Context
Cyclosporine is the first drug to revolutionize organ transplantation; this drug was approved for autoimmune and graft versus host disease (GVHD) treatment. Based on case reports, Cyclosporine overdose has morbidities (including acute renal failure (ARF), seizure, coma, hepatitis, and neurologic disorder) and mortality.
Background
Although cyclosporine was discovered many years ago and is still used to treat many diseases, its narrow therapeutic index can cause significant problems.
Methods
We performed a literature search across three databases, including Medline, EMBASE, and Science Direct, and reviewed statistical sources from January 1, 1983, to April 31, 2020. Papers were eligible for what they described, either acute or acute chronic cyclosporine overdose. At least one serum cyclosporine concentration had to be reported for inclusion. Reports on chronic poisoning, studies on side effects of therapeutic drug uses, and animal studies were excluded.
Results
We found 81 cases from 37 articles that met inclusion criteria, potentially life-treating symptom coma (10%), seizure (16%), cardiac tachycardia (3%), and death (5%). Pediatrics are more susceptible to cyclosporine overdose, treatment interventions like gastric lavage (6.3%), charcoal administration (6.3%), whole blood exchange (5%), a huge overdose of more than 400 mg/kg oral route, or serum levels of more than > 3800 ng/ml related to death, seizure associated with upper threshold level > 500 ng/ml and coma related to the upper level of 1000 ng/ml cyclosporine levels, charcoal administration, and whole blood exchange reduce cyclosporine level and cure the patients.
Conclusions
Fifty percent of patients showed no or minimum toxicity and fifty percent showed severe signs and symptoms of poisoning. Almost all patients have a good outcome if cyclosporine overdose is diagnosed and treated on time.
