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Unexpected overdose of oral cyclosporine in a kidney transplant patient: a case report
  1. Astrid Bacle1,2,
  2. Roxane Lhermitte1,
  3. Brendan Le Daré3,4,
  4. Marion Mercerolle1,
  5. Cécile Vigneau2,
  6. Pascal Le Corre1,2,
  7. Jonathan M Chemouny2
  1. 1Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, Rennes, France
  2. 2Univ Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
  3. 3Laboratoire de toxicologie et médico-légale, CHU Rennes, Rennes, France
  4. 4NSERM, INRAE, Institut NuMeCan (Nutrition, Metabolisms and Cancer), Réseau PREVITOX, Rennes 1 University, Rennes, France
  1. Correspondence to Dr Astrid Bacle, Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, Rennes 35000, France; astrid.bacle{at}univ-rennes1.fr

Abstract

Cyclosporine is a widely used immunosuppressive agent to prevent rejection of solid organ transplant. Here, we describe the case of a 71-year-old man who received the prescribed dose of cyclosporine 10 times 6 days after a kidney transplantation because of a concentration miscalculation involving two galenic forms. The patient presented gastrointestinal and neurological disorders. Therapeutic drug monitoring revealed high cyclosporine blood concentrations (693 ng/mL, therapeutic range 100–300 ng/mL). Symptomatic management of digestive disorders was performed, and haemodialysis was started the day after the cyclosporine overdose in the face of acute renal failure. The patient’s disorders were quickly resolved. The dosing regimen was adapted in order to administer the most appropriate galenic form and to avoid another administration error. Long-term follow-up showed no failure of renal transplantation. The purpose of this case report is to warn physicians and clinical pharmacists about the vigilance required on cyclosporine prescription, especially when two galenic forms are administered to obtain the prescribed dose.

  • case reports
  • kidney transplantation
  • drug-related side effects and adverse reactions
  • kidney failure
  • chronic
  • safety

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All data relevant to the study are included in the article or uploaded as supplementary information.

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