• Acute toxic iron ingestion.
• Secondary iron overload syndromes associated with multiple transfusion therapy.

Contraindicated in:

• Severe renal impairment
• Anuria
• Lactation: Lactation.

Use Cautiously in:

• OB: Safety not established in pregnancy. Treatment should not be withheld in pregnant women with acute iron toxicity
• Pedi: Children <3 yr (safety and effectiveness not established).

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, (INCLUDING ANAPHYLAXIS)HYPERSENSITIVITY REACTIONS , shock (after rapid IV administration).

Drug-Drug:

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

(Generic available)

• Powder for injection: 500 mg/vial; 2 g/vial;

Acute Iron Ingestion

• IM, IV (Adults and Children 3 yr): 1 g, 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).
• SC (Adults and Children 3 yr): 1–2 g/day (20–40 mg/kg/day) infused over 8–24 hr.

Desferal

• Chelates unbound iron, forming a water-soluble complex (ferrioxamine) in plasma that is easily excreted by the kidneys.

• Removal of excess iron. Also chelates aluminum.

Therapeutic Classification: antidotes

Pharmacologic Classification: heavy metal antagonists

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.

(effects on hematologic parameters)

• Reinforce need to keep iron preparations, all medications, and hazardous substances out of the reach of children.
• 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, because tissue toxicity may increase.
• Encourage patients requiring chronic therapy to keep follow-up appointments for lab tests. Eye and hearing exams may be monitored every 3 mo.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned. Breastfeeding should be avoided during therapy and for 1 wk after the last dose.

de-fer-OX-a-meen