Management of DFO side effects

Adverse events with DFO and their management
Common side effects	Injection site reactions	Treat supportively
Common side effects	Infections^1,2	Discontinue DFO until infection resolves^*
Uncommon side effects	Allergic reactions	Slow SC or IV infusions are recommended
	ARDS	Slow SC or IV infusions are recommended
	Cardiac dysfunction^3†	Discontinue vitamin C
	Ocular toxicity⁴	Regular visual acuity tests, slit-lamp & fundoscopy examinations are recommended
	Ototoxicity⁴	Regular audiometry is recommended
^*DFO is a siderophore and can deliver iron to microorganisms which supports their growth and replication (this is not true of DFX, which sequesters iron from microorganisms). Yersinia and mucormycosis are particular to IOL, but many infections can occur. ^†Vitamin C >500mg/day in severe IOL causes free radical production resulting in cardiomyocyte damage. ARDS, adult respiratory distress syndrome; DFO, deferoxamine; DFX, deferasirox; IOL, iron overload; IV, intravenous; SC, subcutaneous.