An overview of complications associated with deferoxamine therapy in thalassemia

Abstract

Thalassemic syndromes are the most common genetic diseases in the world that are related to blood transfusion and iron overload in the body. In ß-thalassemia major multiple blood transfusions due to ineffective erythropoiesis lead to iron excess in the body. Iron chelating agent deferoxamine is used to treat chronic iron overload in patients with β-thalassemia in an attempt to reduce morbidity and mortality related to deposition of excess iron in body tissue. However, a very short half-time, the need of repetitive injections and non-specialized distribution in tissues can lead to side effects, such as ophthalmic and renal complications, neurological, skeletal changes and hearing loss, headaches, and infection too. Patients should be monitored periodically for complications. The risk of toxic effects in doses of more than 50 mg/kg/d is higher. Keeping deferoxamine therapeutic index can avoid drug overdose and side effects.

Healthcare resource utilization and direct costs of transfusion-dependent thalassemia patients in Dubai, United Arab Emirates: a retrospective cost-of-illness study

“…These differences were caused by the fact that splenectomized patients tend to be more prone to clinical complications [59]. Patients treated with DFO, which has a very short half-life that requires repetitive injections and non-targeted distribution in tissues, can develop brain, lung, and kidney damage that can cause other problems, such as peripheral neuropathy and glandular and growth disorders [60]; this requires more frequent physician consultations than other ICTs. The regression analysis related to consultations revealed that DFO, combined treatment, and a history of splenectomy were associated with an expected increase in the number of consultation services.…”

Quercetin attenuates neurotoxicity induced by iron oxide nanoparticles

“…DFO treatment improves post-stroke cognitive dysfunction and long-term sensorimotor via a decrease in markers of oxidative stress, ferroptosis, BBB permeability, microglial activation in the rat model [275]. Despite DFO is an efficient natural chelator, it has a wide range of side effects including renal complications, dysfunction of auditory and visual systems, growth retardation, especially in children [276,277], allergic reactions at the infusion site [278], and neurological side effects at high doses [271]. Some of these side effects are removed by lowering the dose [276,277].…”

“…Despite DFO is an efficient natural chelator, it has a wide range of side effects including renal complications, dysfunction of auditory and visual systems, growth retardation, especially in children [276,277], allergic reactions at the infusion site [278], and neurological side effects at high doses [271]. Some of these side effects are removed by lowering the dose [276,277].…”

“…Recommended dose 500-1000 mg/day for short time (web Subcutaneous and intravenous [267] Oral [279](dispersible tablet) [271] Oral [92]tablets and solution [271] Stoichiometry (chelator:iron Neurological side effects at high doses [271], ocular and auditory toxicity, renal complications, growth retardation [276,277], local allergic reactions [278] Skin rash, gastrointestinal complications, [283], enhancing liver enzymes [271] Gastrointestinal complications, musculoskeletal pain, neutropenia [284], and enhancing liver enzymes [271] Advantages No side effects in desirable doses and duration of medication (web ref, 14 and 15), supplied by natural sources, and longer plasma half-life than current chelators (e.g. DFO, DFX, and DFP)…”