Acute cyclosporin overdose. A review of present clinical experience

Although cyclosporin is widely used in transplant patients, experience regarding the consequences of an overdose is limited. This article summarises the data available on 27 patients with oral (n = 20) or parenteral (n = 7) overdosage of cyclosporin. The available clinical data are consistent with predictions derived from animal toxicological studies, suggesting a low acute toxicity of the drug in humans. Acute oral overdoses result in minimal clinical manifestations and/or mild degrees of renal dysfunction, primarily in patients with previously impaired kidney function. Acute parenteral overdoses may have more serious consequences, premature neonates being at particular risk of developing life-threatening reactions. Determinations of blood concentrations of cyclosporin are of limited use in the management of patients with acute overdose. Guidelines are suggested for the management of such patients.