Exjade
Exjade: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Exjade
ATX code: V03AC03
Active ingredient: Deferasirox (Deferasirox)
Producer: Novartis Pharma Stein, AG (Novartis Pharma Stein, AG) (Switzerland)
Description and photo update: 2019-09-07
Prices in pharmacies: from 29,500 rubles.
Buy
Exjade is a complexing drug.
Release form and composition
The drug is available in the form of dispersible tablets: almost white, round, flat-cylindrical, with a beveled edge and engraved "J 125 / NVR" (dosage 125 mg), "J 250 / NVR" (dosage 250 mg) or "J 500 / NVR" (dosage of 500 mg) (7 pcs. in blisters, in a cardboard box of 4 or 12 blisters and instructions for use of Exidzhad).
1 tablet contains:
- active substance: deferasirox - 125, 250 or 500 mg;
- auxiliary components: lactose monohydrate (dry aerosol), lactose monohydrate (200 bases), colloidal anhydrous silicon dioxide, crospovidone, sodium lauryl sulfate, microcrystalline cellulose, povidone K30, magnesium stearate.
Pharmacological properties
Pharmacodynamics
Exjade is a complexing drug that enhances the excretion of iron (Fe) from the body, mainly with feces. Its active ingredient is deferasirox, a triple ligand that has a high affinity for iron (III) and binds it in a 2: 1 ratio.
Due to its low affinity for zinc and copper, deferasirox does not cause a sustained decrease in serum levels of these trace elements.
It was found that while taking deferasirox in a daily dose of 10 mg / kg in adult patients diagnosed with beta-thalassemia with post-transfusion iron overload, the average effective excretion of iron per day was 0.011 9 mg Fe per 1 kg of the patient's body weight. When taken at a dose of 20 mg / kg, the excretion of iron per day was 0.329 mg Fe / kg, and at a dose of 40 mg / kg - 0.445 mg Fe / kg.
In studies on the use of deferazirox for chronic post-transfusion iron overload, adults and children aged two years and older with such diseases requiring regular transfusions as beta-thalassemia, sickle cell anemia and other anemias of congenital and acquired genesis (including myelodysplastic syndrome), congenital hypoplastic anemia of Diamond - Blackfen, acquired aplastic anemia).
Against the background of ongoing blood transfusions in adults and children with beta-thalassemia, regular intake of defrazirox at a daily dose of 20 and 30 mg / kg for 365 days helps to reduce the total iron reserve in the body. At the same time, the iron content in the liver decreases on average by 0.4 and 0.9 mg Fe / g of dry matter of the liver, respectively, and the decrease in the concentration of ferritin in the blood serum is on average 0.036 and 0.926 mg / L, respectively.
When Exidjad is used in patients with iron overload and with other types of anemia at a daily dose of 20 mg / kg, the ratio of iron excretion to its intake is 1.02, which indicates a normal iron balance. Against the background of a daily dose of 30 mg / kg, the ratio is 1.67, which indicates an increased excretion of iron from the body. In patients who rarely receive exchange transfusions or blood transfusions, taking deferasirox at 10 mg per 1 kg of body weight per day for 365 days allows you to maintain normal serum ferritin concentration and iron content in the liver, and helps to achieve a balance between the intake of iron in the body and its breeding. The criterion for assessing the therapeutic effect is the dynamics of the concentration of ferritin in the blood serum,because it reflects changes in the iron content in the liver.
At an initial level of iron concentration in the liver ≥ 7 mg Fe / g of dry matter of the liver in 58.5% of patients who took the drug at the age of 2 years with beta-thalassemia and chronic post-transfusion iron overload, not receiving deferoxamine treatment, against the background of the use of deferasirox in the daily At a dose of 20–30 mg / kg of body weight for 365 days, a decrease in the iron content in the liver was observed to a value of ≤ 7 mg Fe / g of dry matter of the liver.
The effect of Exidzhad on changing the serum ferritin content and the ratio of iron excretion to its intake is dose-dependent in the range of daily doses from 5 to 30 mg / kg.
With sickle cell anemia and chronic post-transfusion iron overload, taking the drug reduces the iron content in the liver by an average of 1.3 mg Fe / g dry matter of the liver, while against the background of the use of deferoxamine this decrease is 0.7 mg Fe / g dry matter liver.
