Deferoxamine (Injection Route)

Deferoxamine works by combining with the iron in the body, and is sometimes paired with other medicines to treat acute iron poisoning.

Overview

Deferoxamine is a drug that helps remove excess iron from the body. It does this by combining with the iron, so that they can be excreted together via the kidneys. Patients with anemia or thalassemia often have many blood transfusions, which may lead to an abnormally high amount of iron in their bodies. Overly high levels of iron can lead to damage of bodily tissues and organs.

This medication is also used to treat acute iron poisoning, especially in children. It may be prescribed with other medications to improve its effect.

Deferoxamine may negatively affect patients who have a medical history of problems with the heart, lungs and kidneys. Patients with these problems should consult with their doctor before starting treatment with deferoxamine, especially patients with heart problems. This is because vitamin C is sometimes prescribed with deferoxamine to help in removing excess iron, but this combination may lead to serious effects in patients with heart problems.

Long term use of deferoxamine may also affect growth in children. Therefore, doctors should check in regularly with children who are taking deferoxamine, to help ensure that their weight and height are increasing according to normal standards.

Despite the side effects of deferoxamine however, it is important to maintain the correct levels of iron in the body, and the doctor will prescribe it if they feel that the benefits of using deferoxamine outweigh the negative effects of the medicine.

Condition(s) treated

  • Excess iron in body

Type of medicine

  • Iron chelator

Side Effects

When using deferoxamine, patients may encounter side effects, although not all patients who use this medicine will experience them. The following lists some more common side effects patients may get while on treatment:

  • Loss of vision
  • Loss of color vision
  • Cataracts
  • Any other changes to vision
  • Pain in the eye
  • Ringing in ears
  • Any other changes to hearing
  • Fingernails, lips, or skin turning blue
  • Seizures
  • Quickened heartbeat
  • Quick breathing, or trouble with breathing
  • Redness in the skin
  • Difficulty with urination
  • Cramps in legs
  • Cramps in muscles
  • Unusual bleeding or bruising

During treatment, the patient may notice their urine turning reddish in color. This is a temporary and harmless effect that should go away as the patient stops using the medicine.

Getting a serious bacterial or fungal infection is a possible but rare side effect of using deferoxamine. They may become fatal if not promptly treated. The patient should look out for:

  • Nausea
  • Vomiting
  • Diarrhea
  • Fever
  • Tenderness or pain in the stomach and abdominal area

Deferoxamine may also cause a serious lung problem known as acute respiratory distress syndrome, also known as ARDS. Symptoms of this condition include:

  • Severe dizziness
  • Trouble with breathing
  • Labored or quickened breathing

Patients should also be alert to a possible but uncommon allergic reaction to deferoxamine. They should keep an eye out for the following symptoms:

  • Rashes
  • Itching
  • Swelling of the skin
  • Swelling of the face, tongue and throat
  • Severe dizziness
  • Difficulty with breathing

If the patient notices any of the side effects that have been listed, they should contact their doctor or a qualified healthcare professional immediately for medical advice. As the above is not a complete list of side effects that may happen while using deferoxamine, patients should tell their doctor if they notice an unwanted effect that has not been covered by this guide.

Irritation or inflammation of the skin at the injection site may occur. This is a milder side effect that should go away by itself. However if it worsens or persists, the patient should talk to their doctor about it. They should also resolve any questions they have about side effects before beginning treatment.

Dosage

Deferoxamine is usually administered in a hospital or clinic by a trained and qualified healthcare professional, such as a doctor or nurse. However, the patient may also choose to take the medicine at home. In such cases, the patient or their caregiver should be familiar with the procedure and have resolved all questions they have about the medicine and its use, prior to treatment. Deferoxamine is given as an injection.

Every dosage should be given with a new, unused needle, vial and syringe. Before every use, the vial should be checked for specks, discoloration or any other sign of contamination. If the vial has been contaminated, it should be thrown away and a fresh one should be used.

