Discussion Forums > Thalassemia Major

Splitting exjade

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aam:
Hi andy,

I read in forums that splitting dose is a good idea and many have said its beneficial to decrease liver toxicity and controlling iron in a better way for same dose.  I have a few questions on splitting the dose.

Will splitting the dose cause decrease in the peak concentration of exjade in blood?  Will exjade still be effective when peak concentration is less?   In other words, does exjade require minimum serum concentration in blood to be effective?    Does  splitting the dose mean 10 mg/dl  for longer duration in blood[24hr]  is equally effective as 20mg/dl for 12 hr?

Thanks,
 


Can you advice on this concentration and effectiveness issue?

Pratik:
All the people over here at Thalpal, who used split dosage has noticed nothing but positive results, including me.

So yes, do it without doubt and you shall yourself notice the difference.

-P.

Andy Battaglia:
Exjade has a half life of 8-16 hours. Peak concentration occurs 1.5 to 4 hours after taking the drug. What this tells us is that during the second part of that 8 hours, the concentration is dropping. By splitting the dose, you can cover a 24 hour period with chelation. This is not possible with once per day. The goal expressed by most top thal doctors is chelation 24/7. This can be accomplished with Ferriprox, but can only happen with a split dose of Exjade. For desferal, you need to be chelating around the clock to get 24/7 coverage. The total Exjade in the body will not be as high at any one time with the split dose as it gets with once daily, but this is preferable for many patients, as the side effects are also reduced. Generally, we are hearing better results from liver and kidney monitoring, and patients are finding Exjade works much better when the chelation is 24/7. This coincides with observations about desferal. The same 2 gram dose of desferal taken over a 18 hour period will chelate more iron than when taken over a 12 hour period. Since red blood cells break down constantly, releasing their iron into the blood, we should also be striving for 24/7 chelation, so there are never periods when a chelator isn't active in the body. I feel that patients can also help themselves by taking chelating substances like IP6 and green tea extract, as these substances can reach areas that most chelators have much difficulty reaching. The recent reports on Sharmin's son have further backed up the use of antioxidant chelating supplements. I don't think you will find many 12 year old thal majors whose hormone levels and pituitary gland are perfectly normal. Her son's are. This backs up both the use of chelation 24/7 and also the use of these antioxidants. IP6 can clean iron out anywhere in the body. I believe supplementing should become a routine for thals.

Oakland Children's Hospital, recognized as the top thal center in the US, has endorsed the split dose method for Exjade. This should assure all on the value of this method.

aam:
Thank you Andy & Pratik for your advise.  We just ordered green tea extract and IP 6.  We have also started splitting the exjade dose.

--

Dharmesh:
I am on splitted dosage.

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