Desferal Injection

Introduction

Deferoxamine mesylate is a chelating agent used to treat iron overload conditions. It binds excess iron in the body and facilitates its excretion, making it useful in conditions where iron accumulation is a problem, such as in patients with chronic blood transfusions or certain types of iron overload diseases.

Uses

Deferoxamine mesylate is primarily used for:

Treating chronic iron overload due to repeated blood transfusions, as in patients with thalassemia major and other conditions requiring frequent transfusions.
Managing acute iron poisoning when other chelation therapies are not available or suitable.
Reducing iron accumulation in various chronic conditions that lead to iron overload.

Brand Name	Desferal
Type	Injection
Weight	500 mg/vial
Generic	Deferoxamine Mesylate
Manufacturer	Novartis (Bangladesh) Ltd.
Available in	English বাংলা

Mechanism of Action

Deferoxamine mesylate works by binding free iron in the bloodstream. The iron-deferoxamine complex is then excreted from the body primarily through the urine. This helps to reduce iron levels and prevent the toxic effects of excess iron, which can damage organs and tissues.

How Long Does It Take to Work?

The effects of deferoxamine mesylate can typically be observed within a few hours to days of starting treatment. The rate of improvement in iron levels and related symptoms can vary depending on the severity of iron overload and the patient’s response to the drug.

Absorption

Deferoxamine mesylate is not absorbed when taken orally and must be administered via injection or infusion. It is typically given intramuscularly, subcutaneously, or intravenously to achieve therapeutic levels in the body.

Route of Elimination

The iron-deferoxamine complex is primarily eliminated through the urine. Small amounts may also be excreted through the feces. The efficiency of elimination depends on renal function and the dose administered.

Dosage

Deferoxamine mesylate should only be given parenterally. The dose should not exceed 6.0 grams in a twenty-four hour period. Although Deferoxamine can be given by intramuscular injection, in most cases it exerts a considerably greater effect when administered by continuous infusion either intravenously (especially in cases of acute iron intoxication) or subcutaneously (especially in patients with chronic iron overload).

Rapid intravenous injection of Deferoxamine exceeding 15 mg/kg/h has produced flushing of the skin, urticaria, hypotension and shock

The dosage of deferoxamine mesylate is individualized based on the severity of iron overload and patient response. Typical dosing regimens include:

Chronic Iron Overload: 20-60 mg/kg per day, administered subcutaneously or intravenously, often over several hours.
Acute Iron Poisoning: Dosing may be higher and more frequent, depending on the severity of the poisoning and clinical guidelines.

Dosage adjustments may be needed based on clinical response and side effects.

Administration

Deferoxamine mesylate is administered by injection or infusion. The route and frequency of administration are determined by the healthcare provider, based on the patient’s condition and treatment response.

Side Effects

Common side effects include:

Local reactions at the injection site, such as redness, pain, or swelling.
Gastrointestinal symptoms like nausea or vomiting.
Skin reactions, including rash or itchiness.

Less common but serious side effects can include:

Ototoxicity (hearing loss) with prolonged use or high doses.
Visual disturbances, including changes in vision.

Toxicity

Signs of toxicity may include:

Hearing loss or tinnitus.
Visual disturbances or blurred vision.
Severe allergic reactions, such as anaphylaxis.

In case of suspected toxicity, discontinue use and seek medical attention immediately.

Precautions

Precautions include:

Monitor for signs of ototoxicity and visual changes, especially with long-term use.
Regularly check renal function and iron levels to adjust dosing as needed.
Use with caution in patients with renal impairment or severe cardiovascular conditions.

Interaction

Deferoxamine mesylate may interact with other medications and substances, including:

Certain antibiotics and other chelating agents, which may affect efficacy or increase side effects.
Iron supplements, which may counteract the effects of deferoxamine.

Disease Interaction

Consider interactions with:

Renal disease: Dose adjustments may be required to avoid accumulation and toxicity.
Hearing or vision disorders: Monitor for potential exacerbation of these conditions.

Drug Interaction

Interactions with other drugs can affect the efficacy or safety of deferoxamine mesylate. Careful management is needed when used with other medications that impact iron metabolism or have similar side effects.

Food Interactions

There are no significant food interactions with deferoxamine mesylate. However, avoid taking iron supplements concurrently as they can reduce the effectiveness of the chelating therapy.

Pregnancy Use

Deferoxamine mesylate should be used during pregnancy only if clearly needed and prescribed by a healthcare provider. The potential benefits must outweigh the risks to the fetus, and it should be used under careful medical supervision.

Lactation Use

The safety of deferoxamine mesylate during lactation has not been well-established. Use with caution and consider potential risks versus benefits. Consult with a healthcare provider before use during breastfeeding.

Acute Overdose

In case of acute overdose, symptoms may include severe side effects such as hearing or vision loss, and allergic reactions. Treatment involves discontinuing the medication, supportive care, and monitoring for adverse effects.

Contraindication

Deferoxamine mesylate is contraindicated in patients with:

Severe renal impairment without appropriate dose adjustments.
Known hypersensitivity to deferoxamine or any of its components.

Use Direction

Use deferoxamine mesylate as directed by a healthcare provider. Follow dosing instructions carefully and report any adverse effects or concerns to your healthcare provider.

Storage Conditions

Store deferoxamine mesylate at room temperature, away from light and moisture. Do not freeze. Ensure the solution is clear and free from particulate matter before use.

Volume of Distribution

The volume of distribution for deferoxamine mesylate is relatively high, as it distributes widely in extracellular fluids. The drug binds to iron and is distributed throughout the body where excess iron is present.

Half Life

The half-life of deferoxamine mesylate varies depending on the route of administration and patient condition, typically ranging from 1 to 2 hours. The drug is rapidly cleared from the bloodstream, with its effects mediated by the binding and excretion of iron.

Clearance

Deferoxamine mesylate is primarily cleared through renal excretion. The clearance rate can be affected by kidney function, and dose adjustments may be necessary in patients with impaired renal function.

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