Chemical formula: C₂₅H₄₈N₆O₈ Molecular mass: 560.684 g/mol PubChem compound: 2973
Deferoxamine interacts in the following cases:
Deferoxamine should be used with caution in patients with renal impairment since the metal complexes are excreted via the kidneys. In these patients, dialysis will increase the elimination of chelated iron and aluminium. Isolated cases of acute renal failure have been reported. Monitoring patients for changes in renal function (e.g. increased serum creatinine) should be considered.
Deferoxamine should not be used in combination with prochlorperazine (a phenothiazine derivative) since prolonged unconsciousness may result.
Oral administration of vitamin C (up to a maximum of 200 mg daily, given in divided doses) may serve to enhance excretion of the iron complex in response to deferoxamine; larger doses of vitamin C fail to produce an additional effect. Monitoring of cardiac function is indicated during such combined therapy. Vitamin C should be given only if the patient is receiving deferoxamine regularly and should not be administered within the first month of deferoxamine therapy. In patients with severe chronic iron-storage disease undergoing combined treatment with deferoxamine and high doses of vitamin C (more than 500 mg daily) impairment of cardiac function has been encountered; this proved reversible when the vitamin C was withdrawn. Vitamin C supplements should not, therefore, be given to patients with cardiac failure.
Used alone deferoxamine may exacerbate neurological impairment in patients with aluminium-related encephalopathy. This deterioration (manifest as seizures) is probably related to an acute increase in brain aluminium secondary to elevated circulating levels. Pretreatment with clonazepam has been shown to afford protection against such impairment. Also, treatment of aluminium overload may result in decreased serum calcium and aggravation of hyperparathyroidism.
There is a limited amount of data on the use of deferoxamine in pregnant patients. Studies in animals (rabbits) have shown reproductive toxicity/teratogenicity. The risk to the foetus/mother is unknown.
Deferoxamine should be used during pregnancy only if the expected benefits to the mother outweigh the potential risk to the foetus.
It is not known whether deferoxamine is excreted into the breast milk. Because many drugs are excreted in human milk, and because of the potential for serious adverse drug reactions in breast-fed newborns/infants, a decision should be made whether to abstain from breast-feeding or to abstain from using the medicinal product, taking into account the importance of the medicinal product to the mother.
In women of child-bearing potential, each case the benefits for the mother must be weighed against the risks for the child.
Patients experiencing CNS effects such as dizziness or impaired vision or hearing should be warned against driving or operating machinery.
Adverse reactions (table) are ranked under heading of frequency, the most frequent first, using the following convention: very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to ≤1/100); rare (≥1/10,000 to ≤1/1,000); very rare (≤1/10,000) including isolated reports; not known (cannot be estimated from the available data).
Some signs and symptoms reported as adverse effects may also be manifestations of the underlying disease (iron and/or aluminium overload).
| Infections and infestations | |
| Rare: | mucormycosis infections have been reported |
| Very rare: | gastroenteritis yersinia infections have been reported |
| Blood and lymphatic system disorders | |
| Very rare: | blood disorders including thrombocytopenia |
| Unknown: | leukopenia |
| Immune system disorders | |
| Very rare: | anaphylactic shock, anaphylactic reactions, angioneurotic oedema. |
| Nervous system disorders | |
| Very rare: | neurological disturbances, including dizziness, precipitation or exacerbation of aluminium-related dialysis encephalopathy, neuropathy peripheral, paraesthesia |
| Unknown: | convulsion |
| Eye disorders | |
| Rare: | loss of vision, scotoma, retinal degeneration, optic neuritis, cataracts (visual acuity decreased), blurred vision, night blindness, visual field defects, chromatopsia (impairment of colour vision), corneal opacities. Eye disorders are rare, except if high doses are given. |
| Ear and labyrinth disorders | |
| Uncommon: | deafness neurosensory, tinnitus. Keeping within dose guidelines helps minimise risk of hearing side effects |
| Vascular disorders | |
| Rare: | hypotension, tachycardia and shock if precautions for administration are not adhered to |
| Respiratory, thoracic and mediastinal disorders | |
| Very rare: | acute respiratory distress lung infiltration |
| Gastrointestinal disorders | |
| Very rare: | diarrhoea |
| Skin and subcutaneous tissue disorders | |
| Very rare: | rash generalised |
| Musculoskeletal and connective tissue disorders | |
| Common: | growth retardation and bone disorder (e.g. metaphyseal dysplasia) are common in chelated patients given doses of 60 mg/kg, especially those who begin iron chelation in the first three years of life. If doses are kept to 40 mg/kg or below, the risk is considerably reduced. |
| Unknown: | muscle spasms |
| Renal and urinary disorders | |
| Unknown: | acute renal failure, renal tubular disorder, blood creatinine increased |
At the injection site pain, swelling, infiltration, erythema, pruritus and eschar/crust are very common; vesicles, local oedema and burning are uncommon reactions. The local manifestations may be accompanied by systemic reactions like arthralgia/myalgia (very common), headache (common), urticaria (common), nausea (common), pyrexia (common), vomiting (uncommon), or abdominal pain (uncommon) or asthma (uncommon).
Excretion of the iron complex may cause reddish-brown discoloration of the urine.
Convulsion has been mainly reported in dialysed patients with aluminium overload.
Deferoxamine chelation therapy aluminum overload may result in hypocalcemia and aggravation of hyperparathyroidism.
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