DEFEROXAMINE MESYLATE
| DEFEROXAMINE MESYLATE (de-fer-ox'a-meen) Desferal Classifications: chelating agent; antidote; Therapeutic: antidote Pregnancy Category: C |
Availability
500 mg vials
Action
Chelating agent isolated from Streptomyces pilosus with specific affinity for ferric ion and low affinity for calcium. Binds ferric ions to form a stable water soluble chelate readily excreted by kidneys.
Therapeutic Effect
Main effect is removal of iron from ferritin, hemosiderin, and transferrin of patient in iron toxicity.
Uses
Adjunct in treatment of acute iron intoxication or iron overload.
Unlabeled Uses
To promote aluminum excretion.
Contraindications
Severe renal disease, anuria, pyelonephritis; primary hemochromatosis; acute infection; pregnancy (category C).
Cautious Use
History of pyelonephritis; infants and children <3 y; elderly, cardiac dysfunction; lactation.
Route & Dosage
| Acute Iron Intoxication Adult: IM/IV 1 g followed by 500 mg at 4 h intervals for 2 doses, subsequent doses of 500 mg q4–12h may be given if necessary (max: 6 g/24 h), infuse at ≤15 mg/kg/h Child: IM/IV 15 mg/kg/h (max: 6 g/24 h) Chronic Iron Overload Adult/Child: IM 500 mg–1 g/d SC 1–2 g/d (20–40 mg/kg/d) infused over 8–24 h (Child, max: 6 g/d or 2 g/dose) |
Administration
Subcutaneous/Intramuscular- Reconstitute by adding 2 mL sterile water for injection to 500 mg vial to yield 250 mg/mL. Dissolve drug completely before it is withdrawn from vial.
- Administer SC dose over 8–24 h using portable minipump devices.
- Use IM route for all patients not in shock; preferred route for acute intoxication.
Intravenous
PREPARE: IV Infusion: ?? Reconstitute by adding 5 mL sterile water for injection to 500 mg vial to yield 100 mg/mL.??After drug is completely dissolved, withdraw prescribed amount from vial and add to NS, D5W, or RL solution. ADMINISTER: IV Infusion: ??Give initial dose at a rate not to exceed 15 mg/kg/h. ??Give subsequent 500 mg doses at a rate of 125 mg/h.??Do not infuse IV rapidly; such infusion is associated with the occurrence of more adverse effects. INCOMPATIBILITIES Solution/admixture: Iron dextran. |
- Store at room temperature 15°–30° C (59°–86° F) for not longer than 1 wk. Protect from light.
Adverse Effects (≥1%)
Body as a Whole: Hypersensitivity (generalized itching, cutaneous wheal formation, rash, fever, anaphylactoid reaction). CV: Hypotension, tachycardia. Special Senses: Decreased hearing; blurred vision, decreased visual acuity and visual fields, color vision abnormalities, night blindness, retinal pigmentary degeneration. GI: Abdominal discomfort, diarrhea. Urogenital: Dysuria, exacerbation of pyelonephritis, orange-rose discoloration of urine. Other: Pain and induration at injection site.Interactions
Drug: Use with ascorbic acid increases cardiac risk, prochlorperazine may cause loss of consciousness.Pharmacokinetics
Distribution: Widely distributed in body tissues. Metabolism: Forms nontoxic complex with iron. Elimination: Primarily in urine; some in feces.Nursing Implications
Assessment & Drug Effects
- Lab tests: Perform baseline kidney function tests prior to drug administration.
- Monitor injection site. If pain and induration occur, move infusion to another site.
- Monitor I&O ratio and pattern. Report any change. Observe stools for blood (iron intoxication frequently causes necrosis of GI tract).
- Note: Periodic ophthalmoscopic (slit lamp) examinations and audiometry are advised for patients on prolonged or high-dose therapy for chronic iron overload.
Patient & Family Education
- Deferoxamine chelate makes urine turn a reddish color.
- Report blurred vision or any other visual abnormality.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug