Drug reference

Desferrioxamine mesilate

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1110, 1111

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Iron poisoning ▶BY CONTINUOUS INTRAVENOUS INFUSION ▶Adult: Initially up to 15 mg/kg/hour, max. 80 mg/kg in 24 hours, dose to be reduced after 4–6 hours, in severe cases, higher doses may be given on advice from the National Poisons Information Service Aluminium overload in dialysis patients ▶BY INTRAVENOUS INFUSION ▶Adult: (consult product literature or local protocols) Chronic iron overload (low iron overload) ▶BY SUBCUTANEOUS INFUSION ▶Adult: The dose should reﬂect the degree of iron overload Chronic iron overload (established overload) ▶BY SUBCUTANEOUS INFUSION ▶Adult: 20–50 mg/kg daily

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Cautions

Aluminium-related encephalopathy (may exacerbate neurological dysfunction) Malignant myeloid conditions. pre-malignant myeloid conditions. risk of splenomegaly and rupture— spleen size should be monitored. sickle-cell disease CAUTIONS, FURTHER INFORMATION ▶Acute respiratory distress syndrome There have been reports of pulmonary inﬁltrates leading to acute respiratory distress syndrome—patients with a recent history of pulmonary inﬁltrates or pneumonia may be at higher risk.

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Drug Action

Recombinant human granulocyte-colony stimulating factor (rhG-CSF) stimulates the production of neutrophils.

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Safety

Interactions

→Appendix 1: iron chelators

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Side Effects

▶Common or very common Arthralgia. bone disorder. fever. growth retardation. headache. muscle complaints. nausea . skin reactions ▶Uncommon Abdominal pain. asthma. deafness neurosensory. tinnitus. vomiting ▶Rare or very rare Angioedema. blood disorder. cataract. diarrhoea. dizziness. encephalopathy. eye disorders. hypersensitivity. hypotension (more common when given too rapidly by intravenous injection). increased risk of infection. nerve disorders. nervous system disorder. paraesthesia. respiratory disorders. shock. tachycardia. thrombocytopenia. vision disorders ▶Frequency not known Acute kidney injury. hypocalcaemia. leucopenia. renal tubular disorder. seizure. urine red ▶Common or very common Arthralgia. cutaneous vasculitis. dyspnoea. haemoptysis. headache. hypersensitivity. leucocytosis. pain. spleen abnormalities. thrombocytopenia ▶Uncommon Acute febrile neutrophilic dermatosis. capillary leak syndrome. hypoxia. pulmonary oedema. respiratory disorders. sickle cell anaemia with crisis SIDE-EFFECTS, FURTHER INFORMATION Treatment should be withdrawn in patients who develop signs of pulmonary inﬁltration.

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Pregnancy

Teratogenic in animal studies. Manufacturer advises use only if potential beneﬁt outweighs risk. Manufacturers advise avoid—toxicity in animal studies.

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Breast Feeding

Manufacturer advises use only if potential beneﬁt outweighs risk—no information available. There is no evidence for the use of granulocyte-colony stimulating factors during breast- feeding and manufacturers advise avoiding their use.

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Renal Impairment

Use with caution.

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Monitoring Requirements

Eye and ear examinations before treatment and at 3-month intervals during treatment. ▶Full blood counts including differential white cell and platelet counts should be monitored. ▶Spleen size should be monitored during treatment—risk of splenomegaly and rupture. eiiii F above

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Dose and formulations

Directions For Administration

For full details and warnings relating to administration, consult product literature. For intravenous infusion (Desferal ®), give continuously or intermittently in Glucose 5% or Sodium chloride 0.9%. Reconstitute with water for injections to a concentration of 100 mg/mL; dilute with infusion ﬂuid.

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Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Powder for solution for injection ▶Desferrioxamine mesilate (Non-proprietary) Desferrioxamine mesilate 500 mg Desferrioxamine 500mg powder for solution for injection vials | 10 vial P £46.63 DT = £46.63 Desferrioxamine mesilate 2 gram Desferrioxamine 2g powder for solution for injection vials | 10 vial P £186.60 ▶Desferal (Novartis Pharmaceuticals UK Ltd) Desferrioxamine mesilate 500 mg Desferal 500mg powder for solution for injection vials | 10 vial P £46.63 DT = £46.63 Neutropenia and stem cell mobilisation 3.1 Neutropenia Neutropenia Management Recombinant human granulocyte-colony stimulating factor (rhG-CSF) stimulates the production of neutrophils and may reduce the duration of chemotherapy-induced neutropenia and thereby reduce the incidence of associated sepsis; there is as yet no evidence that it improves overall survival. Filgrastim p. 1089 (unglycosylated rhG-CSF) and lenograstim p. 1090 (glycosylated rhG-CSF) have similar effects; both have been used in a variety of clinical settings, but they do not have any clear-cut routine indications. In congenital neutropenia ﬁlgrastim usually increases the neutrophil count with an appropriate clinical response. Pegﬁlgrastim p. 1091 is a polyethylene glycol-conjugated (‘pegylated’) derivative of ﬁlgrastim; pegylation increases the duration of ﬁlgrastim activity. Lipegﬁlgrastim p. 1090 is a polyethylene glycol-conjugated via a glycine linker derivative of ﬁlgrastim. Granulocyte-colony stimulating factors should only be prescribed by those experienced in their use. IMMUNOSTIMULANTS › GRANULOCYTE-COLONY STIMULATING FACTORS Granulocyte-colony stimulating f factors

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Dose text by age group

Adult

Initially up to 15 mg/kg/hour, max. 80 mg/kg in

First-line fragment. Read the complete Indications and Dose section above.

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Adult

(consult product literature or local protocols)

First-line fragment. Read the complete Indications and Dose section above.

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Adult

The dose should reﬂect the degree of iron

First-line fragment. Read the complete Indications and Dose section above.

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Adult

20–50 mg/kg daily

First-line fragment. Read the complete Indications and Dose section above.

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Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Desferrioxamine mesilate

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1110, 1111

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 1110

Cautions

PDF pages 1110, 1111

Drug Action

Recombinant human granulocyte-colony stimulating factor (rhG-CSF) stimulates the production of neutrophils.

PDF page 1111

Safety

Interactions

→Appendix 1: iron chelators

PDF page 1110

Side Effects

PDF pages 1110, 1111

Pregnancy

Teratogenic in animal studies. Manufacturer advises use only if potential beneﬁt outweighs risk. Manufacturers advise avoid—toxicity in animal studies.

PDF pages 1110, 1111

Breast Feeding

PDF pages 1110, 1111

Renal Impairment

Use with caution.

PDF page 1110

Monitoring Requirements

PDF pages 1110, 1111

Dose and formulations

Directions For Administration

PDF page 1110

Medicinal Forms

PDF pages 1110, 1111

Dose text by age group

Adult

Initially up to 15 mg/kg/hour, max. 80 mg/kg in

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1110

Adult

(consult product literature or local protocols)

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1110

Adult

The dose should reﬂect the degree of iron

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1110

Adult

20–50 mg/kg daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1110

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.