Cyclophosphamide intoxication because of pharmacy error in two dogs

Area of Science:

• Veterinary Medicine
• Toxicology
• Pharmacology

Background:

• Cyclophosphamide is a chemotherapy drug with significant toxicity.
• Pharmacy errors can lead to accidental drug dispensing, posing risks to animal health.
• This case highlights the potential for severe adverse events when chemotherapy drugs are misprescribed.

Observation:

• Two dogs, a Yorkshire Terrier and a West Highland White Terrier, were inadvertently administered high doses of cyclophosphamide instead of cyclosporine.
• Clinical signs included lethargy, anorexia, vomiting, and diarrhea.
• Both dogs developed severe leukopenia and thrombocytopenia, indicating bone marrow suppression.

Findings:

• Despite severe clinical signs and clinicopathologic abnormalities, both dogs recovered fully with intensive supportive care.
• Treatment strategies varied based on disease severity, including antimicrobials, granulocyte colony-stimulating factor, appetite stimulants, gastroprotectants, and blood product transfusions.
• This report details the first documented survival of dogs with prolonged cyclophosphamide intoxication from a pharmacy error.

Implications:

• Appropriate and timely supportive care is crucial for managing accidental cyclophosphamide intoxication in dogs.
• Veterinarians should be vigilant for potential medication errors, especially when patients present with unexpected toxicities.
• This case underscores the importance of meticulous pharmacy dispensing practices to prevent potentially fatal medication errors in veterinary patients.