Desferal

deferoxamine

(de-fer-ox-a-meen) ,

Desferal

(trade name)

Classification

Therapeutic: antidotes
Pharmacologic: heavy metal antagonists
Pregnancy Category: C

Indications

Acute toxic iron ingestion.Secondary iron overload syndromes associated with multiple transfusion therapy.

Action

Chelates unbound iron, forming a water-soluble complex (ferrioxamine) in plasma that is easily excreted by the kidneys.

Therapeutic effects

Removal of excess iron. Also chelates aluminum.

Pharmacokinetics

Absorption: Poorly absorbed after oral administration. Well absorbed after IM administration and subcut administration.
Distribution: Appears to be widely distributed.
Metabolism and Excretion: Metabolized by tissues and plasma enzymes. Unchanged drug and chelated form excreted by the kidneys; 33% of iron removed is eliminated in the feces via biliary excretion.
Half-life: 1 hr.

Time/action profile (effects on hematologic parameters)

ROUTEONSETPEAKDURATION
IVrapidunknownunknown
IMunknownunknownunknown
Subcutunknownunknownunknown

Contraindications/Precautions

Contraindicated in: Severe renal disease;Anuria; Obstetric: Early pregnancy or child-bearing potential (however, may be used safely in pregnant patients with moderate-to-severe acute iron intoxication).
Use Cautiously in: Pediatric: Children <3 yr (safety not established).

Adverse Reactions/Side Effects

Ear, Eye, Nose, Throat

  • blurred vision
  • cataracts
  • ototoxicity

Cardiovascular

  • hypotension
  • tachycardia

Gastrointestinal

  • abdominal pain
  • diarrhea

Genitourinary

  • red urine (most frequent)

Dermatologic

  • erythema
  • flushing
  • urticaria

Local

  • induration at injection site
  • pain at injection site

Musculoskeletal

  • leg cramps

Miscellaneous

  • allergic reactions
  • fever
  • shock after rapid IV administration

Interactions

Drug-Drug interaction

Ascorbic acid may ↑ effectiveness of deferoxamine but may also ↑ cardiac iron toxicity.

Route/Dosage

Acute Iron Ingestion
Intramuscular Intravenous (Adults and Children ≥3 yr) 1 g, then 500 mg q 4 hr for 2 doses. Additional doses of 500 mg q 4–12 hr may be needed (not to exceed 6 g/24 hr).
Chronic Iron Overload
Intramuscular Intravenous (Adults and Children ≥3 yr) 500 mg–1 g daily IM; additional doses of 2 g should be given IV for each unit of blood transfused (not to exceed 1 g/day in absence of transfusions; 6 g/day if patient receives transfusions).
Subcutaneous (Adults and Children ≥3 yr) 1–2 g/day (20–40 mg/kg/day) infused over 8–24 hr.

Availability (generic available)

Powder for injection: 500 mg/vial, 2 g/vial

Nursing implications

Nursing assessment

  • In acute poisoning, assess time, amount, and type of iron preparation ingested.
  • Monitor signs of iron toxicity: early acute (abdominal pain, bloody diarrhea, emesis), late acute (decreased level of consciousness, shock, metabolic acidosis).
  • Monitor vital signs closely, especially during IV administration. Report hypotension, erythema, urticaria, or signs of allergic reaction. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
  • May cause oculotoxicity or ototoxicity. Report decreased visual acuity or hearing loss. Audiovisual exams should be performed every 3 mo in patients with chronic iron overload.
  • Monitor intake and output and urine color. Inform health care professional if patient is anuric. Chelated iron is excreted primarily by the kidneys; urine may turn red.
  • Lab Test Considerations: Monitor serum iron, total iron binding capacity (TIBC), ferritin levels, and urinary iron excretion before and periodically during therapy.
    • Monitor liver function studies to assess damage from iron poisoning.

