deferoxamine

Generic Name: deferoxamine (de fer OX a meen)
Brand Name: Desferal

What is deferoxamine?

Deferoxamine binds to iron and removes it from the blood stream.

Deferoxamine is used to treat iron overload caused by blood transfusions in adults and children at least 3 years old.

Deferoxamine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about deferoxamine?

You should not use this medication if you are allergic to deferoxamine, if you have severe kidney disease, or if you are unable to urinate.

Before using deferoxamine, tell your doctor if you have kidney disease, heart disease, liver disease, vision or hearing problems, asthma or other breathing disorder, low levels of calcium in your blood (hypocalcemia), or a parathyroid disorder.

Your doctor may tell you to take a vitamin C supplement after you have been using deferoxamine for 1 month. Follow your doctor's instructions about how much vitamin C to take and when to start taking it. Using too much vitamin C while you are using deferoxamine can cause heart problems. Do not take vitamin C supplements without your doctor's advice if you have heart failure.

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To be sure this medication is not causing harmful effects, your kidney and heart function will need to be tested often. You may also need eye exams. Do not miss any follow up visits to your doctor for blood tests or eye exams.

Long-term use of deferoxamine can slow a child's growth. Tell your doctor if the child using this medication is not growing or gaining weight properly. A doctor should check the child's growth every 3 months.

This medication may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

If you need to have any type of x-ray or CT scan using a dye that is injected into a vein, you may need to temporarily stop using deferoxamine. Be sure the doctor knows ahead of time that you are using this medication.

What should I discuss with my health care provider before using deferoxamine?

You should not use this medication if you are allergic to deferoxamine, if you have severe kidney disease, or if you are unable to urinate.

To make sure you can safely use deferoxamine, tell your doctor if you have any of these other conditions:

  • kidney disease (or if you are on dialysis);

  • heart disease;

  • liver disease;

  • vision or hearing problems;

  • asthma or other breathing disorder;

  • low levels of calcium in your blood (hypocalcemia); or

  • a parathyroid disorder.

If you need to have any type of x-ray or CT scan using a dye that is injected into a vein, you may need to temporarily stop using deferoxamine. Be sure the doctor knows ahead of time that you are using this medication.

FDA pregnancy category C. It is not known whether deferoxamine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether deferoxamine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Long-term use of deferoxamine can slow a child's growth. Tell your doctor if the child using this medication is not growing or gaining weight properly.

How should I use deferoxamine?

Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Deferoxamine is sometimes injected into a vein through an IV. The medicine must be given slowly through an IV infusion, and may be given for several hours in a row.

Deferoxamine is also sometimes injected into a muscle using an infusion pump.

You may be shown how to use deferoxamine at home. Do not self-inject this medicine if you do not fully understand how to give the injection and properly dispose of used needles, IV tubing, and other equipment used in giving the medicine.

Deferoxamine must be mixed with a liquid (diluent) before injecting it. The mixed solution should be clear with a colorless or slightly yellow appearance.

Do not use the medication if it has changed colors or has any particles in it. Call your doctor for a new prescription.

It is best to use deferoxamine within 3 hours after mixing it, but you must use it within 24 hours. Throw away the medicine if it has been longer than 24 hours since it was mixed with the liquid.

Your doctor may tell you to take a vitamin C supplement after you have been using deferoxamine for 1 month. Follow your doctor's instructions about how much vitamin C to take and when to start taking it. Using too much vitamin C while you are using deferoxamine can cause heart problems.

Do not take vitamin C supplements without your doctor's advice if you have heart failure.

To be sure this medication is not causing harmful effects, your kidney and heart function will need to be tested often. You may also need eye exams. Do not miss any follow up visits to your doctor for blood tests or eye exams.

If a child is using deferoxamine, a doctor should check the child's growth every 3 months. Do not miss any scheduled visits to your child's doctor.

Each dose of this medication is for one use only. Throw away any mixed medicine that is leftover after giving the injection.

Use a disposable needle only once. Throw away used needles in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets.

Store unmixed deferoxamine at room temperature. You may store mixed medicine at room temperature for up to 24 hours, but do not refrigerate it.

What happens if I miss a dose?

Since deferoxamine is used as needed, it does not have a daily dosing schedule. Call your doctor promptly if your symptoms do not improve after using deferoxamine.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include slow or fast heart rate, stomach discomfort, headache, problems with speech or vision, pale skin, feeling drowsy or agitated, urinating less than usual, confusion, feeling short of breath, or fainting.

What should I avoid while using deferoxamine?

This medication may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Deferoxamine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; joint or muscle pain; fever; headache; nausea or vomiting; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using deferoxamine and call your doctor at once if you have any of these serious side effects:

  • cough, wheezing, gasping, or other breathing problems;

  • urinating less than usual or not at all;

  • drowsiness, confusion, mood changes, increased thirst, loss of appetite, nausea and vomiting;

  • swelling, weight gain, feeling short of breath;

  • nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

  • hearing problems;

  • blurred vision, eye pain, or seeing halos around lights;

  • seizure (convulsions);

  • fast heartbeats;

  • blue lips, skin, or fingernails;

  • severe, watery, bloody diarrhea with cramping;

  • stuffy nose, fever, redness or swelling around your nose and eyes, scabbing inside your nose;

  • stomach or back pain, coughing up blood;

  • easy bruising or bleeding, unusual weakness; or

  • leg cramps, bone problems, or growth changes (in a child using this medication).

