Drug administration deferoxamine

The short half-life of deferoxamine limits its suppression of non-transferrin-bound serum iron (NTBI) to the hours of drug administration, so that effective cardiac iron chelation requires continuous or near-... 

Sofroniadou K, Drossou M, Foundoulaki L, Konstantopoulos K, Kyriakoy D, Zervas J. Acute bone marrow aplasia associated with intravenous administration of deferoxamine (desferrioxamine). Drug Saf 1990 5(2) 152-4. 

Deferoxamine given orally complexes with dietary iron, making the drug and the iron unavailable for absorption. The preferred route of administration is by intramuscular injection. Irritation and pain at the site of administration and the need for daily injections make the treatment unpopular. In addition, even with coadministration of large amounts of ascorbie acid, the iron loss produced is far below that necessary to remove all of the iron accumulated during chronic transfusion therapy. 

Deferoxamine deferoxamine mesylate, desferal mesylate) is poorly absorbed after oral administration, and parenteral administration is required in most cases. For severe iron toxicity (serum iron levels >500 /rg/dL), the intravenous route is preferred. The drug is administered at 10-15 mg/kg/h by constant infusion. Faster rates of infusion (45 mg/kg/h) have been used in a few cases rapid boluses usually are associated with hypotension. Deferoxamine may be given intramuscularly in moderately toxic cases (serum iron 350-500 )ig/dL) at a dose of 50 mg/kg with a maximum dose of 1 g. Hypotension also can occur with the intramuscular route. 

For chronic iron intoxication e.g., thalassemia), an intramuscular dose of 0.5-1.0 g/day is recommended, although continuous subcutaneous administration (1-2 g/day) is almost as effective as intravenous administration. When blood is being transfused to patients with thalassemia, 2 g deferoxamine (per unit of blood) should be given by slow intravenous infusion (rate not to exceed 15 mg/kg/h) during the transfusion but not by the same intravenous fine. Deferoxamine is not recommended in primary hemochromatosis phlebotomy is the treatment of choice. Deferoxamine also has been used for the chelation of aluminum in dialysis patients. Deferoxamine is metabohzed principally by plasma enzymes, but the pathways have not been defined. The drug also is excreted readily in the urine. 

Combinations of these drugs are increasingly utilised so far, no synergies in side effects are evident. A major meta-analysis of 22 trials involving 2187 participants included eight deferoxamine to deferiprone comparisons, five deferoxamine to deferoxamine/deferiprone comparisons, two deferoxamine to deferasirox comparisons, and two comparisons of different routes of deferoxamine administration (bolus versus continuous infusion). The authors concluded that adverse events were less likely with deferoxamine than with deferiprone in one trial and less likely with deferoxamine than deferoxamine and deferiprone combination therapy in two trials [47 ]. 

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