ACUTE IRON INTOXICATION:
IM ROUTE IS PREFERRED AND SHOULD BE USED FOR ALL PATIENTS NOT IN SHOCK.
1000 MG SHOULD BE ADMINISTERED INITIALLY, MAY BE FOLLOWED BY 500 MG EVERY 4 HOURS FOR TWO DOSES. DEPENDING UPON THE CLINICAL RESPONSE, SUBSEQUENT DOSES OF 500 MG MAY BE ADMINISTERED EVERY 4-12 HOURS. THE TOTAL AMOUNT ADMINISTERED SHOULD NOT EXCEED 6000 MG IN 24 HOURS.
INTRAVENOUS ROUTE:
USED ONLY FOR PATIENTS IN A STATE OF CARDIOVASCULAR COLLAPSE AND THEN ONLY BY SLOW INFUSION.
THE RECONSTITUTED SOLUTION IS ADDED TO PHYSIOLOGIC SALINE, (E.G., 0.9% SODIUM CHLORIDE, 0.45% SODIUM CHLORIDE), GLUCOSE IN WATER, OR RINGER'S LACTATE SOLUTION.
AN INITIAL DOSE OF 1000 MG SHOULD BE ADMINISTERED AT A RATE NOT TO EXCEED 15 MG/KG/HR. THIS MAY BE FOLLOWED BY 500 MG OVER 4 HOURS FOR TWO DOSES. DEPENDING UPON THE CLINICAL RESPONSE, SUBSEQUENT DOSES OF 500 MG MAY BE ADMINISTERED OVER 4-12 HOURS AT A SLOWER RATE, NOT TO EXCEED 125 MG/HR. THE TOTAL AMOUNT ADMINISTERED SHOULD NOT EXCEED 6000 MG IN 24 HOURS.
SWITCH TO IM ROUTE AS SOON AS PATIENTS CONDITION IMPROVES.
CHRONIC IRON OVERLOAD:
CHOOSE ON INDIVIDUAL BASIS IM OR IV ROUTE.
IM ADMINISTRATION:
A DAILY DOSE OF 500-1000 MG SHOULD BE ADMINISTERED. IN ADDITION, 2000 MG SHOULD BE ADMINISTERED INTRAVENOUSLY WITH EACH UNIT OF BLOOD TRANSFUSED; HOWEVER, DESFERAL SHOULD BE ADMINISTERED SEPARATELY FROM THE BLOOD. THE RATE OF INTRAVENOUS INFUSION MUST NOT EXCEED 15 MG/KG/HR. THE TOTAL DAILY DOSE SHOULD NOT EXCEED 1000 MG IN THE ABSENCE OF A TRANSFUSION, OR 6000 MG EVEN IF TRANSFUSED THREE OR MORE UNITS OF BLOOD OR PACKED RED BLOOD CELLS.
SUBCUTANEOUS ADMINISTRATION:
A DAILY DOSE OF 1000-2000 MG (20-40 MG/KG/DAY) SHOULD BE ADMINISTERED OVER 8-24 HOURS, UTILIZING A SMALL PORTABLE PUMP CAPABLE OF PROVIDING CONTINUOUS MINI-INFUSION. THE DURATION OF INFUSION MUST BE INDIVIDUALIZED. IN SOME PATIENTS, AS MUCH IRON WILL BE EXCRETED AFTER A SHORT INFUSION OF 8-12 HOURS AS WITH THE SAME DOSE GIVEN OVER 24 HOURS.
THE PRODUCT SHOULD BE USED IMMEDIATELY AFTER RECONSTITUTION. THE PRODUCT MAY BE STORED AT ROOM TEMPERATURE FOR A MAXIMUM PERIOD OF 24 HOURS BEFORE USE.
AS AN ADJUVANT TO IRON CHELATION THERAPY, VITAMIN C IN DOSES UP TO 200 MG FOR ADULTS MAY BE GIVEN IN DIVIDED DOSES, STARTING AFTER AN INITIAL MONTH OF REGULAR TREATMENT WITH DESFERAL. VITAMIN C INCREASES AVAILABILITY OF IRON FOR CHELATION. IN GENERAL, 50 MG DAILY SUFFICES FOR CHILDREN UNDER 10 YEARS OLD AND 100 MG DAILY FOR OLDER CHILDREN.