It is recommended by the manufacturer that the drug is injected into a muscle or under the skin. When injected into a vein, there is a higher risk of side effects such as reddening or irritation at the site of injection, severe dizziness, fainting or a fast heartbeat.

Not all the liquid in the vial may be used during an injection. The medicine should not be kept for further use and should be discarded promptly. Only one vial should be used per scheduled dose.

The dosage of deferoxamine will vary depending on the patient’s condition and needs. The following is a list of an average dose, however the patient should follow their doctor’s prescription closely and stick to their own prescribed dose amount and schedule.

For acute iron toxicity:

  • Adults, teenagers and children aged 3 years and above: 1000 miligrams (mg) for the initial injection into a muscle or vein. The dose may be increased by 500mg every four hours for up to two doses. The total dose should not exceed 6000mg in 24 hours.
  • Children under 3 years of age: The use and dose will be determined by a doctor.

For chronic iron toxicity:

  • Adults, teenagers and children aged 3 years and above: The dosage is determined by a doctor based on the patient’s body weight. An average dose ranges from 1000 to 2000mg, or 20 to 40mg per kilogram of the patient’s body weight, injected over a period of 8 to 24 hours.
  • Children under 3 years of age: The use and dose will be determined by a doctor.

The doctor may prescribe vitamin C (ascorbic acid) to be used with deferoxamine, if the patient has been using it for over a month to treat high iron levels. However, the patient should refrain from consuming vitamin C if the doctor has not directed them to do so. It is recommended by the manufacturer that the adult patient should not exceed 200mg of vitamin C per day.

If the patient has missed a dose, they should not double dose. Instead they should seek medical attention right away.

Interactions

Drugs may interact with each other, or other supplements or herbal products. These interactions may lead to a decreased efficiency of the medicine or even an increased risk of unwanted side effects.

Before starting on deferoxamine, patients should note down any drugs, supplements or herbal products they are currently taking and share the list with their doctor. They should also inform their doctor of any allergies they may have, which includes allergies to food, dyes, animal or herbal products, or to any material such as latex, and especially any allergies to any drug.

The following is an incomplete list of drugs that may interact with deferoxamine. Patients should check with their doctor for a full list.

  • Acetaminophen
  • Arginin
  • Aspirin
  • Barium sulfate
  • Cholecalciferol
  • Dexamethasone
  • Dextran
  • Epoetin Alfa
  • Ginkgo
  • Glipizide
  • Glycerin
  • Guanidine
  • Levofloxacin
  • Levothyroxine
  • Omeprazole
  • Prednicarbate topical
  • Prochlorperazine
  • Sodium iodide
  • Tiotropium
  • Valproic acid

Vitamin C may be prescribed to aid deferoxamine in the removal of iron from the body. However, patients with heart problems should not use vitamin C with deferoxamine as it may lead to a serious drug interaction. The patient should discuss the issue with their doctor before proceeding with the medicine.

Deferoxamine may also interfere with certain medical tests. Therefore, patients should let their healthcare givers know if they are on deferoxamine prior to taking any tests such as gallium scintigraphy or MRIs.

Alcohol and tobacco commonly interact with drugs. Patients should check with their doctor about the use of alcohol and tobacco while on deferoxamine.

Certain medical problems may interact with deferoxamine. The patient should let their doctor know their medical history, especially if they have had or are currently experiencing:

  • Aluminum overload
  • Kidney problems
  • Kidney disease
  • Dialysis treatment
  • Anuria (inability to form urine)
  • Seuizures
  • Bacterial or fungal infections
  • Hyperparathyroidism
  • Encephalopathy
  • Rheumatoid arthritis

Warnings

As deferoxamine may contain inactive ingredients, patients should let their doctor know of any allergies they may have in order to prevent an allergic reaction, as well as their medical history.

