Deferoxamine (Iron/Aluminium Overload in Dialysis)

How it works

It binds free iron and aluminium to form stable complexes (ferrioxamine and an aluminium complex) that are removed from the body, including via dialysis.

Prescribing in practice

• Ocular and auditory toxicity, including retinopathy and hearing loss, can occur, so visual and audiometric assessment is required with prolonged use.
• Rapid intravenous administration can cause hypotension, and infusions should be given at a controlled rate.
• It can increase susceptibility to certain infections such as Yersinia and mucormycosis, which should be considered if a patient becomes unwell.

Monitoring

Monitor visual and auditory function on prolonged therapy, along with iron or aluminium indices and for signs of infection.

Counselling the patient

• Report any change in vision or hearing promptly.
• Your urine may turn a reddish colour, which is expected as iron is removed.
• Seek advice early if you develop fever or feel unwell during treatment.

Evidence & guidelines

Deferoxamine is the established chelator for aluminium and iron overload in dialysis populations, guided by monitoring for cumulative toxicity.