10 tabs
Injectable
500mg, 2000mg
Deferoxamine
Powder for solution for injection 500 mg and 2 g
This medicine has been prescribed for your current condition, so do not use it in similar cases or recommend its use to others.
Before using this medicine, consult your doctor in the following cases:
If you have any type of allergy to deferoxamine or other allergens.
If you have a history of any visual, hearing or dizziness disorders.
If you have severe renal failure, anuria, primary hemochromatosis.
Concurrent use of this medicine with other drugs, especially phenothiazine derivatives such as prochlorperazine, and also if you take vitamin C.
Before performing laboratory tests.
Pregnancy: This drug is classified as a pregnancy drug in category C and its use during pregnancy is only permitted if necessary under the advice of a doctor.
Lactation: Although there is no information available to show that this drug is excreted in breast milk, it is recommended that this drug be used with caution in breastfeeding women.
If you are using other medications while taking this drug, inform your doctor.
Take the drug as directed by your doctor and at regular intervals, and avoid taking too much of the drug.
This drug may cause the urine to turn orange or red.
The intravenous route of administration of this drug is only used in patients with cardiovascular collapse, and the drug should be administered intramuscularly at the first opportunity.
High doses of deferoxamine in people with low ferritin levels can cause growth retardation in children and adolescents. Therefore, children taking deferoxamine should be monitored for growth every three months.
Rapid intravenous injection of this drug has been reported to cause hypotension and shock, so this drug should be administered intramuscularly, slowly subcutaneously, and slowly intravenously.
Taking vitamin C with deferoxamine can damage heart function, so avoid taking deferoxamine with vitamin C or products containing vitamin C in adults.
Taking this drug in people with aluminum poisoning can cause hypocalcemia and exacerbate hyperparathyroidism. It also increases the likelihood of neurological symptoms in patients with aluminum encephalopathy and prepares the ground for dementia in these patients.
Hearing and vision problems have been reported with long-term use of this drug at high doses, especially in people with low blood ferritin and the elderly. Therefore, vision and hearing examinations should be performed periodically during treatment.
Cases of respiratory distress syndrome have been reported in adults and children with acute iron toxicity and thalassemia who are taking high doses of this drug.
This drug is contraindicated in severe kidney disease, anuria, and hemochromatosis.
The efficacy and safety of this drug in children under 3 years of age have not been proven.
The dosage of the drug varies from person to person and is determined by the doctor, but the usual dosage of this drug is as follows:
Adults and children 3 years and older:
Intramuscular injection: Initially, an initial dose of 1000 mg should be used, then if necessary, two doses of 500 mg every 4 hours, and then, if necessary, subsequent doses of 500 mg every 4 to 12 hours, depending on the patient’s response to treatment. The maximum dose is 6000 mg in 24 hours.
Intravenous injection: An initial dose of 1000 mg is administered at a maximum rate of 15 mg per kilogram of body weight per hour. Then, if necessary, two doses of 500 mg every 4 hours, and then, if necessary, subsequent doses of 500 mg every 4 to 12 hours, depending on the patient’s response to treatment. The doses used after the initial dose should be used at a maximum rate of 125 mg per hour. The maximum dose is 6000 mg in 24 hours.
Subcutaneous injection: 1000 to 2000 mg per day or 40 to 20 mg per kg per day by infusion pump over 8 to 24 hours.
In children, the dose is 20 to 40 mg per kg per day every 8 to 12 hours, for 5 to 7 days per week. The average dose in children should not exceed 40 mg per kg per day.
In adults, the dose is 40 to 50 mg per kg per day every 8 to 12 hours, for 5 to 7 days per week. The average dose in adults should not exceed 60 mg per kg per day. The intravenous infusion should not be given at a rate greater than 15 mg per kg per hour.
Intramuscular injection: A daily dose of 1000 to 500 mg may be given intramuscularly. The maximum daily dose should not exceed 1000 mg.
For intramuscular injection, dissolve the contents of the 500 mg and 2 g vials in 2 ml and 8 ml of sterile water for injection, respectively, and inject.
For subcutaneous and intravenous infusion, dissolve the contents of the 500 mg and 2 g vials in 5 ml and 20 ml of sterile water for injection, respectively, to obtain a solution with a concentration of 95 mg/ml.
For slow intravenous infusion, the above-prepared solution can be diluted with one of the injectable solutions of 0.9% sodium chloride or 5% dextrose.
Subcutaneous injection of concentrations higher than the recommended concentration (95 mg/ml) increases the likelihood of local reactions at the injection site.
Intravenous injection of this drug is indicated in cases of acute poisoning, characterized by cardiovascular collapse and systemic symptoms such as coma, shock, metabolic acidosis, or
Deferoxamine is an active chelating agent used as an adjunct in the treatment of iron toxicity. It is also used to accelerate iron excretion following repeated blood transfusions, for example in thalassemia patients. Deferoxamine is used by intravenous, intramuscular, or intraperitoneal injection to control aluminum deposition in bone in patients with renal failure and in the treatment of neurotoxicities or bone abnormalities in patients undergoing dialysis.
