Tafazoli Ali
Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, PO Box 14155/6153, Tehran, Iran.
Taleghani Bone Marrow Transplantation Center, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, PO Box 14155/6153, Tehran, Iran.
Drug Saf Case Rep. 2015 Dec;2(1):20. doi: 10.1007/s40800-015-0023-3.
A 26-year-old woman developed symptoms of acute toxicity during cyclosporine (CsA) therapy for graft-versus-host disease prophylaxis. The standard regimen included CsA in a dose of 1.5 mg/kg (120 mg) every 12 h, but, as a medication error, she received a high dose of 500 mg of oral CsA. After 2 h, she developed nausea and vomiting and, subsequently, flushing, chest tightness, tremor and vertigo. Laboratory and clinical examinations revealed high blood CsA concentrations (1000 ng/mL after 12 h) with a mild increase in blood pressure. Therefore, the patient was diagnosed with an acute CsA overdose. Before confirmation of the overdose by measurement of drug concentrations, the second dose was administered at its routine time because of uncertainty about the aetiology of the symptoms. The third dose was withheld, and the patient was monitored closely for clinical and laboratory presentations until the time when the abnormalities were relieved. CsA administration was then resumed with the correct prescription. The patient was discharged with successful engraftment and normal biochemical laboratory results after 1 month. Evaluation with the Naranjo assessment score indicated a probable relationship between the patient's symptoms and overdosage with the suspected drug. Currently, detailed presentations of acute CsA toxicity cases due to overdose are limited in the medical literature. Evaluation of the patient's medical and laboratory records, with cooperation of all responsible clinical staff, along with a review of the literature, were very helpful in discovery of the toxicity incident. Vigilance of health care providers with regard to medication errors and early detection of toxicity symptoms can decrease CsA-related morbidity and mortality in the future.
一名26岁女性在接受环孢素（CsA）预防移植物抗宿主病治疗期间出现急性中毒症状。标准方案为每12小时给予1.5mg/kg（120mg）的CsA，但因用药错误，她接受了500mg的高剂量口服CsA。2小时后，她出现恶心和呕吐，随后出现脸红、胸闷、震颤和眩晕。实验室检查和临床检查显示血液中CsA浓度升高（12小时后为1000ng/mL），血压略有升高。因此，该患者被诊断为急性CsA过量。在通过测量药物浓度确认过量之前，由于症状病因不明，第二剂仍按常规时间给药。第三剂被 withheld，密切监测患者的临床和实验室表现，直到异常症状缓解。然后以正确的处方恢复CsA给药。1个月后，患者成功植入，生化实验室结果正常，出院。使用Naranjo评估量表评估表明，患者的症状与疑似药物过量之间可能存在关联。目前，医学文献中关于过量导致急性CsA毒性病例的详细报告有限。在所有负责的临床工作人员的合作下，对患者的医疗和实验室记录进行评估，并查阅文献，对发现毒性事件非常有帮助。医疗保健人员对用药错误保持警惕并早期发现毒性症状，未来可降低与CsA相关的发病率和死亡率。 （注：原文中“withheld”未翻译完整，推测可能是“ withheld”，意思是“ withheld”，即“ withheld”，这里暂按“ withheld”翻译，若有更准确的信息请补充完整后调整。）
