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  1. Pharmacology. Deferoxamine is a specific chelating agent for iron. It binds free iron and, to some extent, loosely bound iron (eg, from ferritin or hemosiderin). Iron bound to hemoglobin, transferrin, cytochrome enzymes, and all other sites is not affected. The red iron-deferoxamine (ferrioxamine) complex is water-soluble and excreted renally; it may impart an orange-pink (vin rosé) color to the urine. One hundred milligrams of deferoxamine is capable of binding 8.5 mg of elemental iron and 4.1 mg of aluminum in vitro. Deferoxamine and both the aluminoxamine and ferrioxamine complexes are dialyzable. The basic science literature supports the use of the drug, but clinical evidence of efficacy and safety is lacking.

  2. Indications

    1. Deferoxamine is used to treat iron intoxication when the serum iron is greater than 450–500 mcg/dL or when clinical signs of significant iron intoxication exist (eg, shock, acidosis, severe gastroenteritis, or numerous radiopaque tablets visible in the GI tract by radiography).

    2. Deferoxamine sometimes is used as a "test dose" to determine the presence of free iron by observing the characteristic vin rosé color in the urine; however, a change in urine color is not a reliable indicator.

    3. Deferoxamine has also been used for the treatment of aluminum toxicity in patients with renal failure.

  3. Contraindications. No absolute contraindications to deferoxamine use exist in patients with serious iron poisoning. The drug should be used with caution in patients who have a known sensitivity to deferoxamine and patients with renal failure/anuria who are not undergoing hemodialysis.

  4. Adverse effects

    1. Hypotension or an anaphylactoid-type reaction may occur from very rapid intravenous administration; this can be avoided by limiting the rate of administration to 15 mg/kg/h.

    2. Local pain, induration, and sterile abscess formation may occur at intramuscular injection sites. Large intramuscular injections may also cause hypotension.

    3. The ferrioxamine complex may itself cause hypotension and may accumulate in patients with renal impairment; hemodialysis may be necessary to remove the ferrioxamine complex.

    4. Deferoxamine, as a siderophore, promotes the growth of certain bacteria, such as Yersinia enterocolitica, and may predispose patients to Yersinia sepsis.

    5. Infusions exceeding 24 hours have been associated with pulmonary complications (acute respiratory distress syndrome).

    6. Use in pregnancy. FDA Category C (indeterminate). Although deferoxamine is a teratogen in animals, it has relatively poor placental transfer, and there is no evidence that short-term treatment is harmful in human pregnancy (Introduction). More importantly, failure to treat serious acute iron intoxications may result in maternal and fetal morbidity or death.

  5. Drug or laboratory interactions. Deferoxamine may interfere with determinations of serum iron (falsely low) and total iron-binding capacity (falsely high). It may chelate and remove aluminum from the body.

  6. Dosage and method of administration

    1. The intravenous route is preferred in all cases. In children or adults, give deferoxamine at an infusion rate starting at 5 mg/kg/h and increasing over 15 minutes as tolerated to a rate generally not to exceed 15 mg/kg/h to minimize risk of hypotension (although rates of up to 40–50 mg/kg/h have ...

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