deferoxamine (Rx)

Brand and Other Names:Desferal
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 500mg/vial
  • 2g/vial

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)  

Sickle Cell Leg Ulcers (Orphan)

Orphan designation for treatment of sickle cell leg ulcers

Orphan spnsor

  • TauTona Group; 604 Fifth Avenue; Redwood City, California 94063

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

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

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                Monitor Closely (16)

                • aluminum hydroxide

                  deferoxamine decreases levels of aluminum hydroxide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron; its affinity for other minerals is unknown.

                • ascorbic acid

                  deferoxamine, ascorbic acid. Other (see comment). Use Caution/Monitor. Comment: Ascorbic acid increases the availability of iron for chelation with deferoxamine. Ascorbic acid should be avoided in pts. with cardiac failure undergoing deferoxamine Tx. Clinical cardiac monitoring recommended for pts. supplemented with ascorbic acid.

                • calcium carbonate

                  deferoxamine decreases levels of calcium carbonate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron; its affinity for other minerals is unknown.

                • carbonyl iron

                  deferoxamine decreases levels of carbonyl iron by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron.

                • ferric maltol

                  deferoxamine decreases levels of ferric maltol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron.

                • ferrous fumarate

                  deferoxamine decreases levels of ferrous fumarate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron.

                • ferrous gluconate

                  deferoxamine decreases levels of ferrous gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron.

                • ferrous sulfate

                  deferoxamine decreases levels of ferrous sulfate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron.

                • iron dextran complex

                  deferoxamine decreases levels of iron dextran complex by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron.

                • iron sucrose

                  deferoxamine decreases levels of iron sucrose by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron.

                • polysaccharide iron

                  deferoxamine decreases levels of polysaccharide iron by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron.

                • prochlorperazine

                  deferoxamine, prochlorperazine. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Synergistic increase in neurological adverse effects.

                • rose hips

                  deferoxamine, rose hips. Other (see comment). Use Caution/Monitor. Comment: Ascorbic acid increases the availability of iron for chelation with deferoxamine. Ascorbic acid should be avoided in pts. with cardiac failure undergoing deferoxamine Tx. Clinical cardiac monitoring recommended for pts. supplemented with ascorbic acid.

                  deferoxamine decreases levels of rose hips by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron.

                • sodium bicarbonate

                  deferoxamine decreases levels of sodium bicarbonate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron; its affinity for other minerals is unknown.

                • sodium citrate/citric acid

                  deferoxamine decreases levels of sodium citrate/citric acid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron; its affinity for other minerals is unknown.

                • tobramycin inhaled

                  tobramycin inhaled and deferoxamine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

                Minor (0)

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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

                  BRAND FORM. UNIT PRICE PILL IMAGE
                  Desferal injection
                  -
                  500 mg vial
                  Desferal injection
                  -
                  2 gram vial
                  deferoxamine injection
                  -
                  2 gram vial
                  deferoxamine injection
                  -
                  500 mg vial
                  deferoxamine injection
                  -
                  2 gram vial
                  deferoxamine injection
                  -
                  500 mg vial
                  deferoxamine injection
                  -
                  2 gram vial
                  deferoxamine injection
                  -
                  500 mg vial
                  deferoxamine injection
                  -
                  500 mg vial
                  deferoxamine injection
                  -
                  2 gram vial

                  Copyright © 2010 First DataBank, Inc.

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                  Patient Handout

                  Patient Education
                  deferoxamine injection

                  DEFEROXAMINE - INJECTION

                  (deff-er-OX-uh-meen)

                  COMMON BRAND NAME(S): Desferal

                  USES: This medication is used along with other treatments (such as causing vomiting with syrup of ipecac, stomach pumping) to treat sudden iron poisoning. It is most effective when given as soon as possible after the iron was eaten. This medication can also be used to help get rid of iron in patients with high iron levels due to many blood transfusions. Deferoxamine is an iron-binding agent that belongs to a class of drugs known as heavy metal antagonists. It works by helping the kidneys and gallbladder get rid of the extra iron.This medication is not recommended for use in children less than 3 years old (see also Precautions section).

                  HOW TO USE: Depending upon your medical condition, this medication is injected directly into a muscle, under the skin, or into a vein as directed by your doctor.Dosage is based on your medical condition and response to treatment.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.If you are using this medication to treat high iron levels, your doctor may direct you to take vitamin C (ascorbic acid) after you have been using this medication for at least 1 month. Taking vitamin C will help replace the loss of vitamin C due to high iron levels and help the medication work to get rid of the iron. If you have heart disease (such as heart failure), tell your doctor before taking vitamin C while using this medication (see also Drug Interactions). The manufacturer recommends that adults using this drug take no more than 200 milligrams of vitamin C a day.Tell your doctor if your condition persists or worsens.

                  SIDE EFFECTS: Pain and swelling at the injection site or blurred vision may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.This medicine may cause your urine to turn reddish. This effect is harmless.When this medication is given into a vein, flushing, severe itching, severe dizziness, fast heartbeat, and fainting can occur. The manufacturer recommends that, when possible, this medication be given either in the muscle or under the skin.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: other vision changes (such as vision loss, loss of color vision, cataracts), eye pain, hearing changes (such as ringing ears, decreased hearing/loss).Rarely, this drug may cause serious (sometimes fatal) bacterial or fungal infections. Get medical help right away if you notice any of the following: unexplained diarrhea/abdominal pain/fever.This drug may rarely cause a serious (rarely fatal) lung condition (acute respiratory distress syndrome or ARDS). Get medical help right away if you notice any of the following: sudden/severe shortness of breath, labored or rapid breathing, severe dizziness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                  PRECAUTIONS: Before using deferoxamine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney problems, rheumatoid arthritis, diabetes, any fungal infection.If you are using this medication for aluminum poisoning, also tell your doctor or pharmacist if you have: seizures, decreased calcium levels in the blood, hyperparathyroidism.This drug may make you dizzy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Children (especially those younger than 3 years of age) may be more sensitive to the side effects of this drug, especially the effects on bone growth.Older adults may be more sensitive to the side effects of this drug, especially vision/hearing problems.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown whether this drug passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this medication is not recommended. Consult your doctor before breast-feeding.

                  DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some of the products that may interact with this drug include: prochlorperazine.If you have a certain heart problem (heart failure), this drug should not be used with vitamin C (ascorbic acid) because very serious interactions may occur. Consult your doctor or pharmacist for more details before starting deferoxamine.This medication may interfere with certain laboratory tests (including gallium scintigraphy), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

                  OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness, fainting, fast heartbeat, loss of vision, sudden paleness in face/lips/palms of hands, coma.

                  NOTES: Do not share this medication with others.In patients receiving this medication long-term, laboratory and/or medical tests (such as eye exams, hearing tests, growth and body weight in children, kidney function tests, cardiac function tests in patients using deferoxamine and vitamin C) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

                  MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

                  STORAGE: Store unmixed vials at room temperature away from light and moisture. Do not store in the bathroom. After mixing, use within time period indicated in product instructions. Discard unused portion. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

                  Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

                  IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                  Formulary

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                  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.
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                  5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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                  NC NOT COVERED – Drugs that are not covered by the plan.
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                  Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.