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Deferoxamine (DFO) is a medication used for iron (approved indication) and aluminum toxicity (off-label). It is in the chelator class of drugs. Deferoxamine chelates non-transferrin bound iron (free iron), iron in transit between transferrin and ferritin (labile chelating iron pool), hemosiderin, and ferritin. This activity will highlight the mechanism of action, adverse reactions, interactions, and other factors such as off-label use, dosing, indications, monitoring, and pharmacokinetics. The information is pertinent for members of interprofessional teams in the treatment of iron toxicity and aluminum toxicity. Objectives: Identify the mechanism of action of deferoxamine. Describe the potential adverse effects of deferoxamine. Review the appropriate monitoring for patients using deferoxamine. Outline interprofessional team strategies for improving care coordination and communication to advance the use of deferoxamine and improve outcomes. Access free multiple choice questions on this topic.

Deferoxamine treatment can be a tedious and painful process, with common local skin reactions. The patient will require strong supportive relationships with several providers, nurses, and family to maximize compliance. To provide safe chelation therapy, a patient must comply with their primary care doctor, ophthalmologist, endocrinologist, nephrologist, and hematologist. These interprofessional teams are vital to successful outcomes that decrease mortality and complications. Many of those who require chelation begin at a young age due to hereditary disease. Compliance in this age group is usually high compared to others due to parental support.[35] Compliance with the strict regimen can become problematic in adolescence or when life burdens become too cumbersome for a patient to manage. One multicenter study in Germany found that patients had more misery from chelation treatment than the disease requiring it.[35] Patient involvement, education, and behavioral support are of utmost importance. A systematic review from the Agency for Healthcare Research and Quality on interventions to improve adherence to self-administered medications found that reduced out-of-pocket expenses, case management, and patient education with behavioral support improved medication adherence.[36] Shared decision-making also has an important role. There are a variety of chelators available for Iron overdose, and providers should seek the option with the lowest burden to the patient. Allowing patients to change the chelator for various reasons helped increase compliance with the regimen.[37] We must remember that chelation will be a life-long therapy for most of these patients. It is thus critical for providers to be empathetic, educational, and inspiring.