Not only the preservation of normal myocardial function is noted, but also an improvement in impaired myocardial function (the left ventricular ejection fraction is 56% or more, the transverse relaxation time is 5–20 ms) in patients with beta-thalassemia and chronic post-transfusion iron overload, taking Exjade daily dose from 30 to 40 mg / kg for 365 days.
Treatment with the drug helps to reduce the iron content in the myocardium and progressively improve the lateral relaxation time. In patients without myocardial injury, taking deferasirox prevents iron buildup in the heart.
In patients with thalassemia and chronic nontransfusion iron overload, the use of Exidzhad at a daily dose of 10 mg / kg for 365 days leads to a decrease in the iron content in the liver by an average of 3.8 mg Fe / g of liver dry matter, the concentration of ferritin in serum by 0.222 mg / L from baseline, while in patients receiving placebo, the level of iron in the liver increases by 0.38 mg Fe / g dry matter of the liver, and the level of ferritin in serum - by 0.114 5 mg / ml.
Pharmacokinetics
After oral administration, deferasirox is well absorbed, its maximum concentration (C max) in the blood plasma is reached after an average of 1.5-4 hours. The absolute bioavailability is about 70%. When Exidjad is taken 0.5 hours before breakfast with a normal or high fat content, its bioavailability according to AUC (area under the pharmacokinetic curve "concentration-time") increases by about 13-25%. When the tablet is taken with a standard breakfast or breakfast, in which the fat content is more than 50% of the total energy value, the AUC increases by about 2 times.
The relative AUC values when taking deferasirox as a suspension with apple or orange juice are equivalent to those when it is used as an aqueous suspension.
In steady state, the increase in C max and AUC 0-24 of deferasirox occurs almost linearly with dose. The cumulation factor (F c) in the body is 1.3–2.3.
Plasma protein binding (mainly albumin) - up to 99%. The apparent volume of distribution (V d) in adults is approximately 14 liters.
The main metabolic pathway of deferasirox is glucuronidation by UGT1A1 [uridine diphosphate glucuronyltransferase (UGT) family 1, polypeptide A1] and, to a lesser extent, by UGT1A3 (UGT family 1, polypeptide A3), followed by excretion in the bile. In the course of enterohepatic recirculation in the intestine, glucuronates are deconjugated and reabsorbed. About 8% of deferasirox undergoes oxidative metabolism mediated by cytochrome CYP450.
In vitro, the inhibitory effect of hydroxycarbamide on the metabolism of deferasirox is not observed.
Deferasirox is excreted with metabolites mainly (84% of the dose) through the intestines, the rest (up to 8%) through the kidneys.
The average half-life (T 1/2) can range from 8 to 16 hours.
In children and adolescents aged 2 to 17 years, the overall bioavailability of deferazirox is lower than in adult patients, both after a single and multiple doses. In connection with the individual selection of the dosage regimen of Exidzhad, some deviations in bioavailability have no clinical significance.
It was found that in patients with impaired liver function class A and B on the Child - Pugh scale, the mean AUC of deferasirox is higher than in patients with normal liver function, by 16 and 76%, respectively. With mild and moderate liver dysfunction, the mean C max is 22% higher than in patients with normal liver function. An increase in the activity of hepatic enzymes up to 5 times compared with the upper limit of the norm has no effect on the pharmacokinetics of deferazirox.
The pharmacokinetics of deferasirox in patients over the age of 65 with impaired liver or kidney function has not been studied.
Indications for use
- patients aged 2 years and older: chronic post-transfusion iron overload;
- patients aged 10 years and older: chronic non-transfusion iron overload on the background of thalassemia.
Contraindications
Absolute:
- the level of creatinine concentration in the blood serum exceeding the upper limit of the age norm by 2 times or more;
- impaired renal function with creatinine clearance (CC) less than 60 ml / min;
- high-risk myelodysplastic syndrome, hemoblastosis, malignant neoplasms of non-hematological genesis in patients with rapid disease progression, for whom chelation therapy is ineffective;
- severe liver dysfunction (class C on the Child-Pugh scale);
- galactose intolerance, lactase deficiency, glucose-galactose malabsorption syndrome;
- simultaneous use of drugs that form complexes with iron ions;
- breast-feeding;
- age under 2 years old;
- hypersensitivity to the components of the drug.