Less serious side effects may include:

  • dizziness, ringing in your ears;

  • flushing (warmth, redness, or tingly feeling);

  • mild itching or skin rash;

  • numbness or burning pain anywhere in the body;

  • mild diarrhea, nausea, or upset stomach;

  • reddish colored urine; or

  • pain, burning, swelling, redness, irritation, or a hard lump where the medicine was injected.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Deferoxamine dosing information

Usual Adult Dose for Iron Poisoning -- Acute:

For the treatment of acute iron intoxication:

IM Administration: (This route is preferred and should be used for all patients who are not in shock.)

Initial Dose: 1000 mg.
This may be followed by 500 mg every 4 hours for two doses. Depending upon the clinical response, subsequent doses of 500 mg may be administered every 4-12 hours. The total amount administered should not exceed 6000 mg in 24 hours.

IV Administration: (This route should be used only for patients in a state of cardiovascular collapse and then only by slow infusion.)
The rate of infusion should not exceed 15 mg/kg/hr for the first 1000 mg administered. Subsequent intravenous dosing, if needed, must be at a slower rate, not to exceed 125 mg/hr.

The reconstituted solution is added to physiologic saline, glucose in water, or Ringer's lactate solution.

Initial Dose: 1000 mg should be administered at a rate not to exceed 15 mg/kg/hr.
This may be followed by 500 mg over 4 hours for two doses. Depending upon the clinical response, subsequent doses of 500 mg may be administered over 4-12 hours. The total amount administered should not exceed 6000 mg in 24 hours.

As soon as the clinical condition of the patient permits, intravenous administration should be discontinued and the drug should be administered intramuscularly.

Usual Adult Dose for Iron Poisoning -- Chronic:

For the treatment of chronic iron overload due to transfusion-dependent anemias: (The more effective of the following routes of administration must be chosen on an individual basis for each patient.)

IM Administration:
500-1000 mg daily should be administered intramuscularly. In addition, 2000 mg should be administered intravenously with each unit of blood transfused. However, deferoxamine should be administered separately from the blood. The rate of intravenous infusion must not exceed 15 mg/kg/hr. The total daily dose should not exceed 1000 mg in the absence of a transfusion, or 6000 mg even if transfused three or more units of blood or packed red blood cells.

Subcutaneous Administration:
1000-2000 mg daily (20-40 mg/kg/day) should be administered over 8-24 hours, utilizing a small portable pump capable of providing continuous mini-infusion. The duration of infusion must be individualized. In some patients, as much iron will be excreted after a short infusion of 8-12 hours as with the same dose given over 24 hours.

Usual Geriatric Dose for Iron Poisoning -- Acute:

Dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Usual Geriatric Dose for Iron Poisoning -- Chronic:

Dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Usual Pediatric Dose for Iron Poisoning -- Acute:

Less than 3 years: Iron mobilization with deferoxamine is relatively poor in patients under the age of 3 years with relatively little iron overload. The drug should ordinarily not be given to such patients unless significant iron mobilization (e.g., 1 mg or more of iron per day) can be demonstrated.

Greater than or equal to 3 years:

IM: 50 mg/kg/dose every 6 hours.
Maximum Dose: 6 g/day

IV: 15 mg/kg/hr
Maximum Dose: 6 g/day

Alternative Dosing: IM or IV:
Initially: 20 mg/kg or 600 mg/m2
Followed by 10 mg/kg or 300 mg/m2 every 4 hours for 2 doses. Subsequent doses of 10 mg/kg or 300 mg/m2 every 4-12 hours may be appropriate depending on the clinical response.
Maximum Dose: 6 g/day

Pediatric patients receiving deferoxamine should be monitored for body weight and growth every 3 months.

Usual Pediatric Dose for Iron Poisoning -- Chronic:

Less than 3 years: Iron mobilization with deferoxamine is relatively poor in patients under the age of 3 years with relatively little iron overload. The drug should ordinarily not be given to such patients unless significant iron mobilization (e.g., 1 mg or more of iron per day) can be demonstrated.

Greater than or equal to 3 years:

IV: 15 mg/kg/hour
Maximum Dose: 12 g/day

Subcutaneous Infusion (via portable controlled infusion device): 20-50 mg/kg/day over 8-12 hours
Maximum Dose: 2 g/day


Pediatric patients receiving deferoxamine should be monitored for body weight and growth every 3 months.

What other drugs will affect deferoxamine?

Tell your doctor about all other medicines you use, especially prochlorperazine (Compazine, Compro) or a vitamin C supplement.

There may be other drugs that can interact with deferoxamine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about deferoxamine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 3.01. Revision Date: 2012-01-16, 5:25:43 PM.

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