Deferoxamine binds to trivalent iron and prevents it from participating in chemical reactions. It can bind to free serum iron, ferritin iron, and hemosiderin, but cannot remove iron from hemoglobin or myoglobin. Deferoxamine can also remove aluminum from various tissues and form a stable, water-soluble complex.
In patients with thalassemia who regularly receive blood transfusions, iron gradually accumulates in the body, which if not excreted, causes hemosiderosis. Therefore, deferoxamine is injected using a special pump. By combining this drug with iron, a substance is obtained that can be excreted by the kidneys.
Deferoxamine chelates iron by binding trivalent iron ions to the 3-hydroxyamine groups of its molecule. This drug also causes aluminum chelation to a lesser extent.
Absorption: It is absorbed orally in very small amounts, but in patients with severe iron poisoning, it may also be absorbed this way. The drug’s intramuscular absorption is also variable.
Distribution: After injection, it is widely distributed in the body.
Metabolism: Small amounts of it are metabolized by plasma enzymes.
Excretion: Excreted in urine, as unchanged drug or as deferoxamine (deferoxamine-iron complex). The half-life of the drug is 1.6 hours and the half-life of its metabolite is 8.5 hours.
Acute iron poisoning.
Chronic iron overload resulting from repeated blood transfusions.
Diagnosis of aluminum poisoning in patients with chronic kidney disease.
Treatment of aluminum poisoning in patients with chronic kidney disease.
– Acute iron poisoning.
Adults and children: Initially, one gram is injected intramuscularly or intravenously, followed by 500 mg every four hours, for two doses, then, if necessary, 500 mg every 4-12 hours intramuscularly or intravenously. In case of intravenous infusion, its rate should not exceed 15 mg/kg per hour. The dose of this drug should not exceed six grams in 24 hours.
– Chronic iron overload due to repeated blood transfusions.
Adults and children: 0.1-5 g/day intramuscular injection, plus 2 grams separately with each unit of blood administered. Intravenous infusion should not exceed 15 mg/kg per hour. The maximum dose is 1 gram daily when blood transfusion is not being performed and 6 grams per day in patients receiving transfusions. Alternatively, subcutaneous infusion of 1-2 grams of the drug over 8-24 hours.
– Diagnosis of aluminum poisoning in patients with chronic kidney disease.
A test dose of 50 mg/kg intravenously in the last hour of dialysis is prescribed if the serum aluminum level is 200-60 mcg/L and there are signs of toxicity. Do not use if aluminum levels are greater than 200 mcg/L.
– Treatment of aluminum poisoning in patients with chronic kidney disease.
Administer 5-10 mg/kg intravenously, 4-6 hours before dialysis. Administer once every 7-10 days with 3-4 dialysis sessions, with intervals between doses. Do not use if aluminum levels are greater than 200 mcg/L.
Contraindications: Hypersensitivity to the drug or other ingredients of the formulation, severe renal failure or anuria, except when used to treat iron or aluminum poisoning in patients undergoing dialysis (defroxamine and feroxamine are excreted primarily by the kidneys), primary hemochromatosis.
Precautions: Treatment with high doses of this drug in acute poisoning or thalassemia leads to ARDS. This complication has also been reported in children.
Long-term use of this drug at high doses or in patients with low ferritin levels and in the elderly can lead to hearing impairment. High doses can worsen some neurological symptoms such as seizures in patients with aluminum encephalopathy. The drug can cause the onset of dementia in dialysis patients. High doses and low ferritin levels can lead to growth retardation in children. Treatment of aluminum poisoning can lead to hypocalcemia and worsening of hyperparathyroidism.
In patients with high iron levels, the rate of infections such as Yersinia enterocolitis and Yersinia soda and tuberculosis is increased. Treatment with deferoxamine increases this risk. If infection occurs, discontinue treatment.
Rapid infusion of the drug can lead to flushing, hypotension, urticaria, and shock.
Rare cases of mucormycosis have been reported following drug use. If this occurs, discontinue the drug. Visual disturbances have been reported following high doses, low ferritin, and elderly individuals. Coadministration of deferoxamine with ascorbic acid rarely causes cardiac disorders, and it is best not to administer them together.
Side effects
Central nervous system: fever, dizziness, neuropathy, convulsions, headache, exacerbation of aluminum encephalopathy.
Cardiovascular: flushing, hypotension, tachycardia, shock, edema.
Respiratory: acute respiratory distress syndrome in adults, asthma.
Skin: formation of swollen areas on the skin, skin rash, itching.
Eye, ear: blurred vision, decreased visual acuity, change in visual field, night blindness, optic neuropathy, retinal pigmentation, cataract, audiometric hearing loss with or without clinical signs.
Gastrointestinal: diarrhea, abdominal discomfort.
Musculoskeletal: arthralgia, leg cramps, myalgia, paresthesia, metaphyseal dysplasia (dose-related)
Local: pain, erythema, and swelling at the injection site.
Other side effects: anaphylactic reactions, dysuria, renal failure, infection (Yersinia, mucormycosis)
Note: In case of hypersensitivity to the drug, changes in vision or hearing, or severe impairment of kidney function, the drug should be discontinued.
Poisoning and treatment
Clinical manifestations: Development and exacerbation of side effects.
Treatment: Includes symptomatic treatment. Feroxamine can be removed from the body by hemodialysis
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