In addition, taking the drug is contraindicated during pregnancy. The appointment of Exijad is possible only in exceptional cases when, in the opinion of the doctor, the expected clinical effect for the mother exceeds the possible toxic threat to the fetus.
Exjade should be prescribed with caution to elderly patients (over 65 years); when the level of creatinine in the blood serum exceeds the upper limit of the age norm or impaired renal function with CC more than 60 ml / min, especially in patients with additional risk factors such as dehydration, severe infections and / or concomitant therapy with drugs that can adversely affect kidney function; with impaired liver function, the simultaneous use of anticoagulants, non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticosteroids (GCS), oral bisphosphonates, in patients with a platelet count below 50 x 10 9 / l.
Exjade, instructions for use: method and dosage
The tablets must not be swallowed whole or chewed!
A suspension of dispersible tablets is taken orally, on an empty stomach, no later than 0.5 hours before meals, once a day, preferably always at the same time.
To prepare the suspension, the required dose of Exidzhad is placed in a vessel containing 100-200 ml of water, orange or apple juice, and stirred until a homogeneous solution is obtained. After drinking the finished suspension, the patient must additionally pour a small amount of water or juice into the vessel with the remaining suspension and, after thoroughly mixing, take the resulting liquid inside.
It is not recommended to use carbonated drinks or milk to dissolve tablets, since in these liquids the dissolution process takes a long time and is accompanied by the formation of foam.
When prescribing the drug, the dose is calculated in mg per 1 kg of the patient's body weight, rounding as close as possible to one of the doses of Exjade tablets: 500 mg, 250 mg or 125 mg.
Chronic post-transfusion iron overload
A physician with experience in the treatment of chronic post-transfusion iron overload should initiate and administer Exjade therapy.
In case of chronic post-transfusion iron overload, it is recommended to start using Exidzhad after transfusion of red blood cells in a volume of more than 20 units (approximately 100 ml / kg) or in the presence of clinical data confirming the development of chronic iron overload (including if the concentration of serum ferritin exceeds 1 mg / l).
Recommended dosage: initial dose - at the rate of 20 mg / kg per day.
The initial daily dose, providing a decrease in the amount of iron in the body, for adult patients who require a transfusion of erythrocyte mass of more than 14 ml / kg for 30 days, can be 30 mg / kg.
The initial daily dose to maintain normal iron levels in the body in adult patients who require transfusion of erythrocyte mass less than 7 ml / kg for 30 days can be 10 mg / kg.
After previous effective therapy with deferoxamine, Exidjad should be started with a dose corresponding to 1/2 the dose of deferoxamine. If the patient received 40 mg / kg of deferoxamine per day, then the initial daily dose of deferazirox should not exceed 20 mg / kg.
Treatment with the drug is recommended to be accompanied by regular (once every 30 days) monitoring of the concentration of ferritin in the blood serum. If necessary, due to changes in serum ferritin levels, every 90-180 days should be a step-by-step dose adjustment, each time increasing or decreasing the previous dose by 5-10 mg / kg.
If, against the background of Exidjad at a dose of 30 mg / kg, the level of serum ferritin concentration continues to be 2.5 mg / L or more, indicating the ineffectiveness of therapy, the daily dose should be increased to 40 mg / kg. The maximum daily dose should not exceed 40 mg per 1 kg of body weight.
Once the target serum ferritin concentration, which is usually between 0.5 and 1 mg / L, is reached, consideration should be given to gradually reducing the dose of the drug in steps to ensure that serum ferritin levels are maintained in this range.
Interruption of Exjade treatment should be considered if serum ferritin levels are significantly less than 0.5 mg / L.
It should be borne in mind that the use of an unreasonably high dose of deferazirox for the treatment of patients with a slight degree of iron overload or a slight increase in serum ferritin concentration increases the risk of the toxic effect of the drug.
Chronic non-transfusion iron overload in patients with thalassemia
Chelation therapy with Exjade can be started only if chronic non-transfusion iron overload is proven (that is, the initial level of iron concentration in the liver exceeds 5 mg Fe / g of liver dry matter, or the content of ferritin in the blood serum is more than 0.8 mg / l).
