section name header

Pronunciation ⬇

de-fer-OX-a-meen

Classifications ⬆ ⬇

Therapeutic Classification: antidotes

Pharmacologic Classification: heavy metal antagonists

Indications ⬆ ⬇

REMS

Action ⬆ ⬇

  • Chelates unbound iron, forming a water-soluble complex (ferrioxamine) in plasma that is easily excreted by the kidneys.
Therapeutic effects:
  • Removal of excess iron. Also chelates aluminum.

Pharmacokinetics ⬆ ⬇

Absorption: Poorly absorbed after oral administration. Well absorbed after IM administration and SUBQ administration. IV administration results in complete bioavailability.

Distribution: Appears to be widely distributed.

Metabolism/Excretion: Metabolized by tissues and plasma enzymes. Unchanged drug and chelated form excreted by the kidneys; 33% of iron removed is eliminated in the feces via biliary excretion.

Half-Life: 1 hr.

Time/Action Profile ⬆ ⬇

( effects on hematologic parameters)

ROUTEONSETPEAKDURATION
IVrapidunknownunknown
IMunknownunknownunknown
SUBQunknownunknownunknown



Contraind./Precautions ⬆ ⬇

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, tachycardia

Derm: erythema, flushing, urticaria

EENT: blurred vision, cataracts, ototoxicity

GI: abdominal pain, diarrhea

GU: red urine.

Local: induration at injection site, pain at injection site

MS: leg cramps

Misc: fever, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), shock(after rapid IV administration)

Interactions ⬆ ⬇

Drug-drug:

  • Ascorbic acid may ↑ effectiveness of deferoxamine but may also risk of ↑ cardiac iron toxicity.

Route/Dosage ⬆ ⬇

Acute Iron Ingestion

  • IM IV (Adults and Children ≥3 yr): 1 g initially; then 500 mg every 4 hr for 2 doses. Additional doses of 500 mg every 4–12 hr may be needed (not to exceed 6 g/24 hr).

Chronic Iron Overload

  • IM IV (Adults and Children ≥3 yr): 500 mg–1 g daily IM; additional doses of 2 g should be given IV for each unit of blood transfused (not to exceed 1 g/day in absence of transfusions; 6 g/day if patient receives transfusions).
  • SUBQ (Adults and Children ≥3 yr): 1–2 g/day (20–40 mg/kg/day).

Availability ⬆ ⬇

(Generic available)
  • Powder for injection: 500 mg/vial; 2 g/vial

Assessment ⬆ ⬇

  • In acute poisoning, assess time, amount, and type of iron preparation ingested.
  • Monitor for signs of iron toxicity: early acute (abdominal pain, bloody diarrhea, emesis) and late acute (↓ level of consciousness, shock, metabolic acidosis).
  • Monitor vital signs closely, especially during IV administration, for hypersensitivity reactions. Report hypotension, erythema, urticaria, or signs of allergic reaction. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
  • May cause oculotoxicity or ototoxicity. Report ↓ visual acuity or hearing loss. Audiovisual exams should be performed every 3 mo in patients with chronic iron overload.
  • Monitor intake and output and urine color. Inform health care professional if patient is anuric. Chelated iron is excreted primarily by the kidneys; urine may turn red.

Lab Test Considerations:

  • Monitor serum iron, total iron binding capacity (TIBC), and ferritin levels, as well as urinary iron excretion before and periodically during therapy.

Implementation ⬆ ⬇

  • IM route is preferred in acute iron intoxication unless patient is in shock.
  • IM: Administer deep IM and massage well. Rotate sites. IM administration may cause transient severe pain.
    • Reconstitution: Reconstitute 500-mg vial with 2 mL and 2-g vial with 8 mL of sterile water for injection. Reconstituted solution is yellow and stable for 1 wk after reconstitution if protected from light. Discard unused portion. 213 mg/mL.
    • Used in conjunction with induction of emesis or gastric aspiration and lavage with sodium bicarbonate and supportive measures for shock and metabolic acidosis in acute poisoning.
  • SUBQ: Reconstitution: Reconstitute 500-mg vial with 5 mL and 2-g vial with 20 mL of sterile water for injection.Concentration: 95 mg/mL. SUBQ route used to treat chronically elevated iron therapy is administered into abdominal SUBQ tissue via infusion pump for 8–24 hr per treatment.

IV Administration:

  • IV: Reconstitution: Reconstitute 500-mg vial with 5 mL and 2-g vial with 20 mL of sterile water for injection. Reconstituted solution is clear and colorless to slightly yellow. Administer ≤3 hr of reconstitution or 24 hr if prepared under laminar flow hood. Discard unused portion. Concentration: 95 mg/mL.Diluent: Further dilute reconstituted solution in D5W, 0.9% NaCl, 0.45% NaCl, or LR. Concentration: 3–3.5 mg/mL.

Patient/Family Teaching ⬆ ⬇

  • Explain purpose and side effects of medication to patient. Advise to read Patient Information before starting therapy.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
  • Reassure patient that red coloration of urine is expected and reflects excretion of excess iron.
  • May cause dizziness or impairment of vision or hearing. Caution patient to avoid driving or other activities requiring alertness until response from medication is known.
  • Advise patient not to take vitamin C preparations without consulting health care professional. May ↑ tissue toxicity.
  • Encourage patients requiring chronic therapy to keep follow-up appointments for lab tests. Eye and hearing exams may be monitored every 3 mo.
  • Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected. Breastfeeding should be avoided during therapy and for 1 wk after the last dose.

Evaluation/Desired Outcomes ⬆ ⬇

  • Removal of excess iron. Also chelates aluminum.

US Brand Names ⬆

Desferal