lSIDE-EFFECTS
GENERAL SIDE-EFFECTSDizziness.urine discolouration
SPECIFIC SIDE-EFFECTS
▶With intramuscular useArrhythmia.chills.diarrhoea.drug
fever.headache.hotflush.hypokalaemia.malaise.
nausea.pain.skin reactions.thrombocytosis.tremor.
vomiting
▶With intravenous useAngioedema.diarrhoea.dysphagia.
extrasystole.gastrointestinal discomfort.hotflush.
hypersensitivity.memory loss.mucosal discolouration
red.peripheral oedema.pleural effusion.rash pustular.
red discolouration of plasma.restlessness.skin reactions.
swelling.throat complaints
▶With oral useFever.headache.hypersensitivity.nausea.
pruritus
lBREAST FEEDINGPresent in milk but not known to be
harmful.
lEFFECT ON LABORATORY TESTS
▶With intravenous useDeep red colour of hydroxocobalamin
may interfere with laboratory tests.
lDIRECTIONS FOR ADMINISTRATION
▶With intravenous useForintravenous infusion (Cyanokit)®,
given intermittentlyinSodium chloride 0. 9 %, reconstitute
5 g vial with 200 mL Sodium Chloride 0. 9 %; gently invert
vial for at least 1 minute to mix (do not shake).
▶With oral useFor administration bymouth, injection
solution may be given orally; it will not have prolonged
effect via this route.
lPRESCRIBING AND DISPENSING INFORMATION
▶With intramuscular useThe BP directs that when vitamin B 12
injection is prescribed or demanded, hydroxocobalamin
injection shall be dispensed or supplied.
Poisoning by cyanides
▶With intravenous useCyanokit®is the only preparation of
hydroxocobalamin that is suitable for use in victims of
smoke inhalation who show signs of significant cyanide
poisoning.
lNATIONAL FUNDING/ACCESS DECISIONS
NHS restrictionsCobalin-H®is not prescribable in NHS
primary care.
Neo-Cytamen®is not prescribable in NHS primary care.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Solution for injection
▶Hydroxocobalamin (Non-proprietary)
Hydroxocobalamin 1 mg per 1 mlHydroxocobalamin 1 mg/ 1 ml
solution for injection ampoules| 5 ampouleP£ 12. 49 DT = £ 6. 70
▶Cobalin(AMCo)
Hydroxocobalamin 1 mg per 1 mlCobalin-H 1 mg/ 1 ml solution for
injection ampoules| 5 ampouleP£ 9. 50 DT = £ 6. 70
▶Neo-Cytamen(RPH Pharmaceuticals AB)
Hydroxocobalamin 1 mg per 1 mlNeo-Cytamen
1000 micrograms/ 1 ml solution for injection ampoules|
5 ampouleP£ 12. 49 DT = £ 6. 70
Powder for solution for infusion
▶Cyanokit(SERB)
Hydroxocobalamin 5 gramCyanokit 5 g powder for solution for
infusion vials| 1 vialP£ 772. 002 Iron overload
Iron overload
Overview
Severe tissue iron overload can occur in aplastic and other
refractory anaemias, mainly as the result of repeated blood
transfusions. It is a particular problem in refractoryanaemias with hyperplastic bone marrow, especially
thalassaemia major, where excessive iron absorption from
the gut and inappropriate iron therapy can add to the tissue
siderosis.
Iron overload associated with haemochromatosis can be
treated with repeated venesection. Venesection may also be
used for patients who have received multiple transfusions
and whose bone marrow has recovered. Where venesection is
contra-indicated, and in thalassaemia, the long-term
administration of the iron chelating compound
desferrioxamine mesilate p. 578 is useful. Desferrioxamine
mesilate (up to 2 g per unit of blood) may also be given at the
time of blood transfusion, provided that the desferrioxamine
mesilate isnotadded to the blood and isnotgiven through
the same line as the blood (but the two may be given through
the same cannula).
Iron excretion induced by desferrioxamine mesilate is
enhanced by ascorbic acid (vitamin C) p. 629 daily by mouth;
it should be given separately from food since it also
enhances iron absorption. Ascorbic acid should not be given
to children with cardiac dysfunction; in children with normal
cardiac function ascorbic acid should be introduced 1 month
after starting desferrioxamine mesilate.
Desferrioxamine mesilate infusion can be used to treat
aluminium overloadin dialysis patients; theoretically 100 mg
of desferrioxamine binds with 4. 1 mg of aluminium.ANTIDOTES AND CHELATORS›IRON CHELATORS
Deferasirox 18-Jul-2017
lDRUG ACTIONDeferasirox is an oral iron chelator.lINDICATIONS AND DOSE
Transfusion-related chronic iron overload when
desferrioxamine is contra-indicated or inadequate in
patients with beta thalassaemia major who receive
frequent blood transfusions ( 7 mL/kg/month or more of
packed red blood cells) (specialist use only)
▶BY MOUTH
▶Child 2–5 years:Initially 7 – 21 mg/kg once daily, dose
adjusted according to serum-ferritin concentration and
amount of transfused blood—consult product
literature, then adjusted in steps of 3. 5 – 7 mg/kg every
3 – 6 months, maintenance dose adjusted according to
serum-ferritin concentration; maximum 28 mg/kg per
day; Usual maximum 21 mg/kg
Transfusion-related chronic iron overload in patients with
beta thalassaemia major who receive frequent blood
transfusions ( 7 mL/kg/month or more of packed red
blood cells) (specialist use only)
▶BY MOUTH
▶Child 6–17 years:Initially 7 – 21 mg/kg once daily, dose
adjusted according to serum-ferritin concentration and
amount of transfused blood—consult product
literature, then adjusted in steps of 3. 5 – 7 mg/kg every
3 – 6 months, maintenance dose adjusted according to
serum-ferritin concentration; maximum 28 mg/kg per
day; Usual maximum 21 mg/kg
Transfusion-related chronic iron overload when
desferrioxamine is contra-indicated or inadequate in
patients with beta thalassaemia major who receive
infrequent blood transfusions (less than 7 mL/kg/month
of packed red blood cells) (specialist use only)|
Transfusion-related chronic iron overload when
desferrioxamine is contra-indicated or inadequate in
patients with other anaemias (specialist use only)
▶BY MOUTH
▶Child 2–17 years:Initially 7 – 21 mg/kg once daily, dose
adjusted according to serum-ferritin concentration and
amount of transfused blood—consult product
literature, then adjusted in steps of 3. 5 – 7 mg/kg every576 Iron overload BNFC 2018 – 2019
Blood and nutrition9