section name header

Indications ⬇

REMS

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.

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

US Brand Names ⬆ ⬇

Desferal

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)

ROUTEONSETPEAKDURATION
IVrapidunknownunknown
IMunknownunknownunknown
SUBQunknownunknownunknown

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.

Pronunciation ⬆

de-fer-OX-a-meen