Deferoxamine

Mechanism :

It has a strong affinity towards to ferric form of iron (trivalent) and binds to it, thus, forming ferrioxamine which is a stable complex that can be easily excreted by the kidneys hence preventing accumulation of iron in the body. Ferric ions bind the 3 hydroxamic group of dreferoxamine creating ferrioxamine that is readily excreated by the kidneys. To prevent accumulation of iron in body.

Indication :

Acute and chronic iron toxicity
Toxicity due to transfusional iron overload

Contraindications :

Hypersensitivity to drug or its components

Anuria

Creatinine clearance less than 10

Maintain caution in children, geriatrc population, low ferritin level, creatinine clearance <50, aluminium overload

Dosing :

Available as powder for reconstitution for injection: 500 mg/vial, 2 g/vial.

In acute Iron Poisoning:

<3 years:

Safety, efficacy has not been established yet.

≥3 years:

1 g to be administered initially via intramuscular route. Next, 500mg to be given every 4 hours for 2 doses for patients not in shock Based on clinical response, next doses of 500mg Q4-12hr may be administered. Take care that the maximum dose is 6 grams in 24 hours.

Reserve intravenous administration only for patients in cardiovascular collapse or shock: 1gram slow intravenous infusion One must not exceed 15mg/kg/hour for the initial dose;,next doses must not be infused > 125mg/hour Regimen: 20 mg/kg intramuscular route (in patients not in shock) or intravenous (in patients in cardiovascular collapse or shock), next, 10 mg/kg IM or IV every 4 hours x2, based on response, can give more doses of 10 mg/kg IM or IV every 4-12 hours. Do not give more than 6 grams per day (IM or IV). In severe cases, may continue infusion till 24 hrs

In chronic Iron Overload:

<3 years:

Safety, efficacy has not been established yet.

≥3 years:

500 mg-1 gram via intramuscular route QD (maximum of 1gram QD).

Subcutaneous route: 1-2 gram (20-40 mg/kg/day) via subcutaneous route q8-24 using a small portable pump that can give continuous mini-infusion; must individualize the time duration of infusion Intravenous administration in patients with IV cannula: 40-50 mg/kg/day q8-12 for 5-7 days a week (maximum of less than 60 mg/kg/day and intravenous infusion rate of less than 15 mg/kg/hour) Deferoxamine may be given before or after blood transfusion in poorly compliant patients and must not be given concurrently as this can cause errors in interpreting adverse drug events.

Adverse Effect :

At injection site: irritation, thickening, infiltration, pain, redness, wheal formation, eschar, burning, edema, itching, crusting, vesicles with systemic allergic features

Systemic features: Abdominal pain, joint pain, asthma, pyrexia, headache, mucle pain, emesis, nausea

CVS features: Low blood pressure due to rapid intravenous infusion,elevated heart rate, shock

Hypersensitivity reactions: anaphylaxis, shock, angioedema, generalized rash, urticaria

GIT features: abdominal discomfort, loose stools, nausea, emesis

Liver-related: elevated transaminases, liver disease

Hematological features: blood dyscrasias like low platelet count, low WBC count

Musculoskeletal features: muscle spasms, retarded growth, osteogenic changes like metaphyseal dysplasia especially if doses = 60 mg/kg, especially in patients who start on iron chelation in the first 3 years of life. However, there is less risk if doses are = 40 mg/kg

CNS features: dizziness, peripheral sensory, motor, or mixed neuropathy, paraesthesias, epilepsy, exacerbation/precipitation of aluminum-related dialysis encephalopathy

Special Senses: high-frequency sensori-neural hearing loss, tinnitus are rare when dosing is within set limits and if dose is decreased when ferritin levels decrease, vision defects like impaired acuity, blurring, loss of vision, dyschromatopsia, night blindness, field defects, scotoma, retinopathy, optic neuritis, cataracts are rare when dosing is within set limits

RS features: acute respiratory distress syndrome (ARDS) features like breathlessness, cyanosis with/without interstitial infiltrates

Uro-genital features: pain during micturition, acute renal failure, elevated serum creatinine and renal tubular disorders

Interaction :

Ascorbic acid, calcium ascorbate, niacinamide ascorbate, prochlorperazine, sodium ascorbate, technetium oxidronate, zinc ascorbate are some drugs that can interact with this drug.

Lactation :

There is no available human data to determine effects on the infant during breast feeding. However, caution must be maintained in lactating women. Consider monitoring the ferritin and iron levels in breastfed infants.

Pregnanacy :

The drug may be used in pregnant females as there is no expected risk of hazards to the growing fetus based on limited available data in humans

Pregnancy Category: C