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Last updated: 07/2015


Desferrioxamine, Desferal, DFO

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  • Acute iron intoxication manifested by any or all of the following: iron level greater than 90 umol/L, shock, acidosis, severe gastroenteritis, significant number of radioopaque pills on Xray.


  • Intravenous route is preferred in ALL cases. The IV dose can be administered intraosseous (IO) in emergency situations
  • 15/mg/kg/hour (not to exceed 6 g in 24 hour) as continuous infusion until lab values and clinical status are normalized and urine is normal colour.

    *In some severe cases, higher infusion rates have been used. Consult the IWK Regional Poison Centre.



  •  For a final IV concentration of 4 mg/mL: Add 2 g ( 9.5 mL of 210 mg/ml solution) to 500 mL of sodium chloride 0.9% or dextrose 5% in water. Maximum rate of adminstration is 15 mg/kg/hour. (Note the possible adverse effects of rapid and prolonged administration mentioned in potential hazards of administration section.)

Compatibility, Stability

  • Compatible with sodium chloride 0.9%, dextrose 5% in water and lactated ringer’s.
  • Stable for 24 hours at room temperature.

Potential Hazards of Administration

  • Infusions greater than 24 hours may be associated with severe or fatal pulmonary toxicity.
  • Headache, nausea, urticaria, arthralgia, myalgia, fever.
  • Pain and induration at the site of injection.
  • Reddish discolouration of the urine as chelated iron is being excreted.
  • Allergic reactions (dermatological, anaphylaxis).
  • Respiratory distress syndrome has been reported following IV administration of excessive doses. Treatment should be interrupted if signs of toxicity occur.
  • Rapid IV injection (greater than 15 mg/kg/hour) has produced flushing, urticaria, hypotension and shock.
  • Decreased serum glucose, sodium, calcium and increase blood coagulability.
  • Infection with yersinia species or mucormycosis may be promoted by deferoxamine.
  • Visual disturbances, hearing loss and audiometric abnormalities have been reported, especially if high doses used. Serial ophthalmological and audiological testing should be performed, if symptoms noted and then as necessary.


  • Use with caution in patients with impaired renal function. Adequate urine output is required to excrete the deferoxamine-iron complex. If oliguria or anuria develop, dialysis may be required.

Bailey, B., Blais, R., Gaudreault, P., Gosselin, S., & Laliberte, M. (2009). Antidotes en toxicologie d'urgence (3rd ed.). Quebec, Canada: Centre antipoison du Quebec.

Balmadrid, C., & Bono, M. (2009). Recognizing and managing iron toxicity. Emergency Medicine, (May), 36-41.

Goldfrank, L. R., Nelson, L. S., Lewin, N. A., Howland, M. A., Hoffman, R. S., (2015). Goldfrank's toxicologic emergencies(Tenth ed.). New York: McGraw Hill.

Micromedex, T. H. A. (2014). Micromedex health care systems. Retrieved from

Olson, K. R. (2007). Poisoning & drug overdose (Sixth ed.). New York: McGraw Hill.

Phelps SJ, C. C. (2013).  Teddy bear, pediatric injectable drugs. Retrieved from

Shannon, M. W., Borron, S. W., & Burns, M. J. (2007). Haddad and Winchester's clinical management of poisoning and drug overdose (Fourth ed.). Philadelphia: Saunders Elsevier.

Trissel, Lawrence, A,. (2013). Handbook on injectable drugs (17th ed.). Bethesda, Maryland: American Society of Health-System Pharmacists