Desferrioxamine mesilate

How it works

It binds free iron (and aluminium) to form a stable complex, ferrioxamine, which is water-soluble and excreted by the kidneys, removing excess metal from the body.

Prescribing in practice

• It is the antidote of choice in serious acute iron poisoning, and rapid intravenous infusion can cause hypotension, so the rate must be controlled.
• Long-term use is associated with ocular and auditory toxicity (including retinopathy and hearing loss), so baseline and periodic eye and ear assessments are advised.
• Urine may turn a reddish (vin rosé) colour reflecting iron excretion, and dosing follows current prescribing references for the indication.

Monitoring

Monitor for infusion-related hypotension, conduct periodic ophthalmological and audiometric assessment with prolonged use, and watch for opportunistic infections.

Counselling the patient

• Your urine may turn a reddish colour, which is expected and harmless and shows iron is being removed.
• Regular eye and hearing checks may be needed with long-term treatment.
• Report any change in vision or hearing to your clinician.

Evidence & guidelines

Desferrioxamine is the long-established iron chelator recommended for significant acute iron poisoning and transfusional iron overload in UK toxicology and haematology practice.