If it is not possible to assess the iron content in the patient's liver, then chelation therapy must be performed carefully, minimizing the risk of excessive chelation.
Recommended dosage: initial daily dose - 10 mg / kg body weight. Further, based on the results of monitoring the concentration of ferritin in the blood serum, carried out once every 30 days, you can step by step (by 5-10 mg / kg) to increase the dose of Exidzhad every 90-180 days. For patients with good tolerance to therapy, dose adjustment is indicated even when the iron content in the liver is maintained at a level of 7 mg Fe / g of liver dry matter or a serum ferritin level of 2 mg / l (without a tendency to decrease).
In thalassemia, the efficacy and safety of taking Exidjad in doses of more than 20 mg / kg of body weight have not been established, so their appointment is contraindicated.
If the serum ferritin concentration is 2 mg / l or less, and the assessment of the iron concentration in the liver is not carried out, then the dose of 10 mg / kg of body weight cannot be exceeded.
When the level of iron concentration in the liver reaches less than 7 mg Fe / g of dry matter of the liver or ferritin content of 2 mg / l or less, it is recommended to lower the dose of the drug when using deferazirox at a dose of more than 10 mg / kg body weight.
With chronic non-transfusion iron overload, Exjade therapy should be discontinued if the iron level in the liver reaches 3 mg Fe / g of liver dry matter, or the ferritin concentration is less than 0.3 mg / L.
It is possible to resume the use of Exidjad when a clinical need arises.
Special categories of patients
Patients over the age of 65 do not need to correct the dosage regimen. This category of patients needs careful monitoring of the condition. When symptoms of adverse events appear, consideration should be given to reducing the dose of Exijad.
For the treatment of children and adolescents aged 2-17 years, a general dosage regimen is used, only over time, when calculating the dose, it is necessary to take into account a possible change in body weight.
In case of impaired renal function, adjustment of the initial dose is not required. Treatment of this category of patients should be accompanied by regular (once every 30 days) monitoring of the serum creatinine level and, if necessary, reduce the daily dose by 10 mg / kg.
In case of moderate hepatic dysfunction (class B on the Child-Pugh scale), the initial dose should be reduced by about 1/2 of the usual dose. Monitoring the state of liver function should be carried out before starting treatment, then once every 14 days during the first 30 days of therapy, then - with an interval of 30 days.
Side effects
Adverse events are classified as follows: very common (≥ 1/10); often (≥ 1/100, <1/10); infrequently (≥ 1/1000, <1/100), very rarely (<1/10 000); the frequency is unknown - there are separate reports of adverse reactions (there is no possibility to establish a connection between the use of Exidjad and the development of these reactions):
- on the part of the immune system: the frequency is not established - hypersensitivity reactions, including angioedema, anaphylactic reactions (more often during the first months of therapy);
- from the nervous system: often - headache; infrequently - dizziness;
- on the part of the organ of hearing: infrequently - hearing loss;
- on the part of the organ of vision: infrequently - maculopathy, early cataract; rarely - optic neuritis;
- from the respiratory system: infrequently - pain in the larynx and / or pharynx;
- from the digestive system: often - abdominal pain, diarrhea, bloating, constipation, nausea, vomiting, dyspepsia, increased activity of liver enzymes; infrequently - stomach and duodenal ulcers, gastrointestinal bleeding, cholelithiasis, gastritis, hepatitis, cholelithiasis; rarely - esophagitis; frequency not established - liver failure;
- from the urinary system: the frequency has not been established - acute renal failure (in most cases it is reversible), tubulointerstitial nephritis;
- mental disorders: infrequently - anxiety, sleep disturbances;
- dermatological reactions: often - itching, skin rash; infrequently - a violation of pigmentation; frequency not established - urticaria, Stevens-Johnson syndrome, alopecia, leukocytoclastic vasculitis;
- laboratory indicators: very often - an increase in the level of creatinine in the blood serum; often - proteinuria; infrequently - glucosuria, tubulopathy (Fanconi syndrome);
- others: infrequently - a feeling of increased fatigue, an increase in body temperature, edema.
