Monotherapy Fe chelation treatment for chronic Fe overload eg, transfusional hemosiderosis, as seen in thalassemia major, sideroblastic anemia, auto-immune hemolytic anemia & other chronic anemias. Idiopathic (primary) hemochromatosis in patients in whom concomitant disorders (eg, severe anemia, cardiac disease, hypoproteinemia) preclude phlebotomy. Fe overload associated w/ porphyria cutanea tarda in patients unable to tolerate phlebotomy. Treatment for acute Fe poisoning. Treatment for chronic Al overload in patients w/ end-stage renal failure (under maintenance dialysis) w/ Al-related bone disease, dialysis encephalopathy or Al-related anemia. Diagnosis of Fe or Al overload.
Chronic Fe overload 20-60 mg/kg daily. Patients w/serum ferritin level <2,000 ng/mL 25 mg/kg/day;serum ferritin level 2,000-3,000 ng/mL 35 mg/kg/day; higher serum ferritin up to 55 mg/kg/day. Acute Fe poisoning Up to 80 mg/kg/day. Chronic Al overload 5 mg/kg once wkly. Test for Fe overload 500 mg IM. Infusion test for Al overload 5 mg/kg as slow IV infusion.
Rapid IV infusion may lead to hypotension & shock (eg, flushing, tachycardia, circulatory collapse & urticaria). Disturbances of vision & hearing. Monitor for changes in renal function. Growth retardation (especially in patients <3 yr). Monitor body wt & longitudinal growth every 3 mth in ped patients. Acute resp distress syndrome, following high IV doses. Increased susceptibility to infections eg, w/ Yersinia enterocolitica & Yersinia pseudotuberculosis. Rare cases of mucormycosis. Cardiac impairment w/ high doses of vit C. In patients w/ Al-related encephalopathy, high doses may exacerbate neurological dysfunction. Treatment of Al overload may result in hypocalcemia & aggravation of hyperparathyroidism. Renal impairment. May affect ability to drive or operate machinery. Pregnancy & lactation.
Risk of temporary impairment of consciousness w/ prochlorperazine. Increased risk of impairment of cardiac function w/ high dose vit C. Gallium-67 imaging results may be distorted.
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