deferoxamine (Desferal)

Introduction

Tradename: Desferal. (deferoxamine mesylate)

Indications

• chelation therapy for iron poisoning
• investigational use for treatment of Al+3 accumulation in renal failure
• hemochromatosis
• removal or corneal rust rings following surgical removal of foreign bodies

Contraindications

• pregnancy

pregnancy category = c

safety in lactation = ?

Dosage

• acute iron poisoning
  • 10-15 mg/kg/hr IV until serum iron < 250 ug/dL or until urine turns from "salmon" color to clear
  • 50 mg/kg IM/IV up to 500-1000 mg twice, 4 hours apart
• chronic iron overload
  • 0.5-1 g IM QD
  • infusion: 20-40 mg/kg/day infused over 8-24 hours
• max dose 6.0 g/day
• infusion for > 24 hours associated with increased risk of ARDS (acute respiratory distress syndrome)

Powder for injection: 500 mg.

Pharmacokinetics

• widely distributed to tissues
• eliminated in the urine
• chelation complex can be removed by dialysis

elimination via kidney

Adverse effects

• not common (1-10%)
  • pain & induration at site of injection
• uncommon (< 1%)
  • flushing, hypotension, tachycardia, shock, swelling, fever, erythema*, urticaria*, pruritus*, rash, abdominal discomfort, diarrhea, cutaneous wheal formation, leg cramps, blurred vision, cataracts, hearing loss, anaphylaxis

* Administer antihistamines for allergic reactions.

Mechanism of action

• chelates iron by binding ferric (Fe+3) ions
• 1 g of deferoxamine chelates 85 mg of Fe+3
• Fe+3:deferoxamine complex is H2O soluble & excreted in the urine
• deferoxamine also chelates aluminum

More general terms

• chelating agent

Additional terms

• deferoxamine infusion test

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=2973
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=62880
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=62881