Deferoxamine

Deferoxamine is a prescription medication used to treat Acute Iron Poisoning and Chronic Iron Overload. 

• Deferoxamine is available under the following different brand names: Desferal.

Adult and pediatric dosage

Powder for injection

• 500mg/vial
• 2g/vial

Acute Iron Poisoning

Adult dosage

• IM administration is indicated for all patients NOT in shock; administer 1g IM initially and then 500mg every 4 hours for 2 doses
• Depending upon clinical response, subsequent doses of 500mg every 4-12 hours
• Maximum dose: 6g in 24 hours

Pediatric dosage

• Children younger than 3 years of age: Safety and effectiveness has not been established
• Children 3 years of age or older: Administer 1g IM initially and then 500mg every 4 hours for 2 doses for all patients not in shock
• Depending upon clinical response, subsequent doses of 500mg every 4-12 hours can be administered; maximum dose 6g in 24 hours
• IV administration should be reserved for patients in a state of cardiovascular collapse or shock; 1g slow IV infusion 
• Rate of infusion should not exceed 15mg/kg/hr for the first dose; subsequent doses should not be infused at a faster rate than 125mg/hr
• 20mg/kg IM (for all patients not in shock) or IV (only if patient in cardiovascular collapse/shock); then, 10 mg/kg IM/IV every 4 hours x2; then, depending on clinical circumstance, may administer additional doses of 10 mg/kg IM/IV every 4-12 hours as needed
• IV infusion rate: initial 1g at 15 mg/kg/hr, all subsequent doses no more than 125 mg/hr
• No more than 6g/day (IM/IV), but in severe cases should continue infusion up to 24 hours

Chronic Iron Overload

Adult dosage

• SC administration: 1-2 g (20-40mg/kg/day) SC over 8-24 hours using a small portable pump capable of providing continuous mini-infusion; individualize infusion duration
• IV administration in patients with IV access: 40-50mg/kg/day over 8-12 hours for 5-7 days/week (maximum not to exceed 60mg/kg/day and an IV infusion rate of greater than 15mg/kg/hr)
• IM administration: 0.5-1g once daily (maximum of 1g per day)

Pediatric dosage

• Children younger than 3 years of age: Safety and effectiveness has not been established
• Children 3 years of age or older: 0.5-1g IM once daily (maximum of 1g per day)
• SC administration: 1-2 g (20-40mg/kg/day) SC over 8-24 hours using a small portable pump capable of providing continuous mini-infusion; individualize infusion duration
• IV administration in patients with IV access: 40-50mg/kg/day over 8-12 hours for 5-7 days/week (maximum of 60mg/kg/day and an IV infusion rate of maximum of 15mg/kg/hr)

Dosage Considerations – Should be Given as Follows: 

• See "Dosages."

Common side effects of Deferoxamine include:

• reddish-colored urine, 
• muscle spasm, 
• numbness or tingling, 
• burning pain, 
• unusual bleeding, 
• easy bruising, 
• nausea, 
• vomiting, 
• diarrhea, 
• dizziness, and
• pain, burning, swelling, redness, rash, itching, blistering, scarring, or a hard lump at the injection site

Serious side effects of Deferoxamine include:

• hives, 
• difficulty breathing, 
• swelling of the face, lips, tongue, or throat, 
• blurred vision, 
• poor night vision, 
• trouble seeing colors, 
• trouble with side (peripheral vision), 
• seeing halos around lights, 
• eye pain, 
• cloudy appearance in the eye, 
• pain behind the eyes, 
• ringing in the ears, 
• hearing problems, 
• lightheadedness, 
• little or no urination, 
• shortness of breath, 
• rapid breathing, 
• fever, 
• severe, watery, bloody diarrhea with cramping, 
• flushing (sudden warmth, redness, or tingly feeling), 
• stuffy nose, 
• fever, 
• redness or swelling around the nose and eyes, 
• scabbing inside the nose, 
• muscle weakness, 
• bone pain, 
• seizure, 
• confusion, and
• problems with speech or memory

Rare side effects of Deferoxamine include:

• none 

This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Deferoxamine has severe interactions with no other drugs. 
• Deferoxamine has serious interactions with no other drugs. 
• Deferoxamine has moderate interactions with at least 16 other drugs. 
• Deferoxamine has minor interactions with no other drugs. 

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Contraindications

• Known hypersensitivity to deferoxamine or any of its components
• Patients with severe renal disease or anuria

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Deferoxamine?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Deferoxamine?”

Cautions

• Administration by rapid IV injection may cause flushing of the skin, urticaria, hypotension, and shock; administer IM or by slow SC or IV infusion
• Rare fatal cases of mucormycosis have been reported; if any signs and symptoms occur, discontinue treatment and conduct mycological tests immediately
• Severe chronic iron overload may precipitate reversible cardiac function impairment if high doses of Vitamin C (over 500 mg once daily in adults) are given concomitantly; do not administer Vitamin C to HF patients; wait over 1 month after treatment to begin supplemental Vitamin C therapy; administer vitamin C only if the patient is receiving Desferal regularly, ideally soon after setting up the infusion pump; do not exceed a daily vitamin C dose of 200 mg in adults, given in divided doses; monitor cardiac function closely during such combined therapy
• Dialysis patients with aluminum-related encephalopathy may experience neurological dysfunction (seizures), possibly due to an acute increase in circulating aluminum; onset of dialysis dementia may be precipitated; treatment in the presence of aluminum overload may result in decreased serum calcium and aggravation of hyperparathyroidism
• Monitor for changes in renal function
• Not a substitute for standard measures generally used in iron toxicity (eg, induced emesis, gastric lavage)
• Iron overload increases susceptibility of patients to Yersinia enterocolitica and Yersinia pseudotuberculosis infections; treatment may therefore enhance patient's susceptibility
• Monitor pediatric patients for body weight and growth every 3 months

Pregnancy and Lactation

• Use with caution if benefits outweigh risks during pregnancy. 
• Lactation: Unknown if excreted in breast milk, use caution.