Pharmacology · Chelating agents
Deferoxamine !
An iron chelator given by injection for acute iron poisoning and for iron overload from repeated transfusions. The iron complex turns urine reddish.
Updated 2026-11-01
Also called: Desferrioxamine, deferoxamine mesylate
Mechanism of action
Deferoxamine binds ferric iron in a stable complex (ferrioxamine) that can no longer take part in toxic reactions. It removes free iron and iron from ferritin and haemosiderin, but not iron from transferrin, haemoglobin or cytochromes. The water-soluble complex is excreted by the kidneys, colouring the urine reddish, and partly in bile. It also binds aluminium.
- Excess iron is free in blood and tissues
- Deferoxamine wraps it as ferrioxamine
- The complex can no longer cause oxidative damage
- Kidneys excrete it: reddish urine
Pharmacokinetics
- Absorption
- Given by injection: intramuscular, subcutaneous or slow intravenous infusion
- Elimination
- The iron complex goes mainly into urine, partly into bile; it is removed by haemodialysis
Indications
- Acute iron poisoning with metabolic acidosis, repeated vomiting, lethargy, hypotension or shock, or a high serum iron
- Transfusional iron overload in chronic anaemias such as thalassaemia Thalassemias (α and β) →
- Aluminium overload, for example in dialysis patients
Adverse effects
Common
- Reddish (rosé) urine
- Flushing, urticaria and hypotension, mainly with rapid intravenous infusion
- Dizziness
Contraindications
- Severe kidney disease or anuria (unless on dialysis)
- Hypersensitivity to deferoxamine
- Not used for primary (hereditary) haemochromatosis, where phlebotomy is preferred
Key interactions
- Vitamin C
- Increases chelatable iron but can worsen cardiac function; avoided in heart failure
What is monitored
- Blood pressure during the infusion
- Serum iron, acid-base status and urine colour in acute poisoning
- Kidney function
- Hearing and eye tests, ferritin and growth in long-term use
Administration and safety
- Intramuscular in patients without shock; intravenous only in cardiovascular collapse
- Always a slow infusion, never a rapid intravenous injection
- Slow subcutaneous infusion over many hours for chronic overload
Nursing care
- Estimate how much iron was taken (count the remaining tablets)
- Watch blood pressure and stop or slow the infusion if hypotension appears
- Explain that reddish urine is expected
- Report fever, abdominal pain or diarrhoea (Yersinia) and new breathing problems
Pregnancy and breastfeeding
Animal studies show fetal harm; in severe iron poisoning it is used when the benefit outweighs this risk.
Test yourself
Think of the answer, then tap the question to see it.
Which iron does deferoxamine not remove?
Iron in transferrin, haemoglobin and cytochromes.
Why does urine turn reddish during treatment?
The excreted iron–deferoxamine complex (ferrioxamine) is coloured.
Why is deferoxamine never given as a rapid intravenous injection?
Rapid injection causes flushing, urticaria, hypotension and shock.
Which infections are associated with deferoxamine?
Yersinia infections and mucormycosis.
Related conditions
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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - DEFEROXAMINE- deferoxamine mesylate injection, powder, lyophilized, for solution (DailyMed (U.S. National Library of Medicine), 2026); Guía para el Manejo de Emergencias Toxicológicas (Ministerio de Salud y Protección Social; Organización Panamericana de la Salud, 2017); eEML - Electronic Essential Medicines List (World Health Organization, 2025); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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