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Deferoxamine information from DrugsUpdate  

See Available Brands of Deferoxamine in India

P - Caution when used during pregnancy
LI - Lab *

Deferoxamine (also known as desferrioxamine B, desferoxamine B, DFO-B, DFOA, DFB or desferal) is a bacterial siderophore produced by the actinobacter Streptomyces pilosus. It has medical applications as a chelating agent used to remove excess iron from the body. The mesylate salt of DFO-B is commercially available.

Pharmacodynamics

Pharmacokinetics

Deferoxamine has a high affinity for ferric iron and forms chelates or stable water-soluble complexes with iron and other trivalent metal ions eg, aluminum. It removes free and bound iron from haemosiderin and ferritin, increasing the excretion of iron in urine and bile.


Absorption Poorly absorbed from the GI tract.


Metabolism Metabolised mainly in the plasma.


Excretion Chelates with metal ions, which are then excreted in the urine.

Deferoxamine Indications / Deferoxamine Uses

Information Not Available

Deferoxamine Adverse Reactions / Deferoxamine Side Effects

Rapid IV injection: Flushing, urticaria, hypotension and shock. SC or IM injection: Local pain. Prolonged SC: Pruritus, erythema and swelling. GI disorders, dysuria, fever, allergic skin rashes, tachycardia, cardiac arrhythmias, convulsions and leg cramps; visual disturbances, cataract formation, hearing loss; may retard growth in very young childn. Pulmonary syndrome with high IV doses.

Precautions

Flushing of the skin, urticaria, hypotension, and shock have occurred in a few patients when Deferoxamine mesylate was administered by rapid intravenous injection. Iron overload increases susceptibility of patients to Yersinia enterocolitica and Yersinia pseudotuberculosis infections.In some rare cases, treatment with Deferoxamine mesylate has enhanced this susceptibility, resulting in generalized infections by providing this bacteria with a siderophore otherwise missing.In such cases, Deferoxamine mesylate treatment should be discontinued until the infection is resolved. In patients receiving Deferoxamine mesylate, rare cases of mucormycosis, some with a fatal outcome, have been reported. If any of the suspected signs or symptoms occur, Deferoxamine mesylate should be discontinued, mycological tests carried out and appropriate treatment instituted immediately. In patients with severe chronic iron overload, impairment of cardiac function has been reported following concomitant treatment with Deferoxamine mesylate and high doses of vitamin C (more than 500 mg daily in adults).The cardiac dysfunction was reversible when vitamin C was discontinued.? The following precautions should be taken when vitamin C and Deferoxamine mesylate are to be used concomitantly: ?Vitamin C supplements should not be given to patients with cardiac failure. ?Start supplemental vitamin C only after an initial month of regular treatment with Deferoxamine mesylate. ?Give vitamin C only if the patient is receiving Deferoxamine mesylate regularly, ideally soon after setting up the infusion pump. ?Do not exceed a daily vitamin C dose of 200 mg in adults, given in divided doses. ? Clinical monitoring of cardiac function is advisable during such combined therapy. In patients with aluminum-related encephalopathy, high doses of Deferoxamine mesylate may exacerbate neurological dysfunction (seizures), probably owing to an acute increase in circulating aluminum.Deferoxamine mesylate may precipitate the onset of dialysis dementia.Treatment with Deferoxamine mesylate in the presence of aluminum overload may result in decreased serum calcium and aggravation of hyperparathyroidism. Overdosage Symptoms: Hypotension, tachycardia, GI disturbances, transient loss of vision, aphasia, agitation, headache, nausea, pallor, CNS depression, coma, bradycardia and acute renal failure. There is no antidote and treatment is symptomatic. Haemodialysis is helpful in drug removal.

Special Precautions

Impaired renal function; may color the urine reddish-brown, exacerbate aluminum-related encephalopathy and precipitate seizure (prophylactic with antiepileptic if at risk); susceptible to infection; monitor urinary excretion of iron, ophthalmological, audiological and cardiac function examinations; pregnancy.

Other Drug Interactions

Increased risk of neurological symptoms when used concurrently with phenothiazines. Ascorbic acid improves Fe excretion but it should not be given during the 1st mth of starting deferoxamine treatment as it may worsen Fe toxicity. May affect imaging results if given together with gallium-67.

