desferrioxamine mesilate: clinical use

Prescribing considerations

• Use under specialist supervision, guided by the indication and measured iron or aluminium burden.
• Use caution in renal impairment because chelated complexes are predominantly cleared through the kidneys.
• Avoid rapid intravenous administration because hypotension, shock and collapse may occur.
• During suspected Yersinia infection or mucormycosis, stop treatment and investigate and treat urgently.
• Aluminium-related encephalopathy may initially worsen; consider neurological risk and hyperparathyroidism.

Contraindications and cautions

• Hypersensitivity to desferrioxamine mesilate, unless successful desensitisation permits treatment.

Monitoring

• Assess iron burden and avoid excessive chelation, particularly when ferritin is low.
• Monitor renal and liver function as clinically appropriate.
• Perform baseline and continuing ophthalmological and audiological assessment during long-term treatment.
• Monitor children's height and weight, particularly in young children.
• Monitor cardiac function when vitamin C is co-prescribed.
• For intensive chelation, assess iron excretion and organ iron burden using appropriate specialist investigations.

Clinical pharmacology

Desferrioxamine forms ferrioxamine and aluminoxamine complexes. It has little affinity for physiologically important calcium and magnesium and is poorly absorbed orally, necessitating parenteral administration.

Formulation and product differences

• The product is a single-use vial containing white or off-white powder for reconstitution.
• Reconstitute with water for injections; compatible infusion fluids may be used for subsequent dilution but not as the initial solvent.
• Use only clear, pale-yellow solution; discard opaque, cloudy or discoloured preparations.
• Heparin is pharmaceutically incompatible with desferrioxamine solutions.