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Antidote / Chelating Agent Pregnancy: C - use in life-threatening iron poisoning; limited human data but animal studies reassuring at low doses

Desferrioxamine Mesilate (Deferoxamine)

Brand names: Desferal

Adult dose

Dose: Acute iron poisoning: 15 mg/kg/h IV (max 80 mg/kg/24 h or 6 g/24 h). IM (if IV unavailable): 2 g IM, repeat 1 g at 4-6 h
Route: IV / IM
Frequency: Continuous IV infusion until serum iron <55 umol/L, symptoms resolve, urine clears
Chelates free iron - ferrioxamine excreted in urine giving 'vin rose' (orange-pink) discolouration, confirming chelation is occurring. Continue until urine clear and serum iron normalised.

Paediatric dose

Dose: 15 mg/hour/kg
Route: IV
Frequency: Continuous infusion; max 80 mg/kg/24 h
Max: 6000 mg/24 h
Reconstitute 500 mg vial in 5 mL water for injection, further dilute in 0.9% NaCl or 5% dextrose.

Dose adjustments

Renal

Contraindicated in severe renal failure (anuria) unless dialysis available - ferrioxamine renally excreted. May use with haemodialysis.

Paediatric weight-based calculator

Reconstitute 500 mg vial in 5 mL water for injection, further dilute in 0.9% NaCl or 5% dextrose.

Clinical pearls

  • Indications for desferrioxamine in iron overdose: serum iron >55 umol/L, symptomatic (shock, acidosis, seizures, altered consciousness), or ingestion >60 mg/kg elemental iron.
  • 'Vin rose' urine: orange-pink discolouration confirms ferrioxamine formation - treatment is working. Clear urine = chelation may be stopped (with normalised labs).
  • Maintain IV rate <=15 mg/kg/h to avoid hypotension. Use a syringe pump.
  • Also used for chronic iron overload (transfusion-dependent thalassaemia, sickle cell) - SC infusion via pump over 8-12 h for 5-7 days/week.
  • Aluminium overload in renal dialysis patients - specialist haematology/nephrology indication.
  • Monitor closely for pulmonary toxicity if infusion >24 h - TOXBASE and NPIS advice essential for prolonged infusions.

Contraindications

  • Severe renal failure / anuria (unless dialysis available)
  • Known hypersensitivity to desferrioxamine
  • Primary haemochromatosis (aluminium overload is exception - specialist use)

Side effects

  • Hypotension (especially rapid IV infusion - keep <=15 mg/kg/h)
  • Orange-pink urine (ferrioxamine excretion - expected, not harmful)
  • Pulmonary toxicity with prolonged high-dose use (>24 h at max dose)
  • Ocular and auditory toxicity (long-term chelation therapy, not acute use)
  • Anaphylaxis (rare)
  • Yersinia enterocolitica septicaemia (iron-desferrioxamine complex is a siderophore for Yersinia)

Interactions

  • Prochlorperazine: combination may cause reversible coma - avoid concurrent use
  • Ascorbic acid (Vitamin C): enhances iron mobilisation - only add after several weeks of chelation therapy, not in acute poisoning

Monitoring

  • Serum iron and TIBC
  • Urine colour
  • BP every 15 min (IV)
  • Respiratory function (prolonged use)
  • Serum ferritin (iron overload)
  • Blood glucose

Reference: BNFc; TOXBASE; NPIS UK; BNF 84; SPC Desferal; UK Thalassaemia Society Guidelines 2022. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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