Deferoxamine Mesylate is used for the following indications:

• Treatment of acute iron poisoning.
• Management of chronic iron overload in patients with transfusion-dependent anemia.
• Diagnostic evaluation of aluminum overload using the deferoxamine mesylate infusion test.
• Treatment of chronic aluminum accumulation in patients with end-stage renal failure (ESRF) who are on maintenance dialysis.

Deferoxamine Mesylate (500 mg vials): Each 7.5 mL vial contains a white to off-white sterile lyophilized powder. It includes 500 mg of deferoxamine mesylate as the active ingredient for injection and contains no non-medicinal ingredients. It is supplied in cartons containing 10 vials.

Deferoxamine treats iron toxicity by binding to trivalent (ferric) iron with high affinity, forming a stable complex called ferrioxamine, which is then excreted through the kidneys. Each 100 mg of deferoxamine can bind approximately 8.5 mg of ferric iron. In aluminum toxicity, deferoxamine binds to tissue-deposited aluminum to form aluminoxamine, a stable and water-soluble complex. This increases the level of aluminum in the blood, creating a higher concentration gradient between blood and dialysate, which enhances aluminum removal during dialysis. Each 100 mg of deferoxamine can bind about 4.1 mg of aluminum.

Deferoxamine mesylate should only be given parenterally. The dose should not exceed 6.0 grams in a twenty-four hour period. Although Deferoxamine can be given by intramuscular injection, in most cases it exerts a considerably greater effect when administered by continuous infusion either intravenously (especially in cases of acute iron intoxication) or subcutaneously (especially in patients with chronic iron overload).

Rapid intravenous injection of Deferoxamine exceeding 15 mg/kg/h has produced flushing of the skin, urticaria, hypotension and shock

Concomitant use of Prochlorperazine:
Concurrent administration of deferoxamine with prochlorperazine, a phenothiazine derivative, may cause temporary loss or impairment of consciousness.

Concomitant use of Vitamin C:
In patients with iron overload accompanied by ascorbic acid deficiency, oral vitamin C at standard doses (150–250 mg daily) may enhance the urinary excretion of the iron–deferoxamine complex. Higher doses do not provide additional benefit.

Concomitant use of Erythropoietin:
Aluminum toxicity may reduce red blood cell production (erythropoiesis). In dialysis patients with iron and/or aluminum overload who are receiving both deferoxamine and erythropoietin, the erythropoietin dose should be adjusted if necessary, and iron levels should be regularly monitored.

Deferoxamine mesylate is contraindicated in patients who are hypersensitive to the drug or to any component of its container, except in cases where successful desensitization has been achieved.

Pregnant Women:
There are no sufficient well-controlled studies in pregnant women. Animal studies (in rabbits) have shown reproductive toxicity. The potential risk to the fetus and mother is unknown. Women of childbearing age with chronic iron and/or aluminum overload should not receive deferoxamine unless effective contraception is used, starting before treatment and continuing throughout therapy and for at least one month after stopping treatment. During pregnancy, especially in the first trimester, deferoxamine should only be used if the risk of acute iron poisoning is considered greater than the potential risk of teratogenic effects.

Nursing Women:
It is not known whether deferoxamine mesylate is excreted in breast milk. Since many drugs are present in human milk and there is a potential risk of serious adverse effects in breastfed infants, a decision should be made either to discontinue breastfeeding or to discontinue the drug, considering the importance of treatment for the mother.

Treatment with deferoxamine should be started and supervised by a physician experienced in managing chronic iron overload caused by blood transfusions. It should be noted that some reported adverse effects may actually reflect symptoms of the underlying condition, such as iron and/or aluminum overload. As with all medications, deferoxamine must be kept out of the reach of children. Rapid intravenous administration at doses exceeding 15 mg/kg/hour may cause skin flushing, urticaria, hypotension, and shock.

Vitamin C supplements should be avoided in patients with heart failure, as cardiac function may worsen in individuals with severe chronic iron overload who are receiving combined therapy of deferoxamine and high-dose vitamin C (more than 500 mg daily).

As deferoxamine mesylate is only available for parenteral use, the occurrence of acute intoxication is unlikely.

Carboxylic acids and derivatives

Store at 15–25°C. Do not keep above 25°C.