Brand Name Choices
No generic medication is available for Desferal (Deferoxamine Mesylate)
What Desferal is and what it is used for
Desferal is an injection used to remove excess iron or aluminium from your blood. Desferrioxamine mesilate, the active ingredient in Desferal, is a substance called a ‘chelating’ agent. This means that it binds to the iron and aluminium ions in the blood to form a complex which is then excreted from the body. You may have too much iron or aluminium in your blood as a result of iron poisoning or as a side effect of blood transfusion or kidney dialysis. Certain illnesses can also have the same effect. Desferal can also be used to test whether you have certain anaemias or diseases affecting the amount of iron in your blood.
How to take Desferal
The doctor will have decided what dose of Desferal you need and when you should take it. The
dose will be on the pharmacist’s label. Check the label carefully. If you are not sure, ask your
doctor or pharmacist.
A doctor or nurse may prepare your injection for you, or you may be taught how to do this
yourself. The Desferal powder should be dissolved in the ‘water for injection’ that your
pharmacist has given you.
Treatment with the solution should start within 3 hours of the vial being reconstituted. If the
solution has been prepared under sterile conditions (for instance in a hospital), it may be
stored at room temperature (25oC or below) for up to 24 hours before being used. Any unused
Desferal injection should be thrown away.
Ways in which Desferal can be given
Desferal can be given in different ways, for example:
• By injection into a muscle. This is called being given intramuscularly.
• By injection into a vein. This is called being given intravenously. It should be given slowly over a period of time rather than all in one go. This is called a slow infusion.
• By injection under your skin. This is called being given subcutaneously. It may be given over a period of time using a special pump. This is called an infusion.
• By injection into the peritoneum (the membrane that lines the abdominal cavity and forms the outer coating of the abdominal organs). This is called intraperitoneal administration. The dose that you need will depend on why you have to take Desferal. Your doctor will work out exactly how much Desferal you need. This is especially important if you have low serum ferritin levels or acute iron intoxication. The usual doses and ways of taking Desferal are as follows:
• Iron Poisoning Treatment To treat iron poisoning Desferal is usually given intravenously (injected into the vein). The recommended dose is 15 mg/kg body weight every hour. This may be reduced after 4 to 6 hours. The maximum recommended dose is 80 mg/kg body weight every 24 hours. Desferal may also be given intramuscularly (injected into the muscle). The recommended dose if Desferal is given like this is 2 g for an adult or 1 g for a child. This is usually given in a single injection.
• Iron Overload Treatment Your doctor will work out exactly how much Desferal you will need. This will depend on how much extra iron you have in your body. Desferal is usually given subcutaneously (a slow injection under the skin). It can sometimes be given intramuscularly (injected into the muscle) though. The dose is usually between 20 and 60 mg/kg body weight. It is usually given between 5 and 7 times a week, depending on how much extra iron you have got in your body. In children under 3 years of age the average daily dose is not usually more than 40 mg/kg.
• Aluminium Overload Treatment Desferal is usually given by slow intravenous injection. The exact dose of Desferal that you need will depend on how much extra aluminium you have in your body. Your doctor will do tests to work this out. If you are on dialysis, the usual dose of Desferal is 5 mg/kg body weight. This is normally given once a week. When you are given your Desferal will depend on how much extra aluminium you have in your body. It will either be given during the last 60 minutes of your dialysis or 5 hours before your dialysis starts. If you are on peritoneal dialysis (CAPD or CCPD), the usual dose of Desferal is, again, 5 mg/kg body weight. This is normally given once a week. Usually the Desferal is mixed with the fluid in your dialysis bag. However, it can also be given by any of the other ways listed above. 4
• Testing to see if you have got too much iron in your body Desferal is usually given intramuscularly (injected into a muscle). The usual dose is 500 mg. After you have had your Desferal, your doctor or nurse will probably want you to collect urine samples for about 6 hours. They will then do tests on your urine to see how much iron is in it.
