What is the appropriate IV dosing and administration protocol for 3 g of deferoxamine (Desferal) in a 92‑kg female?

Deferoxamine 3 g IV Administration in a 92 kg Female

For a 92 kg female requiring 3 g IV deferoxamine, administer the dose as a slow continuous infusion over 8–12 hours at a rate not exceeding 15 mg/kg/hr (approximately 23 mg/hr or 1380 mg/hr for this patient's weight), ensuring the total daily dose does not exceed 6000 mg in 24 hours. 1

Dosing Calculation and Administration Protocol

Weight-based dosing considerations:

• At 92 kg, standard chronic iron overload dosing ranges from 40–50 mg/kg/day (3680–4600 mg/day) for adults 1
• The requested 3 g dose falls within safe limits and represents approximately 33 mg/kg for this patient 1

Critical infusion rate restrictions:

• The first 1000 mg must not exceed 15 mg/kg/hr (1380 mg/hr for 92 kg), which translates to infusing the first gram over approximately 43 minutes minimum 1
• Subsequent dosing (the remaining 2000 mg) must not exceed 125 mg/hr, requiring a minimum of 16 hours for the remaining dose 1
• In practical terms, infuse the entire 3 g dose over 8–12 hours to ensure safety margins 2, 1

Reconstitution Instructions

Prepare for IV administration:

• Reconstitute each 2 g vial with 20 mL sterile water for injection (final concentration 95 mg/mL) 1
• For 3 g total: use one 2 g vial plus one 500 mg vial (reconstituted with 5 mL sterile water) 1
• Add reconstituted solution to 0.9% sodium chloride, glucose in water, or Ringer's lactate 1
• Solution should be clear and colorless to slightly yellowish; discard if turbid 1
• Use immediately after reconstitution (within 3 hours) or within 24 hours if prepared under validated aseptic conditions 1

Clinical Context and Route Selection

IV route is specifically indicated for:

• Patients in cardiovascular collapse or shock (requiring slow infusion, not bolus) 1
• Cardiac decompensation from iron overload (50–60 mg/kg/day continuous infusion) 3, 4
• Patients with existing IV access who cannot tolerate subcutaneous administration 1

Continuous IV deferoxamine clears cardiac iron at nearly 5% per month compared to only 1.1–2.2% per month with intermittent subcutaneous dosing, making it superior for cardiac iron overload 5, 2

Critical Safety Monitoring

Infusion-related complications to monitor:

• Hypotension if given as rapid bolus – always use slow infusion 4
• Acute respiratory distress syndrome (ARDS) when infusion rates exceed recommended limits – this is the most serious acute complication 2, 4
• Renal toxicity, particularly with high IV doses – monitor renal function 2

Infection risk:

• Increased susceptibility to Yersinia and Klebsiella infections throughout treatment 2, 4
• Monitor for signs of opportunistic infections 4

Dose-related toxicities (more relevant for chronic use):

• Visual and auditory disturbances – baseline and annual ophthalmologic/audiologic exams recommended 2
• Growth retardation in pediatric patients when doses are excessive relative to iron burden 2

Contraindications and Precautions

Avoid vitamin C supplementation during deferoxamine therapy, as pharmacological vitamin C doses can accelerate iron mobilization beyond transferrin saturation capacity, increasing pro-oxidant activity and risk of sudden death in cardiac involvement 2

Do not administer concurrently with blood transfusion, as this complicates interpretation of side effects like rash, anaphylaxis, and hypotension 1

Transition Planning

As soon as the patient's clinical condition permits, switch from IV to subcutaneous or intramuscular administration 1, as prolonged IV access carries infection risks and continuous IV is typically reserved for acute situations 2, 6

For chronic iron overload maintenance after stabilization, subcutaneous administration at 1000–2000 mg over 8–24 hours via portable pump is the standard approach 1, though deferiprone may be superior for cardiac iron clearance if cardiac involvement is present 5, 3