Acute mycophenolate overdose: case series and systematic literature analysis.
- Ceschi A Swiss Toxicological Information Centre, Associated Institute of the University of Zurich , Freiestrasse 16, CH-8032 Zurich , Switzerland +41 44 634 1034 ; +41 44 252 8833 ; Alessandro.Ceschi@usz.ch.
- Gregoriano C
- Rauber-Lüthy C
- Kupferschmidt H
- Banner NR
- Krähenbühl S
- Taegtmeyer AB
- 2014-03-25
Published in:
- Expert opinion on drug safety. - 2014
Adolescent
Adult
Antidotes
Charcoal
Child
Child, Preschool
Drug Overdose
Female
Humans
Immunosuppressive Agents
Male
Middle Aged
Mycophenolic Acid
Treatment Outcome
Young Adult
English
BACKGROUND
Literature regarding acute human toxicity of mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS) is limited.
OBJECTIVES
Our objectives were to describe all cases of overdose with MMF or EC-MPS reported to the Swiss Toxicological Information Centre (STIC) or in the literature between 1995 and 2013. Therefore, we performed an observational case-series and systematic literature search to determine circumstances, magnitude, management and outcome of overdose with MMF or EC-MPS.
RESULTS
Of 152,762 reports to STIC, 15 (7 pediatric) involved overdose with MMF (n = 13) or EC-MPS (n = 2). Three cases from other centers were identified from a systematic literature search. The magnitude of overdose ranged from 1.2 to 16.7 (median 2.9) times usual dose. Six (33%) MMF overdoses had attributable symptoms, which included abdominal pain, vomiting, headache and dizziness. The majority of findings were minor, although a 9-fold MMF overdose caused hypotension 8 h after ingestion and a 12.5-fold overdose caused leukopenia after 5 days. Symptoms did not occur in patients who took 2.5 times or less of their usual MMF dose. Gastrointestinal decontamination measures with activated charcoal were undertaken in one-third of cases.
CONCLUSIONS
Acute MMF and EC-MPS overdoses had a favorable outcome in all cases reported to STIC and in the literature.
Literature regarding acute human toxicity of mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS) is limited.
OBJECTIVES
Our objectives were to describe all cases of overdose with MMF or EC-MPS reported to the Swiss Toxicological Information Centre (STIC) or in the literature between 1995 and 2013. Therefore, we performed an observational case-series and systematic literature search to determine circumstances, magnitude, management and outcome of overdose with MMF or EC-MPS.
RESULTS
Of 152,762 reports to STIC, 15 (7 pediatric) involved overdose with MMF (n = 13) or EC-MPS (n = 2). Three cases from other centers were identified from a systematic literature search. The magnitude of overdose ranged from 1.2 to 16.7 (median 2.9) times usual dose. Six (33%) MMF overdoses had attributable symptoms, which included abdominal pain, vomiting, headache and dizziness. The majority of findings were minor, although a 9-fold MMF overdose caused hypotension 8 h after ingestion and a 12.5-fold overdose caused leukopenia after 5 days. Symptoms did not occur in patients who took 2.5 times or less of their usual MMF dose. Gastrointestinal decontamination measures with activated charcoal were undertaken in one-third of cases.
CONCLUSIONS
Acute MMF and EC-MPS overdoses had a favorable outcome in all cases reported to STIC and in the literature.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1517/14740338.2014.903032
- PMID 24655210
- Persistent URL
- https://sonar.rero.ch/global/documents/228729
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