Usual Adult Dose for Iron Poisoning - Acute

Initial dose: 1000 mg, IM or IV (maximum IV rate: 15 mg/kg/hour)
Maintenance dose: 500 mg, IM or IV, every 4 hours, for 2 doses; additional 500 mg doses every 4 to 12 hours may be given based on clinical response
Maximum dose: 6000 mg per 24 hour period

Comments:

• IM administration is preferred for all patients not in shock.
• Slow IV administration should only be used for cardiovascular collapse.
• As soon as the clinical condition allows, discontinue IV and switch to IM administration.
• This drug is an adjunct to, not a substitute for, standard treatment for acute iron intoxication (e.g. inducing emesis, gastric lavage)

Usual Adult Dose for Iron Poisoning - Chronic

1000 to 2000 mg, subcutaneously over 8 to 24 hours, daily
or
40 to 50 mg/kg/day, IV over 8 to 12 hours (maximum IV rate: 15 mg/kg/hour), 5 to 7 days per week
Maximum IV dose: 60 mg/kg/day
or
500 to 1000 mg, IM,
Maximum IM dose: 1000 mg/day

Comments:

• Subcutaneous administration is recommended.
• Intravenous administration can be used in patients with intravenous access.

Usual Pediatric Dose for Iron Poisoning - Acute

3 years and older:
Initial dose: 1000 mg, IM or IV (maximum IV rate: 15 mg/kg/hour)
Maintenance dose: 500 mg, IM or IV, every 4 hours, for 2 doses; additional 500 mg doses every 4 to 12 hours may be given based on clinical response
Maximum dose: 6000 mg per 24 hour period

Comments:

• IM administration is preferred for all patients not in shock.
• Slow IV administration should only be used for cardiovascular collapse.
• As soon as the clinical condition allows, discontinue IV and switch to IM administration.
• This drug is an adjunct to, not a substitute for, standard treatment for acute iron intoxication (e.g. inducing emesis, gastric lavage)

Usual Pediatric Dose for Iron Poisoning - Chronic

3 years and older:
1000 to 2000 mg, subcutaneously over 8 to 24 hours, daily
or
20 to 40 mg/kg/day, IV over 8 to 12 hours (maximum IV rate: 15 mg/kg/hour), 5 to 7 days per week
Maximum IV dose: 40 mg/kg/day (until growth has ceased)
or
500 to 1000 mg, IM,
Maximum IM dose: 1000 mg/day

Comments:

• Monitor for body weight and growth every 3 months.
• Subcutaneous administration is recommended.
• Intravenous administration can be used in patients with intravenous access.

Renal Dose Adjustments

Contraindicated in severe renal impairment

Liver Dose Adjustments

Data not available

Dose Adjustments

Chronic Iron Overload:

• Poorly compliant patients can receive their IV dose prior to or following same day blood transfusion.
• Do not administer concomitantly with blood transfusion: errors in interpreting side effects can occur.

Precautions

Safety and efficacy have not been established in patients younger than 3 years.

Consult WARNINGS section for additional precautions.

Dialysis

Deferoxamine is dialyzable; however, no dose adjustment guidelines have been reported.

Other Comments

Administration advice:

• Administer immediately (starting within 3 hours) after reconstitution.