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deferoxamine (Rx)Brand and Other Names:Desferal

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 500mg/vial
  • 2g/vial
more...

Acute Iron Poisoning

IM administration is indicated for all patients NOT in shock; administer 1g IM initially and then 500mg Q4hr for 2 doses

Depending upon clinical response, subsequent doses of 500mg Q4-12hr can be administered

Maximum dose: 6g in 24 hours

IV administration should be reserved for patients in a state of cardiovascular collapse or shock; 1g slow IV infusion

Rate of infusion should not exceed 15mg/kg/hr for the first dose; subsequent doses should not be infused at a faster rate than 125mg/hr  

Chronic Iron Overload

SC administration: 1-2g (20-40mg/kg/day) SC over 8-24 hours using a small portable pump capable of providing continuous mini-infusion; individualize infusion duration

IV administration in patients with IV access: 40-50mg/kg/day over 8-12 hours for 5-7 days/ week (maximum of < 60mg/kg/day and an IV infusion rate of <15mg/kg/hr)

IM administration: 0.5-1g QD (maximum of 1g QD)  

Additional Information

Can be administered prior to or following same day blood transfusion in patients that are poorly compliant; should not be administered concurrently as this can lead to errors in interpretation of ADRs

Dosage Forms & Strengths

powder for injection

  • 500mg/vial
  • 2g/vial
more...

Acute Iron Poisoning

<3 years: Safety and effectiveness has not been established

≥3 years: Administer 1g IM initially and then 500mg Q4hr for 2 doses for all patients not in shock

Depending upon clinical response, subsequent doses of 500mg Q4-12hr can be administered; maximum dose: 6g in 24 hours

IV administration should be reserved for patients in a state of cardiovascular collapse or shock; 1g slow IV infusion

Rate of infusion should not exceed 15mg/kg/hr for the first dose; subsequent doses should not be infused at a faster rate than 125mg/hr

20 mg/kg IM (for all patients not in shock) or IV (only if patient in cardiovascular collapse/shock); then, 10 mg/kg IM/IV q4hr x2; then, depending on clinical circumstance, may administer addtional doses of 10 mg/kg IM/IV q4-12hr PRN 

IV infusion rate: Initial 1 g at 15 mg/kg/hr, all subsequent doses no more than 125 mg/hr

No more than 6 g/day (IM/IV), but in severe cases should continue infusion up to 24 hours

Chronic Iron Overload

<3 years: Safety and effectiveness has not been established

≥3 years: 0.5-1g IM QD (maximum of 1g QD)

SC administration: 1-2g (20-40mg/kg/day) SC over 8-24 hours using a small portable pump capable of providing continuous mini-infusion; individualize infusion duration  

IV administration in patients with IV access: 40-50mg/kg/day over 8-12 hours for 5-7 days/ week (maximum of < 60mg/kg/day and an IV infusion rate of <15mg/kg/hr)  

Additional Information

Can be administered prior to or following same day blood transfusion in patients that are poorly compliant; should not be administered concurrently as this can lead to errors in interpretation of ADRs

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Interactions

Interaction Checker

deferoxamine and

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            Adverse Effects

            Frequency Not Defined

            Injection site reactions (eg, localized irritation, induration, infiltration, pain, erythema, wheal formation, eschar, burning, swelling, pruritus, crust, vesicles, local edema); these may be associated with systemic allergic reactions

            Systemic reactions (eg, abdominal pain, arthralgia, asthma, fever, headache, myalgia, nausea, vomiting)

            Cardiovascular reactions (eg, hypotension with too rapid IV infusion, tachycardia, shock)

            Hypersensitivity reactions (eg, anaphylactic reaction with or without shock, angioedema, generalized rash, urticaria)

            Digestive reactions (eg, abdominal discomfort, diarrhea, nausea, vomiting)

            Hematologic reactions (eg, blood dyscrasia including thrombocytopenia and leucopenia)

            Hepatic reactions (eg, increased transaminases, hepatic dysfunction)

            Musculoskeletal reactions (eg, muscle spasms, growth retardation and bone changes including metaphyseal dysplasia are common in doses ≥ 60 mg/kg, especially those who begin iron chelation in the first three years of life; reduced risk if doses are kept to ≤ 40 mg/kg)

