deferoxamine (de-fer-ox-a-meen) Desferal

 Indications

Acute toxic iron ingestion. Secondary iron overload

syndromes associated with multiple transfusion therapy.

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 subcut

administration.

Distribution: Appears to be widely distributed.

Metabolism and 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

Subcut unknown unknown unknown

Contraindications/Precautions

Contraindicated in: Severe renal disease; Anuria;

OB: Rep: Early pregnancy or childbearing potential

(however, may be used safely in pregnant patients with

moderate-to-severe acute iron intoxication).

Use Cautiously in: Pedi: Children 3 yr (safety not

established).

Adverse Reactions/Side Effects

EENT: blurred vision, cataracts, ototoxicity. CV: hypotension,

tachycardia. GI: abdominal pain, diarrhea.

GU: red urine. Derm: erythema, flushing, urticaria.

Local: induration at injection site, pain at injection

site. MS: leg cramps. Misc: allergic reactions, fever,

shock after rapid IV administration.

Interactions

Drug-Drug: Ascorbic acid mayqeffectiveness of

deferoxamine but may alsoqcardiac iron toxicity. 

Route/Dosage

Acute Iron Ingestion

IM, IV (Adults and Children 3 yr): 1 g, then 500

mg q 4 hr for 2 doses. Additional doses of 500 mg q 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).

Subcut (Adults and Children 3 yr): 1–2 g/day

(20–40 mg/kg/day) infused over 8–24 hr.

Availability (generic available)

Powder for injection: 500 mg/vial, 2 g/vial.