- Facilitate removal of iron in acute iron intoxication
- Facilitate removal of iron overload associated with hemochromatoses or other chronic iron overload
|
VIAL SIZE |
STERILE WATER for INJECTION REQUIRED |
FINAL CONCENTRATION |
|
500 mg |
2 mL |
210 mg/mL |
|
2,000 mg |
8 mL |
210 mg/mL |
- Reconstituted solution stable 7 days at room temperature, do not refrigerate
- Solutions diluted in NS or D5W stable 16 days at room temperature
- Protect from light
- Solutions Compatible: D5W, NS, ringer's lactate
- Incompatible: do not mix with any other drug
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
Chronic Iron Overload: IV or SC infusion
Acute Iron Overload:
| SC | NO |
| IM | YES Usual dilution: undiluted |
| IV Direct |
NO |
| IV Intermittent Infusion | YES Usual dilution: 210 mg/mL Infusion rate: do not exceed 15 mg/kg/hour |
| IV Continuous Infusion |
YES:
Usual dilution: 210 mg/mL |
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric:
- Acute iron overdose:
- 15 mg/kg/hr IV (Maximum: 6 g/day)
- 50 mg/kg/dose IM Q6H (Maximum: 6 g/day)
OR - Alternatively: 20 mg/kg IV/IM (Max: 1,000 mg) initially followed by 10 mg/kg IV/IM (Max: 500 mg) at 4-hour intervals for 2 doses; may repeat with 10 mg/kg (Max:500 mg) Q4-12H depending on clinical response (Maximum: 6 g/day)
- Chronic iron overload:
- 20-50 mg/kg/day to be infused subcutaneously over 8-12 hours and repeated daily (Maximum: 2 g/day)
- 15 mg/kg/hr IV (Maximum: 12 g/day)
Adult:
- Acute iron overdose:
- 15 mg/kg/hour IV (Maximum: 6 g/day)
- 1 g IM stat, then 0.5 g IM Q 4 hours for 2 doses, additional doses of 0.5 g IM Q 4-12 hours up to 6 g/day may be needed depending on the clinical response
- Chronic iron overdose:
- 15 mg/kg/hour IV (Maximum: 12 g/day)
- 0.5-1 g/day IM
- 1-2 g/day SC over 8-24 hours
- Dose should be titrated based on iron stores and urinary iron excretion. Begin at lower end of dosing range for younger children.
- Pain, pruritis, erythema and induration at site of injection
- Following too rapid IV injection >15 mg/kg/hr), generalized erythema, urticaria, hypotension, shock and tachycardia
- Long-term therapy for chronic iron storage disease may cause allergic type reactions (pruritis, rash, tachycardia, fever, anaphylaxis), or other effects (blurred vision, diarrhea, cataracts, abdominal discomfort, leg cramps, or hearing loss, growth retardation)
- May cause a reddish colour to the urine (not hematuria)
- For chronic iron overload, SC is the preferred route for most patients; IV may be preferred in patients with massive iron stores and significant organ damage
- Contraindicated in patients with severe renal failure or anuria
- Local reactions in SC infusion site may be minimized by diluting the deferoxamine in 5-10 mL SWI and adding 1 mg hydrocortisone to each mL of deferoxamine solution.