Desferrioxamine mesilate

How it works

It chelates ferric iron (and aluminium) to form ferrioxamine, a stable water-soluble complex excreted in the urine and bile, reducing tissue iron stores.

Prescribing in practice

• Prolonged or high-dose use can cause dose-related ocular and auditory toxicity (visual and hearing disturbances), so baseline and regular eye and hearing assessments are required.
• Rapid intravenous administration can cause hypotension, flushing and collapse, so it is usually given by slow subcutaneous or intravenous infusion.
• It increases susceptibility to certain infections such as Yersinia and mucormycosis, and the urine may turn reddish.

Monitoring

Monitor serum ferritin, perform periodic audiometry and ophthalmological review, and in children assess growth and skeletal development.

Counselling the patient

• Rotate subcutaneous infusion sites and report any pain, swelling or lump at the site.
• Report any change in vision or hearing without delay.
• Reddish discolouration of the urine is expected; report fever or abdominal pain, which may indicate infection.

Evidence & guidelines

Desferrioxamine is the long-established standard chelator for transfusional iron overload and an antidote in acute iron poisoning, with toxicity monitoring set out in the SPC and MHRA advice.