Discussion Forums > Thalassemia Major
Question for Andy...
Emby:
Andy...though my younger son has split dose, having read somewhere here that Exjade does not last in the system for longer than 18 hours (one place stated 16 hours and one, 18) and that the effect of it in the body is higher during the first few hours of taking Exjade, it becomes less effective during the hours after. Also taking split dose would mean true chelation for the full 24(plus) hours. So I was thinking that wouldn't this be putting more pressure on the kidneys especially as Exjade can have more of an impact on kidneys as the split dose is overlapping the 24 hour period?. Maybe the 6 hours of not having Exjade in the system is to give the kidneys a rest because of it's effect on the kidneys.
Sharmin:
Emby,
It has been found that the opposite may be true, because when we talk about the effectiveness of exjade we talk about its effect on free iron. The kidneys are involved with removing exjade from the system. Administering lower divided doses decreases the side effects on the body as it is likely more harmful to hit the body with large doses of the drug. It is much easier on the kidneys to deal with smaller quantities of exjade over time rather than one large dose. This is true also for the stomach, the liver as well as the kidneys. The lower likelihood of irregularities in liver function and kidney function provide evidence of this.
Emby:
Hello Sharmin...nice to hear from you..hope you are well and especially that special young man you have in your life..hope he is doing well.
I hear what you say but once the body is used to Exjade it shouldn't have major side effects and split dose might still be making the kidneys work harder...and with that we have no long term evidence on impact on kidneys for this. I am asking about this because Desferal can be given full dose and works best given over a period of 12 hours and the full dose for Ferriprox is split 3x daily working best taken at 8 hour intervals covering 24 hours (and not more than 24 hours) and the both of these chelators are hugely successful. I don't think people stick to taking them strictly at these hours so they have a few hours a day the meds are not having the supposed effect in the body yet most still take these meds religously and have been successful managing their iron levels and maintaining healthy organs. The Pharmaceuticals must know this and may have advised taking Exjade as a single dose to work for 18 hours for better balanced management of iron long term and especially with the kidneys as it's working and resting the kidneys for 24 hours without the 24 hours bleeding into the next 24 hours. I'm sorry if I don't make sense.....but I'm just trying to undestand something here :-\
Emby:
....maybe good to split then after a while maintain with single dose?..
Andy Battaglia:
The once daily dosing for Exjade has far more to do with marketing than science. Once a day sounds good and it is what Novartis felt patients wanted most. Oakland has endorsed the split dose method. The reports we hear about split dose are universally positive.
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