Desferal
deferoxamine
(de-fer-ox-a-meen) deferoxamine,Desferal
(trade name)Classification
Therapeutic: antidotesPharmacologic: heavy metal antagonists
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (effects on hematologic parameters)
ROUTE | ONSET | PEAK | DURATION |
---|---|---|---|
IV | rapid | unknown | unknown |
IM | unknown | unknown | unknown |
Subcut | unknown | unknown | unknown |
Contraindications/Precautions
Adverse Reactions/Side Effects
Ear, Eye, Nose, Throat
- blurred vision
- cataracts
- ototoxicity
Cardiovascular
- hypotension
- tachycardia
Gastrointestinal
- abdominal pain
- diarrhea
Genitourinary
- red urine (most frequent)
Dermatologic
- erythema
- flushing
- urticaria
Local
- induration at injection site
- pain at injection site
Musculoskeletal
- leg cramps
Miscellaneous
- allergic reactions
- fever
- shock after rapid IV administration
Interactions
Drug-Drug interaction
Ascorbic acid may ↑ effectiveness of deferoxamine but may also ↑ cardiac iron toxicity.Route/Dosage
Acute Iron IngestionAvailability (generic available)
Nursing implications
Nursing assessment
- In acute poisoning, assess time, amount, and type of iron preparation ingested.
- Monitor signs of iron toxicity: early acute (abdominal pain, bloody diarrhea, emesis), late acute (decreased level of consciousness, shock, metabolic acidosis).
- Monitor vital signs closely, especially during IV administration. Report hypotension, erythema, urticaria, or signs of allergic reaction. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
- May cause oculotoxicity or ototoxicity. Report decreased visual acuity or hearing loss. Audiovisual exams should be performed every 3 mo in patients with chronic iron overload.
- Monitor intake and output and urine color. Inform health care professional if patient is anuric. Chelated iron is excreted primarily by the kidneys; urine may turn red.
- Lab Test Considerations: Monitor serum iron, total iron binding capacity (TIBC), ferritin levels, and urinary iron excretion before and periodically during therapy.
- Monitor liver function studies to assess damage from iron poisoning.
Potential Nursing Diagnoses
Risk for injurypoisoning (Indications)Implementation
- IM route is preferred in acute iron intoxication unless patient is in shock.
- Reconstitute 500-mg vial with 2 mL and 2-g vial with 8 mL of sterile water for injection for a concentration of 213 mg/mL. Dissolve powder completely before administration. Solution is yellow and is stable for 1 wk after reconstitution if protected from light. Discard unused portion.
- Used in conjunction with induction of emesis or gastric aspiration and lavage with sodium bicarbonate, and supportive measures for shock and metabolic acidosis in acute poisoning.
- Intramuscular: Administer deep IM and massage well. Rotate sites. IM administration may cause transient severe pain.
- Subcutaneous: Reconstitute 500-mg vial with 5 mL and 2-g vial with 20 mL of sterile water for injection. Concentration: 95 mg/mL. Subcut route used to treat chronically elevated iron therapy is administered into abdominal subcut tissue via infusion pump for 8–24 hr per treatment.
- Intravenous: Reconstitute 500-mg vial with 5 mL and 2-g vial with 20 mL of sterile water for injection. Concentration: 95 mg/mL. Diluent: D5W, 0.9% NaCl, 0.45% NaCl, or LR. Dissolve powder completely before administration. Solution is clear and colorless to slightly yellow. Administer within 3 hr of reconstitution; 24 hr if prepared under laminar flow hood. Discard unused portion.
- Rate: Maximum infusion rate is 15 mg/kg/hr for first 1000 mg. May be followed by 500 mg infused over 4 hr at a slower rate not to exceed 125 mg/hr. Rapid infusion rate may cause hypotension, erythema, urticaria, wheezing, convulsions, tachycardia, or shock.
- May be administered at the same time as blood transfusion in persons with chronically elevated serum iron levels. Use separate site for administration.
Patient/Family Teaching
- Reinforce need to keep iron preparations, all medications, and hazardous substances out of the reach of children.
- Reassure patient that red coloration of urine is expected and reflects excretion of excess iron.
- May cause dizziness or impairment of vision or hearing. Caution patient to avoid driving or other activities requiring alertness until response from medication is known.
- Advise patient not to take vitamin C preparations without consulting health care professional, because tissue toxicity may increase.
- Encourage patients requiring chronic therapy to keep follow-up appointments for lab tests. Eye and hearing exams may be monitored every 3 mo.
Evaluation/Desired Outcomes
- Return of serum iron concentrations to a normal level (50–150 mcg/100 mL).