Overdose
Symptoms
In case of an acute overdose of Exidjad, the development of nausea, vomiting, diarrhea, headache is possible. Cases of subclinical hepatitis have been reported. Against the background of a single dose of 80 mg / kg in patients diagnosed with beta-thalassemia with iron overload, mild nausea and diarrhea may appear. A single dose of up to 40 mg / kg is well tolerated in healthy individuals.
Treatment
In case of acute overdose, it is necessary to induce artificial vomiting or gastric lavage. If necessary, symptomatic therapy is prescribed. To stop subclinical hepatitis, discontinuation of treatment is required; in the long-term period, patients do not develop complications.
special instructions
Treatment with Exjade should be initiated and carried out only on the basis of the results of relevant studies confirming the disease and after an individual assessment of the possible risks and benefits of chelation therapy.
Against the background of drug treatment, there is a risk of an increase in serum creatinine (approximately in 36% of patients), usually it is non-progressive and remains within the normal range.
The daily dose of Exidjad should be reduced by 10 mg / kg of body weight if, for two consecutive visits, the serum creatinine level in adult patients is more than 33% of the average values before treatment, and in children it exceeds the upper limit of the age norm. or the calculated CC becomes less than 90 ml / min (the lower limit of the norm), and this is not due to other reasons. You can temporarily stop taking the tablets if necessary. The question of resuming treatment is decided on the basis of the individual clinical picture.
It is recommended to determine the level of serum creatinine concentration twice before starting therapy. After the start of the use of Exidzhad or a change in its dose, studies to determine the concentration of creatinine in the blood plasma, CC and / or the content of cystatin C in the blood plasma are carried out weekly, then - with an interval of 4 weeks. In some cases, it may be necessary to additionally monitor such indicators of renal tubular function as glucosuria (in patients without diabetes mellitus and low concentrations of potassium, phosphates, magnesium, uric acid), phosphaturia, aminoaciduria. In cases where these indicators of renal tubular function have deviations from normal values, consideration should be given to reducing the dose or temporarily discontinuing the drug.
The use of Exidzhad should be accompanied by regular (once every 4 weeks) monitoring of the level of proteinuria.
Regular (once every 4 weeks) monitoring of liver function should include a study of the activity of hepatic transaminases and alkaline phosphatase, the concentration of bilirubin. If there is a progression of increased activity of hepatic transaminases, the use of Exidzhad should be discontinued. After establishing the causes of biochemical changes or after restoring the indicators to normal levels, it is possible to consider the issue of resuming therapy using a lower dose. In this case, it is necessary to increase the dose gradually and with caution.
After the development of a skin rash, its spontaneous disappearance is often noted, therefore, with a mild to moderate severity of the skin rash, drug treatment can be continued without dose adjustment. If the rash that appears is more pronounced, then taking the tablets should be temporarily stopped and resumed after the rash disappears with a lower dose, including in combination with short-term use of GCS.
If you suspect the development of Stevens-Johnson syndrome, the drug should be discontinued.
If diarrhea and / or vomiting occurs during the use of Exidzhad, the patient should be provided with appropriate hydration.
Before starting the use of Exidjad, it is recommended to determine the patient's hearing and visual acuity. During treatment, ophthalmological examination, including fundus ophthalmoscopy, should be carried out regularly once a year. If hearing or vision impairment is detected, consideration should be given to reducing the dose or discontinuing therapy.
Treatment is recommended to be accompanied by regular monitoring of hematological parameters. If, against the background of the use of deferazirox, cytopenia of unknown etiology is found, then chelation therapy should be suspended for the period of normalization of hematological parameters, after which it can be resumed.
With long-term use of Exidjad, heart function in patients should be regularly assessed for severe iron overload.
Influence on the ability to drive vehicles and complex mechanisms
Due to the fact that against the background of the use of deferasirox, side effects may develop that negatively affect the patient's ability to perform potentially hazardous activities, it is recommended to be careful when driving or working with complex mechanisms.
Application during pregnancy and lactation
The period of pregnancy is a contraindication to taking the drug. The appointment of Exijad is possible only in exceptional cases when, in the opinion of the doctor, the expected clinical effect for the mother exceeds the possible toxic threat to the fetus.
The appointment of Exidzhad is contraindicated during lactation.