            Nervous System reactions (eg, neurological disturbances including dizziness, peripheral sensory, motor, or mixed neuropathy, paresthesias, seizures; exacerbation or precipitation of aluminum-related dialysis encephalopathy)

            Special Senses reactions (eg, high-frequency sensorineural hearing loss and/or tinnitus are uncommon if dosage guidelines are not exceeded and if dose is reduced when ferritin levels decline; visual disturbances inlcuding decreased acuity, blurred vision, loss of vision, dyschromatopsia, night blindness, visual field defects, scotoma, retinopathy (pigmentary degeneration), optic neuritis, and cataracts are rare if dosage guidelines are not exceeded)

            Respiratory reactions (eg, acute respiratory distress syndrome with dyspnea, cyanosis, and/or interstitial infiltrates)

            Very rare generalized rash

            Urogenital reactions including dysuria, acute renal failure, increased serum creatinine and renal tubular disorders

            Postmarketing Reports

            Renal dysfunction, including renal failure; monitor patients for changes in renal function (eg, increased serum creatinine)

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            Warnings

            Contraindications

            Known hypersensitivity to deferoxamine or any of its components

            Patients with severe renal disease or anuria

            Cautions

            Administration by rapid IV injection may cause flushing of the skin, urticaria, hypotension, and shock; administer IM or by slow SC or IV infusion

            Rare fatal cases of mucormycosis have been reported; if any signs and symptoms occur, discontinue treatment and conduct mycological tests immediately

            Severe chronic iron overload may precipitate reversible cardiac function impairment if high doses of Vitamin C (> 500 mg QD in adults) are given concomitantly; do not administer Vitamin C to HF patients; wait > 1 month after treatment to begin supplemental Vitamin C therapy; administer vitamin C only if the patient is receiving Desferal regularly, ideally soon after setting up the infusion pump; do not exceed a daily vitamin C dose of 200 mg in adults, given in divided doses; monitor cardiac function closely during such combined therapy

            Dialysis patients with aluminum-related encephalopathy may experience neurological dysfunction (seizures), possibly due to an acute increase in circulating aluminum;onset of dialysis dementia may be precipitated; treatment in the presence of aluminum overload may result in decreased serum calcium and aggravation of hyperparathyroidism

            Monitor for changes in renal function

            Not a substitute for standard measures generally used in iron toxicity (eg, induced emesis, gastric lavage)

            Iron overload increases susceptibility of patients to Yersinia enterocolitica and Yersinia pseudotuberculosis infections; treatment may therefpre enhance patient's susceptibility

            Monitor pediatric patients for body weight and growth every 3 months

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Unknown if excreted in breast milk, use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Desferal chelates iron by forming a stable complex that prevents the iron from entering into further chemical reactions; also chelates iron readily from ferritin and hemosiderin but not readily from transferrin; does not combine with the iron from cytochromes and hemoglobin; chelate is readily soluble and is renally excreted

            Pharmacokinetics

            Metabolism: Principally by plasma enzymes; pathways not yet defined

            Excretion: Primarily urine; partly excreted in feces

            Additional Information

            100mg of deferoxamine binds to about 10mg of iron and 4.1mg of aluminum

            End points of treatment are clinical improvement, resolution of anion gap and acidosis, return of urine color to baseline, serum iron level ≤ 100 mcg/dL

            Vin Rose urine, or a change in urine color from baseline, indicates presence of deferoxamine-iron chelate; may not always be present, so cannot be used to rule out significant iron ingestion; patient should be advised to obtain baseline urine for visual comparison and keep at bedside

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            Administration

            Reconstitution

            Preparation for IM administration: 500mg with 2mL SWI/ 2g with 8mL SWI (final concentration after reconstitution for both: 213mg/mL)

            Preparation for IV administration: 500mg with 5mL SWI/ 2g with 20mL SWI (final concentration after reconstitution for both: 95mg/mL)

            Preparation for SC administration: 500mg with 5mL SWI/ 2g with 20mL SWI (final concentration after reconstitution for both: 95mg/mL)

            Use immediately; ≤ 3hours of reconstitution

            When reconstitution is carried under aseptic conditions, may store ≤ 24 hr at 25°C; do not refrigerate; do not reconstitute with other solvents or under different conditions due to risk of precipitation

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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