Desferal

Indications

Deferoxamine Mesylate (also called Desferrioxamine) is an iron-removing medicine (chelating agent). It is used for chronic iron overload, for example in people with thalassaemia or other conditions needing frequent blood transfusions, for acute iron poisoning, and for aluminium overload in people on long-term dialysis.

How It Works

Deferoxamine binds tightly to free iron and to iron in stores such as ferritin, forming a complex that the body passes out in the urine and stool. This lowers the iron load and protects the heart, liver and glands from iron damage. It binds aluminium in a similar way.

Dosage and Administration

It is given by injection only, usually as a slow infusion under the skin over 8 to 12 hours using a small pump, or into a muscle or vein. The first doses are given or supervised by a doctor or nurse, and patients or carers may later be trained to give home infusions. The dose depends on the iron level, body weight and the condition, and is given exactly as prescribed.

Interactions

• High-dose Vitamin C (Ascorbic Acid) can increase iron release and may worsen heart function; take it only if the doctor advises
• Prochlorperazine taken with Deferoxamine has caused loss of consciousness
• Gallium-67 scans may give misleading results during treatment

Contraindications

• Allergy to Deferoxamine
• Severe kidney disease or no urine output, unless the person is on dialysis

Side Effects

Common effects include pain, redness, swelling or itching at the injection site, headache, nausea, joint or muscle pain, fever and reddish-brown urine (harmless, caused by the iron complex). With high doses or long use, hearing loss, ringing in the ears, blurred or reduced vision, slowed growth in children and kidney problems can occur. It can increase the risk of certain infections, especially Yersinia bowel infection.

Get urgent medical help for difficulty breathing, swelling of the face or throat, fainting, sudden loss of vision or hearing, high fever with diarrhoea and stomach pain, or very little urine.

Pregnancy and Lactation

It is generally avoided during pregnancy, especially in the first trimester, unless the benefit clearly outweighs the risk. It is not known whether it passes into breast milk; discuss breastfeeding with your doctor.

Precautions and Warnings

Regular eye and hearing tests are needed during long-term treatment. Children need growth checks. The infusion rate must not be too fast, because rapid injection into a vein can cause flushing, low blood pressure and shock. Very high intravenous doses have caused lung problems. Report fever with stomach pain or diarrhoea quickly. It may cause dizziness or blurred vision, so take care when driving.

Overdose

Signs include flushing, low blood pressure, fast heartbeat, stomach upset, blurred vision, agitation and kidney failure. The infusion is stopped and supportive treatment is given in hospital; dialysis may help.

Therapeutic Class

Iron chelating agent; antidote for iron and aluminium overload.

Storage

Store the unopened vials below 25°C in a dry place, away from light and out of the reach of children. Use the prepared solution straight away, as directed on the pack.