Deferoxamine

Deferoxamine is an iron-chelating injection approved to treat two distinct conditions:

• Acute iron intoxication (iron poisoning): Deferoxamine mesylate for injection and Desferal are each indicated as part of emergency treatment for iron poisoning, used alongside other standard medical measures.
• Transfusional iron overload in chronic anemia: Deferoxamine mesylate for injection and Desferal are each indicated for long-term treatment of iron buildup in people with chronic anemia who receive repeated blood transfusions — such as those with thalassemia or sickle cell disease.
• Not for primary hemochromatosis: None of these products are indicated for primary hemochromatosis, an inherited iron-storage disorder, because phlebotomy (regular blood removal) is the standard treatment for that condition.

Deferoxamine works by chemically binding to free iron in the body — a process called chelation — and locking it into a stable, harmless complex. It targets iron stored in ferritin and hemosiderin (the body's main iron-storage proteins) but does not strip iron from hemoglobin (in red blood cells) or from cytochromes (essential cellular enzymes), so it does not interfere with normal blood function. The iron-deferoxamine complex is water-soluble and is filtered out through the kidneys, turning the urine a characteristic reddish color. It does not significantly increase the loss of electrolytes or other important trace minerals.

Deferoxamine is given only by injection — there is no oral (by mouth) form. The route, dose, and schedule are highly individualized and adjusted throughout treatment based on body weight and the severity of iron overload.

• For acute iron poisoning: Given intramuscularly (into the muscle) for most patients, or intravenously (into a vein) for those in cardiovascular collapse — always in a medical setting.
• For chronic iron overload: Typically given as a subcutaneous infusion (slowly under the skin, often via a small pump) over several hours, on multiple days per week. Intravenous and intramuscular routes are also used in specific circumstances.
• Your care team will determine the right route, timing, and frequency for you. Never adjust your regimen without medical guidance.

The most frequently reported side effects involve the injection site and general body reactions. Common ones include:

• Injection site pain, redness, swelling, itching, or skin irritation
• Nausea, vomiting, abdominal discomfort, or diarrhea
• Reddish or orange-colored urine (expected — this is the iron being removed)
• Fever, headache, or muscle aches
• Dizziness
• Skin rash or hives
• Rapid heartbeat (tachycardia)

More serious reactions — including severe allergic reactions, hearing or vision changes, kidney problems, dangerous infections, and breathing difficulties — require immediate medical attention. Contact your doctor or seek emergency care right away if any of these develop.

• Hypersensitivity (allergic) reactions: Severe reactions including anaphylaxis (a life-threatening whole-body allergic response) have occurred, especially with rapid intravenous infusion. The drug should always be given slowly and by the appropriate route.
• Eye and hearing toxicity: Prolonged use, high doses, or low iron-storage levels can lead to vision problems (blurred vision, loss of color vision, visual field loss, cataracts) and hearing loss or tinnitus. Regular eye and hearing tests are recommended. These effects are often reversible if caught early.
• Kidney toxicity: Acute kidney failure and other kidney problems have occurred. Kidney function should be monitored regularly. The drug is contraindicated in severe kidney disease.
• Respiratory risk: Acute respiratory distress syndrome (a serious breathing emergency) has been reported with excessively high intravenous doses — do not exceed recommended doses.
• Serious infections: Deferoxamine can increase susceptibility to certain infections, including Yersinia (a bacterial gut infection) and mucormycosis (a rare but life-threatening fungal infection). Seek care immediately for unexpected signs of infection.
• Growth suppression in children: High doses combined with low ferritin levels can slow growth in children. Weight and height should be monitored every three months.
• Vitamin C interaction: High-dose vitamin C taken with deferoxamine can cause heart problems, especially in patients with heart failure. Keep vitamin C doses low and never start it during the first month of treatment.
• Pregnancy: Deferoxamine can cause fetal harm. Effective contraception is required during treatment and for one month after the last dose.

Deferoxamine has a few important interactions to be aware of:

• Prochlorperazine (an anti-nausea drug): Taking this at the same time as deferoxamine has caused temporary loss of consciousness — this combination should be avoided.
• High-dose vitamin C supplements: Doses above 500 mg per day in adults taken alongside deferoxamine can cause serious heart problems, particularly in people with heart failure. Vitamin C supplementation should not begin until after the first full month of deferoxamine treatment, and adult doses should stay at or below 200 mg per day.
• Gallium-67 (nuclear imaging agent): Deferoxamine causes rapid urinary excretion of gallium-67, which can distort the results of gallium-67 imaging scans. Deferoxamine should be stopped at least 48 hours before any such scan.

This is not a complete list of interactions. Always talk with your doctor or pharmacist before starting, stopping, or changing any medication.

• Tell your doctor if you have ever had a severe allergic reaction to deferoxamine or any of its components — the drug is contraindicated if you have.
• Tell your doctor if you have severe kidney disease or produce little or no urine — deferoxamine is contraindicated in these situations.
• Pregnancy: Deferoxamine can cause birth defects and fetal harm. Women of childbearing potential must use effective contraception during treatment and for one month after the last dose. Discuss risks and benefits with your doctor if you are pregnant.
• Breastfeeding: Do not breastfeed during treatment or for one week after the last dose due to the potential for serious effects in the infant.
• Children under 3 years: Safety and effectiveness have not been established in this age group; use is generally not recommended unless significant iron removal can be demonstrated.
• Older adults (65+): May be at higher risk for vision problems (including color blindness and macular problems) and hearing loss. Doses are typically started low and monitored carefully.
• Kidney impairment: Use is contraindicated in severe kidney disease; for mild to moderate impairment, lower starting doses are used and kidney function is monitored.
• Liver impairment: Lower starting doses are recommended; follow your doctor's guidance.
• Tell your doctor about all medications, vitamins, and supplements you take, especially vitamin C, before starting deferoxamine.

Too much deferoxamine can cause a drop in blood pressure, rapid heartbeat, nausea, agitation, headache, temporary vision loss, and in severe cases, loss of consciousness, slow heartbeat, acute kidney failure, or serious breathing problems. There is no specific antidote — if an overdose is suspected, the drug is stopped and supportive medical care is provided. Deferoxamine can be removed from the body through dialysis if needed.

Deferoxamine binds to excess iron in the body and converts it into a stable, water-soluble complex that can be safely excreted. It specifically targets iron from ferritin and hemosiderin (iron storage proteins) without interfering with iron in hemoglobin or important cellular enzymes. It does not cause significant loss of electrolytes or other trace minerals. The iron-deferoxamine complex exits the body primarily through the kidneys, which is why urine may turn a reddish color during treatment — this is a normal and expected sign that the drug is working.

After administration, deferoxamine is metabolized primarily by enzymes in the blood plasma, though the exact breakdown pathways are not fully defined. The resulting iron-deferoxamine complex (ferrioxamine) is water-soluble, passes easily through the kidneys, and is excreted in the urine — giving it that characteristic reddish color. A portion is also eliminated through the bile and into the stool.

STORE AT: 20 ºC to 25 °C ( 68 ºF to 77 °F) .