Other Interactions

Information Not Available

Dosage

Intravenous Aluminum overload Adult: Patients with end-stage renal failure, hemodialysis or hemofiltration patients: 5 mg/kg once a wk by slow infusion during the last hr of the dialysis session or 5 hr before the session in more severe cases. For patients on peritoneal dialysis: 5 mg/kg once a wk (via slow IV infusion/SC/IM/intraperitoneally) should be given before the final exchange of the day. Renal impairment: Use with caution. Intravenous Diagnosis of aluminum overload Adult: 5 mg/kg given via slow IV during the last hr of the dialysis session. Increase in serum aluminium conc above baseline >150 ng/ml (measured at the start of the next dialysis session) suggests aluminium overload. Renal impairment: Use with caution. Intramuscular Diagnosis of iron storage disease Adult: 500 mg as a single dose. To estimate the excretion of Fe in urine over the next 6 hr. An excretion of >1 g suggests Fe storage disease and >1.5 g suggests a pathological cause. Renal impairment: Use with caution. Parenteral Acute iron poisoning Adult: Initial dose: 15 mg/kg/hr by slow IV infusion, reducing after 4-6 hr so that the total dose dose not exceed 80 mg/kg in 24 hr. It can also be given via IM Inj as a single dose of 2 g. Child: Given via IM injection: 1 g as a single dose. Renal impairment: Use with caution. Parenteral Chronic iron overload Adult: Initially, 500 mg via IV/SC infusion (usually given over 8-12 hr or in some patients, 24 hr). Usual effective dose range: 20-60 mg/kg daily. Admin 3-7 times a wk depending on extent of iron overload. If given via IM inj, initial dose: 0.5-1 g daily as 1 or 2 injections; maintenance dose is determined by response. Renal impairment: Use with caution. Reconstitution IV: Add 5 ml of sterile water for Inj to each 500 mg vial or 20 ml of sterile water for Inj to each 2 g vial. This results in a 10% solution. This can then be added to saline, glucose or Ringer's lactate solution to be used as an infusion. IM: Add 2 ml of sterile water for Inj to each 500 mg vial or 8 ml of sterile water for Inj to each 2 g vial. Incompatibility Incompatible with heparin.

Food(before/after)

Information Not Available

List of Contraindications

Deferoxamine and Pregnancy

Caution when used during pregnancy Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Deferoxamine and Lactation

Information Not Available

Deferoxamine and Children

Information Not Available

Deferoxamine and Geriatic

Information Not Available

Deferoxamine and Other Contraindications

Severe renal disease or anuria

Storage

Intramuscular Before reconstitution, store below 25 ℃ (77°) F). After reconstitution: May store at room temperature for 7 days; protect from light. Do not refrigerate reconstituted solution. Intravenous: Before reconstitution, store below 25 ℃ (77°) F). After reconstitution: May store at room temperature for 7 days; protect from light. Do not refrigerate reconstituted solution. Parenteral: Before reconstitution, store below 25C (77°F). After reconstitution: May store at room temperature for 7 days; protect from light. Do not refrigerate reconstituted solution. Intravenous: Before reconstitution, store below 25°C (77°F). After reconstitution: May store at room temperature for 7 days; protect from light. Do not refrigerate reconstituted solution.

Lab interference

Intramuscular Before reconstitution, store below 25 ℃ (77°) F). After reconstitution: May store at room temperature for 7 days; protect from light. Do not refrigerate reconstituted solution. Intravenous: Before reconstitution, store below 25 ℃ (77°) F). After reconstitution: May store at room temperature for 7 days; protect from light. Do not refrigerate reconstituted solution. Parenteral: Before reconstitution, store below 25C (77°F). After reconstitution: May store at room temperature for 7 days; protect from light. Do not refrigerate reconstituted solution. Intravenous: Before reconstitution, store below 25°C (77°F). After reconstitution: May store at room temperature for 7 days; protect from light. Do not refrigerate reconstituted solution.

Deferoxamine brands in India:

Desferal Oflonom-Dex Oflostar-D

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