• Testing to see if you have got too much aluminium in your body if you are on dialysis Your doctor or nurse will probably take a blood sample from you before you are given Desferal. This will be taken just before your dialysis. Tests will be done on the blood to see how much aluminium is in it. The usual dose of Desferal is 5 mg/kg body weight. It is usually given by slow intravenous infusion (slow injection into a vein) during the last hour of dialysis. Another blood test will probably be taken before your next session of haemodialysis to check how much aluminium is in your blood.
• Use in older patients Desferal is used in older patients at the same doses as for other adults. What if you have had too much Desferal? (Overdose) If you think you have either been given or have taken too much Desferal tell your doctor or nurse straight away. If you think you have either been given it or have taken it too often, also tell your doctor or nurse straight away. What if you miss a dose of Desferal? If you miss one of your appointments, please let your doctor or nurse know immediately.
Possible side effects
Most people who are prescribed Desferal will benefit from using it. As with all other medicines
though, it can cause side effects in some people.
Do not be alarmed by this list of possible side effects. You may not experience any of them.
Your urine may turn a reddish-brown colour. This is because there is more iron in your urine.
This is usually nothing to worry about, but if you are worried you should talk to your doctor
Some side effects can be serious
Stop taking Desferal and tell your doctor straight away if you notice:
• Bronchospasm or tightness of chest with wheezing or coughing and difficulty in breathing.
• If you feel faint (you might have low blood pressure), have a rash, or experience itching, difficulty breathing or facial and throat swelling. These might be the result of an allergic reaction which is very rare (likely to affect fewer than 1 in 10,000 patients).
• If you notice severe decrease of urine output (sign of kidney problem) or experience convulsion (reported mainly in patients on dialysis). Those side effects were reported with unknown frequency. Important information if you get an infection while you are taking Desferal If you start to feel feverish with a sore throat or stomach pains, or general discomfort or develop shortness of breath while you are taking Desferal, you must seek medical advice immediately. This is because people who have iron or aluminium overload are more vulnerable to certain types of infection. If you get an infection your doctor may want you to do some tests and give you 5 some medicines to treat the infection. You may also have to stop using Desferal until any infections clear up. It is very common (more than 10% of people) to develop pain, swelling, redness, a rash, itch or scabbing at the Desferal injection site. Less frequently blisters and a burning sensation might be experienced. Aching muscles or joints in the arms or legs is also very common. The side effects listed below have also been reported. Up to 1 in 10 people have experienced: Headache, nausea (feeling sick) or fever Itchy rash Changes in their bones, slowing down of growth (especially in children under 3). Up to 1 in 100 people have experienced: Vomiting, stomach pains Asthma Problems with their ears such as tinnitus and deafness. Up to 1 in 1,000 people have experienced: Problems with their eyes such as blurred vision, impaired or loss of vision, not being able to see colours as well (colour blindness), not being able to see at night (night blindness), blind spots, changes in the retina, cataracts (cloudy lenses), cloudiness on the front of the eye (or cornea) Low blood pressure (light headedness, dizziness, faintness). This can happen if Desferal is not given correctly. Increased risk of getting certain infections. Up to 1 in 10,000 people have experienced: Skin rash covering most of the body A serious condition which causes severe breathing problems called Acute Respiratory Distress Syndrome Diarrhoea Changes in the blood which can make you look pale or cause tiredness, headaches, nosebleeds, dizziness or being short of breath when exercising. You might also get more frequent viral infections (fever, chills, sore throat or mouth ulcers), or find that you bleed or bruise more easily than normal. Stomach and gut infections. Other effects such as dizziness, loss of feeling in their hands, feet, arms or legs, numbness or tingling (pins and needles). In patients on dialysis: personality changes, headache, confusion, paralysis of part or all of the body, stiff neck, abnormal, speech and eye movements. Frequency not known (cannot be estimated from the available data). Muscle spasms Abnormal liver or renal function test results If any of the symptoms become troublesome, or if you notice anything else not mentioned here, please go and see your doctor or check with your pharmacist.
Reporting of side effects If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine
How to Store Desferal
The vials of Desferal powder before they are made up into the injection should not be stored above 25°C. Each vial is for single use only. Keep this medicine out of the sight and reach of children. Do not use Desferal after the expiry date which is printed on the outside of the pack. Do not throw away any medicines via wastewater or household waste. Ask you pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
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