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VARIOUS › ALL OTHER THERAPEUTIC PRODUCTS › ALL OTHER THERAPEUTIC PRODUCTS › Iron chelating agents
deferoxamine
V03AC01
Forms & Strengths
- Injectable solution 500 mg/5 mL (100 mg/mL) for IV/IM/SC use
- Injectable solution 1000 mg/10 mL (100 mg/mL) for IV/IM/SC use
- Lyophilized powder for reconstitution
Adult Dosing
- Acute iron poisoning: 20‑40 mg/kg IV bolus, then 5‑15 mg/kg/hr infusion until serum Fe <350 µg/dL
- Chronic iron overload: 20‑40 mg/kg SC, 5‑6 days/week (usually 8‑12 h nightly infusion)
- Maximum cumulative dose 6 g/day to limit toxicity
Pediatric Dosing
- Acute poisoning: same weight‑based dosing as adults (20‑40 mg/kg IV bolus, then 5‑15 mg/kg/hr)
- Chronic overload: 15‑30 mg/kg SC, 5‑6 days/week
- Dose adjustments in severe renal impairment (reduce by 50%)
Indications
- Acute iron toxicity (oral overdose)
- Chronic transfusional iron overload (β‑thalassemia, sickle cell disease)
- Hereditary hemochromatosis when phlebotomy contraindicated
- Iron overload secondary to bone‑marrow transplantation
Mechanism of Action
- Hexadentate chelator binds Fe³⁺ with high affinity
- Forms water‑soluble ferrioxamine complex eliminated in urine (∼70‑90%) and bile
- Reduces free plasma iron, limiting oxidative damage
Contraindications
- Known hypersensitivity to deferoxamine or any formulation component
- Patients with active iron‑deficiency anemia (unless iron repletion planned)
- Severe renal failure not on dialysis (use with caution)
Adverse Reactions
- Local pain, erythema, or swelling at injection site
- Hypotension or tachycardia with rapid IV infusion
- Ototoxicity (tinnitus, hearing loss) with high cumulative doses
- Retinal and visual disturbances (night blindness, pigmentary retinopathy)
- Growth retardation in children on long‑term therapy
- Renal dysfunction (elevated BUN/creatinine, proteinuria)
- Pulmonary fibrosis (rare, with prolonged high‑dose use)
- Acute anaphylactoid reactions (rash, dyspnea)
Drug Interactions
- Vitamin C ↑ iron mobilization → higher chelator demand, monitor for toxicity
- Concurrent use with other iron chelators (deferiprone, deferasirox) may increase chelation‑related adverse effects
- Aminoglycosides: additive nephrotoxicity; monitor renal function
- Oral iron supplements: reduced absorption; separate administration by ≥2 h
- Zinc and copper supplements: may be chelated and depleted; monitor levels
- Antibiotics that require iron (e.g., tetracyclines): efficacy may be reduced
Curated Content: Needs Vetting Before Put to Clinical Use