Deferoxamine


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Aluminum overload Patients w/ end stage renal failure or on haemodialysis or haemofiltration: 5 mg/kg once a wk during the last hr of dialysis or 5 hr before dialysis in severe cases. Patients on peritoneal dialysis: 5 mg/kg once a wk (via slow IV infusion/SC/IM/intraperitoneally) before the final exchange of the day. Diagnosis of aluminum overload 5 mg/kg during the last hr of the dialysis session. Acute iron poisoning Initial: 15 mg/kg/hr, reduce 4-6 hr later. Total dose: ≤80 mg/kg in 24 hr. IV/IM/SC Chronic iron overload Initial: 500 mg via IV/SC infusion. Usual: 20-60 mg/kg/day for 3-7 times/wk depending on extent of overload. Alternatively, initial: 0.5-1 g/day via IM administration, maintenance dose depends on response. IM Acute iron poisoning 2 g as a single dose. Diagnosis of iron storage disease 500 mg as a single dose.
Dosage Details
Intramuscular
Diagnosis of iron storage disease
Adult: 500 mg as a single dose. To estimate the excretion of Fe in urine over the next 6 hr. An excretion of >1 g suggests Fe storage disease and >1.5 g suggests a pathological cause.

Intravenous
Aluminum overload
Adult: Patients with end-stage renal failure, hemodialysis or hemofiltration patients: 5 mg/kg once a wk by slow infusion during the last hr of the dialysis session or 5 hr before the session in more severe cases. For patients on peritoneal dialysis: 5 mg/kg once a wk (via slow IV infusion/SC/IM/intraperitoneally) should be given before the final exchange of the day.

Intravenous
Diagnosis of aluminum overload
Adult: 5 mg/kg given via slow IV during the last hr of the dialysis session. Increase in serum aluminium conc above baseline >150 ng/ml (measured at the start of the next dialysis session) suggests aluminium overload.

Parenteral
Chronic iron overload
Adult: Initially, 500 mg via IV/SC infusion (usually given over 8-12 hr or in some patients, 24 hr). Usual effective dose range: 20-60 mg/kg daily. Admin 3-7 times a wk depending on extent of iron overload. If given via IM inj, initial dose: 0.5-1 g daily as 1 or 2 injections; maintenance dose is determined by response.

Parenteral
Acute iron poisoning
Adult: Initial dose: 15 mg/kg/hr by slow IV infusion, reducing after 4-6 hr so that the total dose dose not exceed 80 mg/kg in 24 hr. It can also be given via IM Inj as a single dose of 2 g.
Child: Given via IM injection: 1 g as a single dose.
Renal Impairment
Use with caution.
Reconstitution
Intramuscular:
Add 2 ml of sterile water for Inj to each 500 mg vial or 8 ml of sterile water for Inj to each 2 g vial.
Intravenous:
Add 5 ml of sterile water for Inj to each 500 mg vial or 20 ml of sterile water for Inj to each 2 g vial. This results in a 10% solution. This can then be added to saline, glucose or Ringer's lactate solution to be used as an infusion.
Incompatibility
Incompatible with heparin.
Contraindications
Severe renal disease or anuria.
Special Precautions
Impaired renal function; may color the urine reddish-brown, exacerbate aluminum-related encephalopathy and precipitate seizure (prophylactic with antiepileptic if at risk); susceptible to infection; monitor urinary excretion of iron, ophthalmological, audiological and cardiac function examinations; pregnancy.
Adverse Reactions
Rapid IV injection: Flushing, urticaria, hypotension and shock. SC or IM injection: Local pain. Prolonged SC: Pruritus, erythema and swelling. GI disorders, dysuria, fever, allergic skin rashes, tachycardia, cardiac arrhythmias, convulsions and leg cramps; visual disturbances, cataract formation, hearing loss; may retard growth in very young childn. Pulmonary syndrome with high IV doses.
IM/IV/Parenteral/SC: C
Overdosage
Symptoms: Hypotension, tachycardia, GI disturbances, transient loss of vision, aphasia, agitation, headache, nausea, pallor, CNS depression, coma, bradycardia and acute renal failure. There is no antidote and treatment is symptomatic. Haemodialysis is helpful in drug removal.
Drug Interactions
Increased risk of neurological symptoms when used concurrently with phenothiazines. Ascorbic acid improves Fe excretion but it should not be given during the 1st mth of starting deferoxamine treatment as it may worsen Fe toxicity. May affect imaging results if given together with gallium-67.
Lab Interference
Interferes with test for total iron-binding capacity and colorimetric Fe assays.
Action
Description: Deferoxamine has a high affinity for ferric iron and forms chelates or stable water-soluble complexes with iron and other trivalent metal ions eg, aluminum. It removes free and bound iron from haemosiderin and ferritin, increasing the excretion of iron in urine and bile.
Pharmacokinetics:
Absorption: Poorly absorbed from the GI tract.
Metabolism: Metabolised mainly in the plasma.
Excretion: Chelates with metal ions, which are then excreted in the urine.
Storage
Before reconstitution, store below 25°C (77°F). After reconstitution: May store at room temperature for 7 days; protect from light. Do not refrigerate reconstituted solution.
Disclaimer: This information is independently developed by MIMS based on Deferoxamine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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