deferoxamine
Deferoxamine (Desferal) is an injectable medication used to treat iron overload (too much iron in the body). It's used in the hospital to treat sudden iron poisoning. It's also used regularly to lower iron levels in people with certain types of anemia who get frequent blood transfusions. Common side effects include pain and irritation at the injection site.
What is Deferoxamine (Desferal)?
What is Deferoxamine (Desferal) used for?
Too much iron as a result of multiple blood transfusions in people with certain types of anemia
Severe and sudden iron poisoning
How Deferoxamine (Desferal) works
Deferoxamine (Desferal) is a chelating agent that lowers the amount of iron in your body. It does this by attaching to and forming a structure around the iron so that it won't be able react in your body and cause harm. Your body then gets rid of this iron structure by passing it through your urine and feces.
Drug Facts
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What are the side effects of Deferoxamine (Desferal)?
Common Side Effects
- Irritation, pain, itching, or swelling at the site of injection
- Headache
- Nausea
- Joint and muscle pain
- Fever
- Nausea
- Vomiting
- Stomach pain
Other Side Effects
- Diarrhea
- Asthma or trouble breathing
- Rash
- Muscle spasms
- Hearing and vision problems
- Slowed growth and bone changes
Serious Side Effects
- Serious fungal infections: fever, cough, chest pain, trouble breathing, headache, nausea, vomiting, stomach pain, blood in the stool
- Serious allergic or infusion reactions: rash, hives, trouble breathing, flushing, dizziness, feeling confused, feeling cold, fast heart rate, chills
- Serious lung problems: trouble breathing, pain while breathing, fast breathing, fast heart beat, finger tips or lips turning blue
- Serious kidney problems: swelling in your feet or ankles, difficulty making urine, feeling tired, feeling confused, nausea, and difficulty breathing.
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Bluish fingernails, lips, or skin
blurred vision or other problems with vision
convulsions (seizures)
difficulty with breathing or fast breathing
fast heartbeat
hearing problems
redness or flushing of the skin
Less common
difficult urination
leg cramps
stomach and muscle cramps
stomach discomfort
unusual bleeding or bruising
vomiting
Incidence not known
Agitation
coma
confusion
decreased urine output
difficulty with swallowing
dizziness
headache
hostility
irritability
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
lethargy
muscle twitching
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
rapid weight gain
shortness of breath
skin rash
stupor
swelling of the face, ankles, or hands
tightness in the chest
unusual tiredness or weakness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Deferoxamine (Desferal)
Pros
Helps the body get rid of excess iron due to multiple blood transfusions
Can be used as part of a treatment plan for people with iron poisoning or overdose
Can be used in children as young as 3 years old
Can be given outside of a provider's office with portable pump, in some cases
Doesn't affect levels of electrolytes or other important trace metals (i.e. magnesium and zinc)
Cons
Can cause vision or hearing problems
Can cause slowing of growth or bone problems in children
Must be given as an injection
Must be mixed before use
Not safe for people with serious kidney problems to use
Pharmacist tips for Deferoxamine (Desferal)
Deferoxamine (Desferal) can cause your urine to change to a reddish-brown color. Your body gets rid of the extra iron through your urine, which makes it change color. This is normal during treatment and not harmful.
Deferoxamine (Desferal) can cause heart problems when given with high doses of vitamin C (over 500 mg daily in adults). But, low doses of vitamin C can actually help this medication work better. You can take vitamin C with deferoxamine (Desferal) if you take this medication regularly, and after one month of treatment (without vitamin C). Ask your provider when you need to start vitamin C and what your dose should be.
You shouldn't take more than 200 mg per day of vitamin C while taking deferoxamine (Desferal) because doing so can cause heart problems. You shouldn't take vitamin C with this medication at all if you have heart failure. If you're taking deferoxamine (Desferal) with vitamin C, your provider might monitor you regularly for heart problems.
If you're getting deferoxamine (Desferal) treatments at home, it's important to prevent infections because this medication can make you more likely to get sick from certain bacteria or fungi. Wash your hands with soap and water, and dry them with a clean towel before every deferoxamine (Desferal) treatment. Always wipe the injection site you choose with a new alcohol swab, and always use a new syringe and needle for each injection.
