Indications
Desferrioxamine (also called Deferoxamine) is used to remove excess iron from the body. Its main uses are chronic iron overload in people who need regular blood transfusions, such as those with thalassaemia, and acute iron poisoning, for example when a child swallows iron tablets. It is also used in some patients on dialysis with aluminium overload.
How It Works
Desferrioxamine is a chelating agent. It binds tightly to free iron (and aluminium) in the blood and tissues to form a stable compound that the body then removes through the urine and the bile. Removing extra iron protects the heart, liver and hormone glands from iron damage.
Dosage and Administration
Desferrioxamine is given by injection, usually as a slow infusion under the skin over 8 to 12 hours using a small pump, or into a vein or muscle. It is started by a doctor or nurse; some patients with thalassaemia are trained to give the home infusions themselves. The dose depends on body weight, iron levels and the reason for use, and is always as prescribed. Regular blood tests (such as serum ferritin) guide treatment.
Interactions
- Vitamin C (Ascorbic Acid) can increase iron removal but may affect the heart in people with severe iron overload; take it only as advised by your doctor and start it only after a month of regular chelation.
- Prochlorperazine taken with Desferrioxamine may cause temporary loss of consciousness.
- Desferrioxamine can affect gallium scans, and an iron or aluminium test may need to be timed around doses.
Contraindications
- Known allergy to Desferrioxamine, unless the doctor decides treatment is essential under close supervision.
- Severe kidney disease without dialysis, as the iron complex is removed by the kidneys.
Side Effects
Common side effects include pain, redness, swelling, itching or a lump at the infusion site, joint or muscle pain, headache, nausea, fever and reddish-brown urine (which is expected and harmless). With high doses or long-term use, hearing loss, ringing in the ears, blurred or reduced vision, problems with growth in children, and certain infections (such as Yersinia gut infection or mucormycosis) can occur. Fast injection into a vein can cause flushing, low blood pressure and shock.
Get urgent medical help if you have a high fever with stomach pain or diarrhoea, breathing difficulty, swelling of the face or throat, a severe allergic reaction, sudden change in vision or hearing, or very little urine.
Pregnancy and Lactation
Desferrioxamine is usually avoided in the first three months of pregnancy and is used later in pregnancy only if the doctor judges it necessary, for example in serious iron poisoning. It is not known whether it passes into breast milk; ask your doctor before breastfeeding.
Precautions and Warnings
- Have eye and hearing tests before starting and regularly during long-term treatment.
- Children need regular checks of height and weight.
- Tell your doctor at once about fever, abdominal pain or diarrhoea, as treatment may need to stop.
- Kidney function is monitored, especially at high doses.
- It may cause dizziness or vision problems; take care when driving.
Overdose
Accidental high doses or fast infusion can cause low blood pressure, fast heartbeat, blurred vision, agitation, kidney problems and breathing difficulty. The infusion is stopped and supportive treatment is given in hospital; it can be removed by dialysis.
Therapeutic Class
Iron chelating agent (antidote for iron and aluminium overload).
Storage
Store the unopened vials below 25°C, away from light, out of the reach of children. Use the made-up solution straight away or as directed on the pack; do not refrigerate the made-up solution.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.