deferoxamine

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).

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.

Availability ⬆ ⬇

(Generic available)

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

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).
SC (Adults and Children ≥3 yr): 1–2 g/day (20–40 mg/kg/day).

US Brand Names ⬆ ⬇

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.

Classifications ⬆ ⬇

Therapeutic Classification: antidotes

Pharmacologic Classification: heavy metal antagonists

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)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	unknown	unknown
IM	unknown	unknown	unknown
SUBQ	unknown	unknown	unknown

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.

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Indications ⬇

Contraind./Precautions ⬆ ⬇