If you experience pain at the injection site when you get deferoxamine (Desferal) infusions, please let your provider know. They can give you suggestions on how to ease the pain and discomfort from the needle.
Frequently asked questions about Deferoxamine (Desferal)
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What are the risks and warnings for Deferoxamine (Desferal)?
Deferoxamine (Desferal) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Vision and hearing problems
Risk factors: High doses of deferoxamine (Desferal) over long periods of time | Low levels of iron-storing proteins
Deferoxamine (Desferal) can cause vision problems such as blurred vision, cataracts, blind spots, or vision loss. This medication can also cause ringing in the ears or hearing loss. These side effects are more likely to occur if you're getting a high dose of the medication and if you've been on treatment for a long period of time. Most of the time, vision and hearing problems will go away after stopping treatment with deferoxamine (Desferal). Your provider should test your vision and hearing occasionally during long periods of treatment.
Kidney problems
Deferoxamine (Desferal) can cause damage to the kidneys which can lead to kidney failure. Your provider might check your kidneys regularly during treatment. This medication shouldn't be used in people with severe kidney damage because your kidneys help you get rid of this medication through urine. Symptoms of kidney damage include swelling in your feet or ankles, difficulty making urine, feeling tired, feeling confused, and difficulty breathing.
Slowed growth in children
Risk factors: High doses of deferoxamine (Desferal) | Low levels of iron-storing proteins
Children receiving high doses of deferoxamine (Desferal) might have slowed growth or bone changes, especially if they started this medication before they turned 4 years old. The bone changes can lead to problems with bone fractures. Your child's provider should measure their weight and height every 3 months. Once the medication is stopped, it's possible for growth rates to partially return to how they were before treatment.
Lung problems
*Risk factors: High IV doses of deferoxamine (Desferal) | Short-term iron overload | Certain blood disorders *
Deferoxamine (Desferal) can cause fluid to build up in your lungs. This results in trouble breathing, lowered blood flow that causes your skin turning blue, and damage to your lungs. This can be life-threatening and requires medical treatment right away. Talk to your provider if you have trouble breathing after receiving a treatment of deferoxamine (Desferal).
Infusion reactions
*Risk factors: Rapid IV infusions *
Deferoxamine (Desferal) can cause a serious reaction if an IV infusion is given too quickly. The reaction might include flushing, hives, low blood pressure, and shock. To prevent this reaction, deferoxamine (Desferal) should be injected into the muscle, or given by subcutaneous infusion or slow IV infusion.
Bacterial or fungal infections
Taking deferoxamine (Desferal) might make you more likely to be infected with certain bacteria or fungi that can cause serious illnesses. If you do get sick, you'll need to stop this medication and get treatment for your infection. Let your provider know if you experience symptoms such as cough, fever, congestion, diarrhea, or stomach pain.
Deferoxamine (Desferal) dosage forms
Typical dosing for Deferoxamine (Desferal)
Too much iron as a result of multiple blood transfusions:
The typical dose is 1,000-2,000 mg daily, given as an infusion under the skin over 8-24 hours by a healthcare provider.
Deferoxamine (Desferal) can also be given through an intravenous (IV) infusion or injected into the muscle by a healthcare provider. Your provider will determine the appropriate dose for you, depending on how you're receiving this medication.
For severe and sudden iron poisoning:
The typical starting dose is 1,000 mg injected into the muscle once by a healthcare provider. Your provider might give you additional smaller doses of deferoxamine (Desferal) every 4-12 hours, depending on how your body responds to the medication.
If you are in shock, your provider will give you deferoxamine (Desferal) through an IV infusion.
Interactions between Deferoxamine (Desferal) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Ascorbic Acid
- Busulfan
How much does Deferoxamine (Desferal) cost?
Deferoxamine (Desferal) contraindications
Severe kidney problems
Not able to make urine
What are alternatives to Deferoxamine (Desferal)?
Too much iron as a result of multiple blood transfusions in people with certain types of anemia
Severe and sudden iron poisoning
Transfusion iron overload in people with certain blood diseases (thalassemia, sickle cell disease, or other anemias)
People age 2 years and older who receive regular blood transfusions
People age 10 years and older with a genetic blood condition called non-transfusion-dependent thalassemias (NTDT)
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