From the FDA Drug Label
OVERDOSAGE There is a minimal experience with cyclosporine overdosage. Forced emesis can be of value up to 2 hours after administration of cyclosporine [MODIFIED]. Transient hepatotoxicity and nephrotoxicity may occur which should resolve following drug withdrawal Oral doses of cyclosporine up to 10 g (about 150 mg/kg) have been tolerated with relatively minor clinical consequences, such as vomiting, drowsiness, headache, tachycardia and, in a few patients, moderately severe, reversible impairment of renal function. However, serious symptoms of intoxication have been reported following accidental parenteral overdosage with cyclosporine in premature neonates General supportive measures and symptomatic treatment should be followed in all cases of overdosage. The best management approach for a cyclosporin overdose is to follow general supportive measures and symptomatic treatment. Additionally, forced emesis may be of value up to 2 hours after administration of cyclosporine. It is also important to note that cyclosporine is not dialyzable to any great extent, nor is it cleared well by charcoal hemoperfusion 1.
From the Research
The best management approach for a cyclosporin overdose involves immediate discontinuation of the drug, supportive care, and close monitoring of vital signs and organ function. This approach is based on the most recent and highest quality study available, which highlights the importance of supportive care in managing cyclosporin overdose 2. Treatment should begin with gastric decontamination using activated charcoal if the patient presents within 1-2 hours of ingestion. Intravenous fluid administration is crucial to maintain adequate hydration and support renal function, as cyclosporin is nephrotoxic.
Some key considerations in the management of cyclosporin overdose include:
- Continuous cardiac monitoring due to potential cardiovascular effects
- Laboratory monitoring, including cyclosporin blood levels, renal function tests, liver function tests, and electrolytes, particularly potassium and magnesium
- Hemodialysis may be considered in severe cases with significant renal impairment, although it is generally not effective for cyclosporin removal due to its high protein binding and lipophilicity
- Management of symptoms and complications, such as hypertension, seizures, or electrolyte imbalances, as specific antidotes do not exist for cyclosporin toxicity
It is also important to note that recovery from cyclosporin overdose typically occurs with supportive care as the drug is metabolized and eliminated, although this may take several days due to cyclosporin's long half-life. Consultation with a poison control center or toxicologist is advisable for guidance on management of severe overdoses 2. The use of sequential plasma exchange and red blood cell exchange has been reported as an effective approach in managing cyclosporin overdose in certain cases 2.