desferrioxamine

Desferrioxamine, commonly called deferoxamine (DFO), is an iron chelating agent used to treat iron overload and, in certain circumstances, acute iron poisoning. It is a hydroxamate siderophore originally produced by the bacterium Streptomyces pilosus and is used clinically as deferoxamine. It binds ferric iron (Fe3+) with high affinity, forming ferrioxamine complexes that are water-soluble and excreted primarily by the kidneys, thereby reducing the body's labile iron pool.

Medical use: Deferoxamine is most commonly prescribed for transfusional iron overload in patients such as those with thalassemia or other chronic anemias. Regular parenteral therapy lowers hepatic iron and ferritin and can reduce organ iron deposition. In cases of acute iron poisoning, deferoxamine is given by slow IV infusion to chelate circulating iron and promote urinary excretion. Dosing is tailored to iron burden and tolerability, and therapy is continued with monitoring of ferritin, transferrin saturation, renal function, and clinical status.

Administration and pharmacokinetics: Administered parenterally (IV or subcutaneous). The ferrioxamine complex is renally excreted; pink-tinged urine may be observed. It is not active when taken orally and has limited intracellular iron penetration.

Adverse effects: Hypotension with rapid IV administration, infusion-site reactions, fever, rash, and GI upset. Long-term use can be associated with ototoxicity and visual disturbances; hypersensitivity reactions and rare anaphylaxis have been reported. Monitoring and dose adjustments are important.

History: Desferrioxamine B is a natural siderophore produced by Streptomyces pilosus and has been used as a therapeutic agent since the 1960s.