While taking deferoxamine, the doctor should perform regular tests on patients, especially those with a medical history of conditions such as heart problems, to ensure that no unwanted or dangerous side effects are developing.

Patients with heart problems should refrain from taking vitamin C with deferoxamine.

Patients on deferoxamine may encounter vision or hearing issues, which usually happens after a few weeks of using the medicine, and especially if they have been prescribed a higher dosage. If the patient notices any changes to their vision such as blurring, a loss of colour vision or other changes, or changes to their hearing such as persistent ringing in the ears or loss of hearing, they should notify their doctor as soon as possible. Deferoxamine may also cause dizziness, lightheadedness and drowsiness. In the meantime, the patient should refrain from activities that require them to be alert, such as driving or operating heavy machinery until the problems have been resolved.

Deferoxamine may lead to a higher chance of serious kidney problems. If the patient notices certain symptoms such as seizures, swelling of their face/ankles/hands, decreased urine output, lethargy, twitching muscles or rapid weight gain, they should seek medical attention as soon as possible.

Patients should also be aware of symptoms of a serious lung problem known as ARDS, which is another possible condition caused by the use of deferoxamine. If they experience trouble with breathing, wheezing, pains or tightness in the chest, or fevers, they should contact their doctor right away.

If patients are scheduled for certain medical tests such as MRIs or blood tests, they should tell their healthcare givers that they are currently taking deferoxamine as it may interfere with their test results.

Deferoxamine may cause bone and growth issues in children. The doctor should check in regularly with the child to make sure that they are growing properly. The parent or caretaker of the child may want to discuss the issue thoroughly with the doctor prior to starting treatment. There is also currently insufficient information on the use and effiency of this medication in children under 3 years of age.

While the effectiveness of deferoxamine in elderly patients has not been shown to be less effective than in younger adults, older patients may be more susceptible to vision and hearing problems, as well as age-related heart or kidney problems. Patients may want to discuss a change in dosage or dose schedule with their doctor before starting deferoxamine.

There is currently insufficient information on how deferoxamine affects pregnant or breastfeeding patients.

Deferoxamine should not be used with any other medication unless directed by a doctor. This includes both prescription and over-the-counter medication, as well as any supplements or herbal products.

Storage

Deferoxamine should be stored in a cool and dry place in unmixed vials. It should not be exposed to sunlight or freezing temperatures, and is preferably kept at room temperature. The medicine should be stored in a place that is inaccessible to children or pets. It should also not be stored in a bathroom as it may be too humid.

Medicine that has been mixed should be kept for a maximum of three hours and discarded afterwards.

The patient should dispose of all unwanted or expired medication promptly and properly. If they are unsure of how to handle medical waste, they should consult their doctor or local waste management for best practices.

Summary

Patients with conditions such as anemia or thalassemia may experience a higher than normal level of iron in their body due to several blood transfusions. Deferoxamine is often prescribed in these cases, so that it can combine with the excess iron and be removed together through the kidneys. It is also used to treat acute iron poisoning.

High levels of iron in the body may lead to tissue and organ damage if not removed in time.

However, the use of deferoxamine may lead to certain side effects, especially where patients with existing heart or kidney problems are concerned. In these cases, the patients should discuss their medical history with their doctors, and whether their dosage or dose schedule should be adjusted to accommodate possible interactions.

The parents or caretakers of children who have been prescribed deferoxamine should ensure that their child receives a regular checkup from their doctor as deferoxamine may interfere with the child’s growth if it is used for longer periods. They may wish to discuss a change in dose with their doctor if the child is not growing properly. There is insufficient information as to whether this medication is safe or efficient in children younger than 3 years of age.

Elderly patients may also experience an increased risk of problems with deferoxamine, particularly with vision or hearing problems, as well as heart or kidney problems.

Despite the list of side effects that may occur with deferoxamine, it is considered a safe and effective medication, and is prescribed by a doctor if they feel it will be more beneficial than disadvantageous to the patient.