrhage during therapy and promptly initiate evaluation and treatment if serious GI adverse event is suspected; risk of gastrointestinal hemorrhage may be increased when administering in combination with drugs that have ulcerogenic or hemorrhagic potential, such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, oral bisphosphonates, or anticoagulants; there have been reports of ulcers complicated with gastrointestinal perforation (including fatal outcome; see Black Box Warnings)

            Neutropenia, agranulocytosis, and thrombocytopenia, including fatal events, reported; preexisting hematologic disorders may increase this risk

            Elderly: Monitor closely for toxicity due to the greater frequency of decreased hepatic, renal, and/or cardiac function

            Serious hypersensitivity reactions (eg, anaphylaxis, angioedema) and erythema multiforme reported

            Rashes may occur during treatment; for rashes of mild to moderate severity, therapy may be continued without dose adjustment; rash often resolves spontaneously; in severe cases, interrupt treatment; may consider reintroduction at lower dose after resolution of rash

            Should not reintroduce patients that have experienced previous hypersensitivity reactions on deferasirox products; may cause anaphylactic shock

            Severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS) which could be life- threatening or fatal reported during therapy; cases of multiforme observed; advise patients of signs and symptoms of severe skin reactions, and closely monitor; if any severe skin reactions suspected, discontinue drug immediately and do not reintroduce therapy

            Auditory disturbances (eg, high frequency hearing loss, decreased hearing) and ocular disturbances (lens opacities, cataracts, increased IOP, retinal disorders) reported

            Avoid overchelation of iron by monitoring serum ferritin levels monthly; when used for nontransfusion-dependent thalassemia, also measure LIC q6Months

            Renal failure (see Black Box Warnings)

            • Evaluate renal glomerular and tubular function before initiating therapy or increasing dose; use prediction equations validated for use in adult and pediatric patients to estimate GFR; obtain serum electrolytes and urinalysis in all patients to evaluate renal tubular function
            • Risk of acute renal failure, fatal is some patients and requiring dialysis in others
            • Exercise caution in pediatric patients with eGFR of 40-60 mL/minute/1.73 m²; if treatment is needed use minimum effective dose and monitor renal function frequently; individualize dose titration based on improvement in renal injury; for patients with renal impairment (eGFR 40–60 mL/min/1.73 m²) reduce starting dose by 50%
            • Therapy can cause acute kidney injury including renal failure requiring dialysis that has resulted in fatal outcomes; renal tubular toxicity, including acquired Fanconi Syndrome, reported in patients receiving therapy, most commonly in pediatric patients with beta-thalassemia and serum ferritin levels <1,500 mcg/L
            • In pediatric patients, interrupt therapy during acute illnesses which can cause volume depletion, such as vomiting, diarrhea, or prolonged decreased oral intake, and monitor renal function more frequently; promptly correct fluid deficits to prevent renal injury; resume therapy as appropriate, based on assessments of renal function, when oral intake and volume status are normal
            • Most fatalities reported with advanced stage hematologic disorder
            • Monitor serum Cr level and CBC
            • Closely monitor renal function if CrCl 40-60 mL/min, particularly in cases where there are additional risk factors that may impair renal function (eg, concomitant medications, dehydration, severe infections)
            • Renal tubulopathy reported; majority of reports were in children and adolescents with beta-thalassemia and serum ferritin levels <1500 mcg/L
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            Pregnancy & Lactation

            Pregnancy

            There are no studies with use in pregnant women to inform drug-associated risks; administration of deferasirox to rats during pregnancy resulted in decreased offspring viability and an increase in renal anomalies in male offspring at doses that were about or less than recommended human dose on a mg/ m² basis; no fetal effects were noted in pregnant rabbits at doses equivalent to human recommended dose on a mg/ m² basis; drug should be used during pregnancy only if potential benefit justifies potential risk to fetus

            Contraception

            • Counsel patients to use non-hormonal method(s) of contraception since drug can render hormonal contraceptives ineffective

            Lactation

            No data are available regarding presence of drug or its metabolites in human milk, effects on breastfed infant, or on milk production; drug and its metabolites is excreted in rat milk; because many drugs are excreted in human milk and because of potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue breastfeeding or to discontinue drug, taking into account importance of drug to mother

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Selective chelator of trivalent iron; reduces liver iron concentration and serum ferritin levels

            Absorption

            Bioavailability: 70%

            Peak Plasma Time: 1.5-4 hr

            Peak plasma concentration and AUC increase in a linear fashion (accumulation factor ~1.3-2.3 following multiple doses)

            Distribution

            Protein Bound: 99% (mostly to albumin)

            Vd: 14.37 L (adults)

            Metabolism

            Glucuronidation, mainly by UGT1A1 and to a lesser extent by UGT1A3

            Inhibits CYP1A2, CYP2C8

            Induces CYP3A4

            Elimination

            Half-life: 8-16 hr

            Excretion: 84% feces; 8% urine

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            Administration

            Oral Administration

            Exjade

            • Do not chew tablets or swallow tablet whole (disperse in water/liquid)
            • Take once daily on an empty stomach at least 30 minutes before food, preferably at the same time each day
            • Completely disperse tablets by stirring in water, orange juice, or apple juice until a fine suspension is obtained
            • Disperse doses of <1 g in 3.5 ounces of liquid and doses ≥1 g in 7 ounces of liquid
            • After swallowing the suspension, resuspend any residue in a small volume of liquid and swallow
            • Do not take with aluminum-containing antacid products

            Jandenu

            • Do not take with aluminum-containing antacid products
            • May be taken on an empty stomach or with a light meal (<7% fat content and approximately 250 calories)
            • Light meal examples: 1 whole wheat English muffin, 1 packet jelly (0.5 ounces), and skim milk (8 fluid ounces) OR turkey sandwich (2 oz. turkey on whole wheat bread with lettuce, tomato, and 1 packet mustard)
            • Oral tablets
              • Swallow tablets whole once daily with water or other liquids, preferably at the same time each day
            • Granules
              • Take granules on an empty stomach or with a light meal, preferably at the same time each day
              • Administer granules by sprinkling the full dose on soft food (eg, yogurt or apple sauce) immediately prior to use and administered orally

            Storage

            Store at room temperature 25°C (77°F); excursions are permitted to 15-30°C (59-86°F)

            Protect from moisture

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            Images

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            Formulary

            FormularyPatient Discounts

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            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.