Details About Overdose or Poisoning Generic Salt ::  Deferoxamine

Deferoxamine

    

Drug Pharmacology ::

I. Pharmacology. Deferoxamineis a specific chelating agent for iron. It binds free iron and, to someextent, loosely bound iron (eg, from ferritin or hemosiderin). Ironbound to hemoglobin, transferrin, cytochrome enzymes, and all othersites is not affected. The red iron-deferoxamine (ferrioxamine) complexis water soluble and is excreted renally, where it imparts anorange-pink, or “vin rosé,” color to the urine. One hundred milligramsof deferoxamine is capable of binding 8.5 mg of elemental iron and 4.1mg of aluminum in vitro. Deferoxamine and both the aluminoxamine andferrioxamine complexes are dialyzable. The basic science literaturesupports the use of the drug, but clinical evidence of efficacy andsafety is lacking.

Drug Indications ::

Indications

   

Deferoxamineis used to treat iron intoxication (see Iron) when the serum iron isgreater than 450–500 mcg/dL or when clinical signs of significant ironintoxication exist (eg, shock, acidosis, severe gastroenteritis, ornumerous radiopaque tablets visible in the GI tract by x-ray).

Deferoxaminesometimes is used as a “test dose” to determine the presence of freeiron by observing for the characteristic vin rosé color in the urine;however, a change in urine color is not a reliable indicator.

C. Deferoxamine has also been used for treatment of aluminum toxicity in patients with renal failure.

Drug Contra-Indications ::

III. Contraindications. Noabsolute contraindications to deferoxamine use exist in patients withserious iron poisoning. The drug should be used with caution inpatients with known sensitivity to deferoxamine and patients with renalfailure/anuria who are not receiving hemodialysis.

Drug Adverse Effects ::

IV. Adverse effects

   

Hypotensionor an anaphylactoid-type reaction may occur from very rapid intravenousbolus administration; this can be avoided by limiting the rate ofadministration to 15 mg/kg/h.

Localpain, induration, and sterile abscess formation may occur atintramuscular injection sites. Large intramuscular injections may alsocause hypotension.

Theferrioxamine complex may itself cause hypotension and may accumulate inpatients with renal impairment; hemodialysis may be necessary to removethe ferrioxamine complex.

Deferoxamine, as a siderophore, promotes the growth of certain bacteria such as Yersinia enterocolitica and may predispose patients to Yersinia sepsis.

E. Infusions exceeding 24 hours have been associated with pulmonary complications (acute respiratory distress syndrome).

F. Use in pregnancy. FDAcategory C (indeterminate). Although deferoxamine is a teratogen inanimals, it has relatively poor placental transfer, and there is noevidence that short-term treatment is harmful in human pregnancy (seeTable III–1). More important, failure to treat a serious acute ironintoxication may result in maternal and fetal morbidity or death.

Drug Lab Interactions ::

Drug or laboratory interactions. Deferoxaminemay interfere with determinations of serum iron (falsely low) and totaliron-binding capacity (falsely high). It may chelate and removealuminum from the body.

Drug Dose Management ::

Dosage and method of administration

   

Theintravenous route is preferred in all cases. In children or adults,give deferoxamine at an infusion rate generally not to exceed 15mg/kg/h (although rates up to 40–50 mg/kg/h have been given in patientswith massive iron intoxication). This correlates to a binding of 1.3mg/kg/h when administered at 15 mg/kg/h. The maximum cumulative dailydose generally should not exceed 6 g (doses up to 16 g have beentolerated). The endpoints of therapy include loss of vin rosé–coloredurine, a serum iron level less than 350 mcg/dL, and resolution ofclinical signs of intoxication.

Oral complexation is not recommended.

Intramuscular injection is notrecommended. If the patient is symptomatic, use the intravenous route.If the patient is not symptomatic but serious toxicity is expected tooccur, intravenous access is essential (eg, for fluid boluses), andintravenous dosing provides more reliable administration.

Drug Chemical Formulations ::

Formulations

   

Parenteral. Deferoxamine mesylate (Desferal), vials containing 500 mg and 2 g of lyophilized powder.

The suggested minimum stocking level to treat a 70-kg adult for the first 24 hours is 12 (500-mg) vials.

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