Pediatric use
The appointment of Exidzhad is contraindicated for the treatment of children under the age of 2 years.
According to the results of the study, the intake of deferasirox for 5 years by children with post-transfusion iron overload did not cause growth retardation in them, but as a precautionary measure, treatment of patients aged 2 to 17 years should be accompanied by regular (once a year) monitoring of body weight, height and the degree of puberty.
With impaired renal function
The use of Exidzhad is contraindicated in case of moderate and severe renal dysfunction (CC less than 60 ml / min).
Care should be taken to treat patients with serum creatinine levels above the age norm.
Correction of the initial dose in case of impaired renal function with CC above 60 ml / min is not required.
Treatment should be accompanied by regular monitoring of the serum creatinine level, which during the first 30 days of therapy is carried out with an interval of 7 days, and then every 30 days. If necessary, a decrease in the daily dose of deferasirox by 10 mg / kg of body weight is indicated.
For violations of liver function
The use of Exidzhad is contraindicated in case of severe liver dysfunction (class C on the Child-Pugh scale).
The drug should be used with caution to treat patients with impaired liver function.
Correction of the initial dose for mild liver dysfunction is not required, for moderate hepatic dysfunction, the initial dose of Exidzhad should be approximately 1/2 of the usual dose. It is necessary to monitor the state of liver function on a monthly basis.
Use in the elderly
It is recommended to prescribe Exjade with caution to patients over the age of 65 years. Correction of the dosage regimen for this category of patients is not required.
Drug interactions
Concomitant therapy with aluminum-containing antacids and other iron chelators is contraindicated due to the lack of data on interaction.
In patients with chronic iron overload, when deferasirox is combined with midazolam, cyclosporine, simvastatin, bepridil, hormonal contraceptives, ergotamine and other drugs that are substrates of the CYP3A4 isoenzyme, their systemic bioavailability decreases. In some cases, it can be pronounced, so caution should be exercised if it is necessary to use combinations with drugs, the metabolism of which is associated with the participation of the CYP3A4 isoenzyme.
The combination with phenobarbital, rifampicin, phenytoin, ritonavir and other powerful inducers of UGT can reduce the effectiveness of deferasirox, therefore, taking into account the clinical response to therapy, it is necessary to provide for an increase in the Exidjad dose.
It is contraindicated to prescribe deferasirox simultaneously with repaglinide due to the lack of information on their interaction. Consideration should be given to the possible interaction of the drug with another substrate of the CYP2C8 isoenzyme paclitaxel.
Cholestyramine significantly reduces the bioavailability of deferasirox.
The combination with theophylline, which is a substrate of the CYP1A2 isoenzyme, is undesirable. In cases where its appointment cannot be avoided, it is recommended to carefully monitor the level of theophylline concentration in blood plasma and, if necessary, reduce its dose.
No interaction with digoxin was observed in healthy individuals.
Taking ascorbic acid in daily doses up to 200 mg is not accompanied by undesirable consequences.
The combination with anticoagulants, NSAIDs, corticosteroids, bisphosphonates for oral administration increases the risk of developing such serious adverse effects from the gastrointestinal tract as ulcers and bleeding.
Perhaps a decrease in the effectiveness of hormonal contraceptives, the metabolism of which is associated with the participation of the isoenzyme CYP3A4.
Analogs
Exidzhad's analogs are Jaden, Desferal.
Terms and conditions of storage
Keep out of the reach of children.
Store at temperatures up to 30 ° C, protected from moisture.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Exjade
Reviews of Exjade are rare, but positive. Taking pills has a good therapeutic effect in the treatment of pathologies associated with an excess of iron in the body. Patients report that taking the drug should be accompanied by a strict diet that excludes foods high in iron.
Price for Exjade in pharmacies
The price for Exjade 250 mg is 27,900–38,723 rubles. per pack of 84 tablets. You can buy a pack of 84 Exjade 500 mg tablets for RUB 48,300–77,485.
Exjade: prices in online pharmacies
|
Drug name Price Pharmacy |
|
Exjade 250 mg dispersible tablets 84 pcs. RUB 29,500 Buy |
|
Exjade 500 mg dispersible tablets 84 pcs. RUB 41,000 Buy |
Maria Kulkes Medical journalist About the author
Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
