Deferoxamine
DESFERAL
What it isParenteral iron chelator; acute iron poisoning and transfusional overload.
Why this oneIt is the chelator for ACUTE iron poisoning, where oral agents are useless.
What limits itProlonged infusion is required, which is why oral agents replaced it for chronic overload. Hypotension if infused fast; ocular and auditory toxicity.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Acute iron intoxication (IM, not in shock) | Adults & peds | 1,000 mg, then 500 mg q4-12h | per clinical response | 6,000 mg/24h |
| Acute iron intoxication (IV, cardiovascular collapse) | Adults & peds | 1,000 mg at <=15 mg/kg/hr, then 500 mg q4-12h at <=125 mg/hr | per clinical response | 6,000 mg/24h |
| Chronic iron overload (SC infusion) | Adults & peds | 20-60 mg/kg/day | per ferritin | 40 mg/kg/day (peds); 60 mg/kg/day (adults) |
Renal Contraindicated in severe renal disease/anuria. In renal impairment start at low end of dosing range; can cause increased creatinine, acute renal failure, renal tubular disorders.
Hepatic Undefined
Max 6,000 mg/24h in acute iron intoxication.
Instructions
- Individualize dose/route by severity of iron overload; minimum 20 mg/kg/day.
- IM for patients not in shock; IV only for cardiovascular collapse.
- Vitamin C (up to 200 mg) may be given as adjuvant to increase iron available for chelation.
Contraindications
- Severe renal disease or anuria
Cautions
- Hypersensitivity reactions (incl. anaphylaxis)
- Auditory and ocular toxicity
- Renal toxicity (increased creatinine, acute renal failure, tubular disorders)
- Respiratory toxicity (ARDS with high-dose IV)
- Growth suppression (in children)
- Serious infections (Yersinia, mucormycosis)
- Cardiac dysfunction with concomitant high-dose vitamin C
Adverse reactions
- Injection site reactions
- Hypersensitivity reactions
- Infections
- Auditory/ocular disturbances
Pregnancy No human data; animal maternal toxicity and adverse fetal outcomes.
Lactation Breastfeeding not recommended during and for 1 week after last dose.
NO BOXED WARNINGS
Principal riskProlonged infusion; ocular and auditory toxicity
Cost, est. cash$20–$2,000/month
Generic entry2004
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityAgent-specific cardiovascular, neurologic or metabolic toxicity requires monitored use in poisoning or overload.
Mechanism of action: Deferoxamine ballicule