Potential Nursing Diagnoses

Risk for injurypoisoning (Indications)

Implementation

  • IM route is preferred in acute iron intoxication unless patient is in shock.
    • Reconstitute 500-mg vial with 2 mL and 2-g vial with 8 mL of sterile water for injection for a concentration of 213 mg/mL. Dissolve powder completely before administration. Solution is yellow and is stable for 1 wk after reconstitution if protected from light. Discard unused portion.
    • Used in conjunction with induction of emesis or gastric aspiration and lavage with sodium bicarbonate, and supportive measures for shock and metabolic acidosis in acute poisoning.
  • Intramuscular: Administer deep IM and massage well. Rotate sites. IM administration may cause transient severe pain.
  • Subcutaneous: Reconstitute 500-mg vial with 5 mL and 2-g vial with 20 mL of sterile water for injection. Concentration: 95 mg/mL. Subcut route used to treat chronically elevated iron therapy is administered into abdominal subcut tissue via infusion pump for 8–24 hr per treatment.
  • Intravenous: Reconstitute 500-mg vial with 5 mL and 2-g vial with 20 mL of sterile water for injection. Concentration: 95 mg/mL. Diluent: D5W, 0.9% NaCl, 0.45% NaCl, or LR. Dissolve powder completely before administration. Solution is clear and colorless to slightly yellow. Administer within 3 hr of reconstitution; 24 hr if prepared under laminar flow hood. Discard unused portion.
  • Rate: Maximum infusion rate is 15 mg/kg/hr for first 1000 mg. May be followed by 500 mg infused over 4 hr at a slower rate not to exceed 125 mg/hr. Rapid infusion rate may cause hypotension, erythema, urticaria, wheezing, convulsions, tachycardia, or shock.
    • May be administered at the same time as blood transfusion in persons with chronically elevated serum iron levels. Use separate site for administration.

Patient/Family Teaching

  • Reinforce need to keep iron preparations, all medications, and hazardous substances out of the reach of children.
  • Reassure patient that red coloration of urine is expected and reflects excretion of excess iron.
  • May cause dizziness or impairment of vision or hearing. Caution patient to avoid driving or other activities requiring alertness until response from medication is known.
  • Advise patient not to take vitamin C preparations without consulting health care professional, because tissue toxicity may increase.
  • Encourage patients requiring chronic therapy to keep follow-up appointments for lab tests. Eye and hearing exams may be monitored every 3 mo.

Evaluation/Desired Outcomes

  • Return of serum iron concentrations to a normal level (50–150 mcg/100 mL).

Desferal

A brand name for DESFERRIOXAMINE.
References in periodicals archive ?
There are currently two chelation drugs approved by the FDA: Exjade and Desferal. Exjade is an oral drug that binds the iron and removes it through the stool.
His family spends at least P46,800 for the procedure, including blood transfusion (P10,800 for three bags of blood) and the intake of three types of medication (desferal, deferiprone and exjade).
However, there was no association seen at the level of regular transfusion and desferal uptake (p>0.05) nor for the additional SCD complications.
Rasheed, ICP Spectrometric-Vis Separation of Cerium (IV)- Desferal Complex Using 4-Vinylbenzyl-Dimethylammonio Pentanesulfonate Zwitterionic Stationary Phase, J.
Deferoxamine Mesylate (DFO) was provided as desferal vials obtained from Novartis pharma, Egypt.
This disease is a major problem, not only for patients and their families, but also for public health system in any country, considering the care and treatment costs, including regular infusions of Deferoxamine Mesylate (desferal), recurrent hospitalization, and other medical procedures [7,8].
Pinedo, "Evaluation of desferal as a bifunctional chelating agent for labeling antibodies with Zr-89," International Journal of Radiation Applications and Instrumentation, vol.
Vladimirov, "Simultaneous determination of Fe(III) and Fe(II) in water solutions and tissue homogenates using desferal and 1,10-phenanthroline," Free Radical Biology & Medicine, vol.
Tenders are invited for Supply Of Injection Human Eryhtropoeitin 6000IU-12, Inj Desferal 500mg-150, inj Albumin bound paclitaxel 100mg 10, Inj Hucog 5000iu (Chorionic Gonadotropin 24 , Tab Prasugrel 10mg 360, Tab Silocap D (Dutasteride 0.5mg+Silodosin 8mg.
Desferal inhibits breast tumor growth and does not interfere with the tumoricidal activity of doxorubicin.
Excellent chelator and is far superior to existing commercial chelators, such as, EDTA, EDDS, Desferal etc and has no pro-oxidant property.
Dubai: The Dubai Branch of the Red Crescent Society of the UAE, donated Dh89,000 to the Dubai Thalassaemia Centre for the purchase of corono or desferal pump machines used to pump out excessive iron that builds up in those requiring regular blood transfusions.