Deferoxamine Mesylate: Brands, Price & Uses in Bangladesh

Deferoxamine Mesylate is an iron-chelating agent used to remove excess iron from the body. Indications are classified below by strength of evidence.

Established / FDA-approved uses

• Acute iron intoxication: Deferoxamine Mesylate is indicated as an adjunct to standard supportive treatment (e.g. gastric decontamination where appropriate) in acute iron poisoning/overdose, particularly when serum iron levels are markedly elevated or the patient is symptomatic.
• Chronic iron overload: Deferoxamine Mesylate is indicated for chronic iron overload due to transfusion-dependent anemias (for example, thalassemia major and other conditions requiring repeated blood transfusions) in patients where iron accumulates from ongoing transfusion therapy.

Important limitation

Deferoxamine Mesylate is not indicated for the treatment of primary hemochromatosis (a hereditary iron-overload disorder), for which therapeutic phlebotomy is generally the treatment of choice; it is reserved for situations where phlebotomy is not feasible or appropriate, under specialist direction.

Deferoxamine Mesylate therapy for chronic iron overload should be initiated and monitored by a physician experienced in the management of iron-overload disorders (e.g. hematologist).

Acute iron intoxication (adults and children)

Chronic iron overload (e.g. transfusional iron overload in thalassemia)

Administration

Deferoxamine Mesylate powder for injection must be reconstituted with an appropriate sterile diluent (see Reconstitution) immediately before use, and any unused reconstituted solution should be discarded. Intravenous infusions must be given slowly at the controlled rate specified above (never as a rapid IV push, except under specialist-directed emergency overdose protocols), as rapid administration can cause hypotension, flushing, and shock-like reactions. Subcutaneous infusion via a small portable pump is the standard method for long-term chronic overload therapy. All doses and duration must be individualized and supervised by a physician experienced in iron-chelation therapy.

Renal impairment

Deferoxamine Mesylate is contraindicated in severe renal disease or anuria because the iron-chelate complex is cleared renally (see Contraindications); in milder renal impairment, use with caution and closer monitoring.

Hepatic impairment

No formal validated dose-adjustment guidelines exist for hepatic impairment; use with caution and clinical monitoring.

The most common and clinically significant adverse effects of Deferoxamine Mesylate include:

• Injection-site reactions: pain, swelling, induration, or itching at subcutaneous/intramuscular injection sites; common with prolonged subcutaneous infusion.
• Infusion-related reactions with rapid IV administration: flushing, urticaria (hives), hypotension, and, rarely, shock-like reactions (see Precautions).
• Gastrointestinal: nausea, vomiting, diarrhea, and abdominal pain/discomfort.
• Ocular: visual disturbances including blurred vision, reduced visual acuity, night blindness, cataracts, and retinal changes, generally with prolonged or high-dose use (see Precautions).
• Auditory: tinnitus and high-frequency sensorineural hearing loss, generally with prolonged or high-dose use (see Precautions).
• Musculoskeletal (children): growth retardation with long-term high-dose therapy relative to iron burden (see Precautions and Pediatric Uses).
• Respiratory: rare acute respiratory distress syndrome (ARDS)-like pulmonary reactions, particularly with high-dose intravenous use (see Precautions).
• Hematologic/other rare effects: leg cramps, dizziness, tachycardia, fever, and rare blood dyscrasias.
• Serious hypersensitivity: anaphylaxis has been reported rarely.