Desferal (desferrioxamine)

Main use Active ingredient Manufacturer

Iron overload Desferrioxamine mesilate Novartis

How does it work?

Desferal injections contain the active ingredient desferrixoamine mesilate, which is a type of
medicine called a chelating agent.

Desferrioxamine is a medicine that binds to excess iron in the body. It is then excreted in the
urine and faeces, thereby reducing iron levels in the body.

Iron is an essential part of haemoglobin, the oxygen-carrying pigment found in red blood
cells. In normal situations, iron balance is tightly controlled. Most average diets supply
adequate amounts of iron and any amounts excess to requirements are excreted. In certain
circumstances, the normal control mechanisms are overwhelmed, leading to an accumulation
of iron in the body (iron overload). Iron builds up in the cells of the kidneys, heart, liver,
brain and other organs, and can cause congestive heart failure, cirrhosis of the liver and
diabetes if left untreated.

Iron overload occurs most commonly as a result of repeated blood transfusions. These might
be necessary to treat bone marrow failure (eg caused by radiation, chemotherapy, viruses or
hereditary reasons) or blood disorders like thalassaemia or anaemias. Or it may be as a result
of iron storage disease, eg haemochromatosis. In this condition, excessive amounts of iron are
absorbed from the gut and deposited in the tissues.

Iron overload can also occur as the result of iron overdosage (iron poisoning).

Desferrioxamine is given to bind to and remove excess iron in all these situations.

Desferrioxamine can also be used to bind to and remove aluminium. It is used in people on
dialysis for end-stage kidney failure, with aluminium overload and aluminium-related bone
disease.

As desferrioxamine is removed from the body after binding to excess iron and aluminium, it
reduces iron or aluminium deposits in the organs or tissues.

Desferal injections may be administered into a muscle (intramuscularly), vein

(intravenously), under the skin (subcutaneously) or into the lining of the abdomen
(peritoneum).
What is it used for?
Iron overload (see above).

Iron poisoning.

Aluminium overload in people on maintenance dialysis for end-stage kidney failure.

Diagnosis of aluminium overload.

Diagnosis of iron storage disease and certain anaemias.

Warning!
This medicine may cause your urine to 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 or nurse.

This medicine can affect your vision and hearing and regular eye and ear
examinations (every three months) will be needed by people on long-term treatment.

Avoid driving or operating machinery if you experience dizziness, visual disturbances

or hearing disturbances during treatment with this medicine.

Children's height and body weight should be monitored every three months during
treatment with this medicine.

People with iron overload are particularly susceptible to infection, and

desferrioxamine may promote certain infections. If you develop a fever, sore throat or
abdominal pain while taking this medicine you should consult your doctor.
Desferrioxamine treatment may need to be stopped temporarily if you have an
infection that needs treating with antibiotics.

Use with caution in

People with disorders of the brain or nerves related to aluminium (encephalopathy).

People with a condition called hyperparathyroidism, in which there is over-production

of parathyroid hormone by glands found in the neck called the parathyroid glands.

Decreased kidney function.

Not to be used in
Known sensitivity or allergy to any ingredient.
This medicine should not be used if you are allergic to any of its ingredients. Please inform
your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform
your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other
medicines may be safely used in pregnancy or breastfeeding providing the benefits to the
mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant
or planning a pregnancy, before using any medicine.

This medicine is not recommended for use in pregnancy, particularly in the first
trimester, unless considered essential by your doctor. Seek medical advice from your
doctor.

It is not known if this medicine passes into breast milk. It is not recommended for use
during breastfeeding unless considered essential by your doctor. Seek medical advice
from your doctor.

Side effects
Medicines and their possible side effects can affect individual people in different ways. The
following are some of the side effects that are known to be associated with this medicine. Just
because a side effect is stated here, it does not mean that all people using this medicine will
experience that or any side effect.

Very common (affect more than 1 in 10 people)

Pain, swelling, redness, itching or scabbing of the skin at the injection site.

Pain in the muscles and joints.

Common (affect between 1 in 10 and 1 in 100 people)

Headache.

Itchy rash (urticaria).

Feeling sick.

Fever.

Supression of growth and bone development especially in children and adolescents.

Uncommon (affect between 1 in 100 and 1 in 1000 people)

 Blistering or burning sensation at the injection site.

Hearing distubances inculding tinnitus and deafness. Tell your doctor if you notice
any changes in your hearing during treatment.

Abdominal pain.

Vomiting.

Asthma.

Rare (affect between 1 in 1000 and 1 in 10,000 people)

Visual disturbances such as blurred vision, night blindness, changes in colour vision
and cataracts. Tell your doctor if you notice any changes in your vision during
treatment.

A rare fungal infection called Murcomycosis, which affects the whole body.

Low blood pressure.

Very rare (affect less than 1 in 10,000 people)

An extreme allergic reaction (anaphylaxis).

Blood disorders, including decreased numbers of platelets in the blood.

Gastric fungal infection (Gastroenteritis yersinia).

Disorder of the peripheral nerves causing weakness and numbness (peripheral

neuropathy).

Pins and needles sensations.

Dizziness.

Diarrhoea.

Unknown frequency

Decreased kidney function.

Muscle spasms.

Convulsions.
The side effects listed above may not include all of the side effects reported by the medicine's
manufacturer.

For more information about any other possible risks associated with this medicine, please
read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are taking, including
those bought without a prescription and herbal medicines, before you start treatment with this
medicine. Likewise, always ask your doctor or pharmacist before taking any new medicines
during treatment with this one, to check that the combination is safe.

Vitamin C is sometimes given to people who are receiving desferrioxamine regularly because
it can enhance the excretion of iron caused by desferrioxamine. If this is the case, the vitamin
C should not be given in the first month of desferrioxamine treatment. Heart monitoring is
recommended if this combination is used. Vitamin C should not be given to people with heart
failure.

Desferrioxamine should not be given to people taking prochlorperazine, as this may result
in prolonged unconciousness.