Iron chelator (parenteral)

Desferrioxamine mesilate

Brand names: Desferal

Adult dose

Dose: Iron overload: 20–60mg/kg/day SC infusion 8–12h, 5–7 days/week; Acute iron poisoning: 15mg/kg/h IV (max 80mg/kg/24h)

Route: SC infusion / IV / IM

Frequency: Daily

Clinical pearls

BSH iron overload guidelines: traditional gold standard for transfusion-dependent thalassaemia (now often replaced by oral chelators)
TOXBASE / NPIS: acute iron overdose with serum iron >90 micromol/L or symptomatic
Pink-orange urine (vin rosé) confirms chelation

Contraindications

Severe renal impairment (relative)
Hypersensitivity

Side effects

Local injection-site reactions
Hypotension (rapid IV)
Allergic / anaphylactic reactions
Hearing loss (high cumulative)
Retinopathy
Yersinia / mucormycosis infection risk
Pulmonary toxicity (high-dose IV)

Interactions

Vitamin C (paradoxically increases iron toxicity in cardiac iron overload — limit dose, give concurrent only)

Monitoring

Audiology
Ophthalmology
Renal function
Ferritin
Cardiac MRI T2*
Local infection signs

Reference: BNF; BSH iron overload; TOXBASE / NPIS; SmPC; https://bnf.nice.org.uk/drugs/desferrioxamine-mesilate/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Desferrioxamine mesilate · Iron chelator (parenteral)

Pathways