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Accidental High-Dose Cyclosporine Administration in a Kidney Transplant Recipient: A Case Report and Literature Review
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Farnaz Tavakoli   , Hanieh Esfandiari Bayat , Esmat Abdollahpour * |
| Department of Nephrology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran |
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Abstract: (52 Views) |
Abstract
We present the case of a 54-year-old female patient with a history of two kidney transplants who was receiving standard immunosuppressive therapy post-transplantation. Due to a medication error, she received cyclosporine (Sandimmun) at a dose of 500 mg in the morning and 1000 mg at night—20 times the prescribed regimen of 25 mg in the morning and 50 mg at night—for three consecutive days. She presented with symptoms of nausea, vomiting, tremor, facial flushing, headache, and elevated blood pressure. Laboratory investigations revealed a marked increase in serum creatinine and severe metabolic acidosis. Her serum cyclosporine concentration was measured at 524 ng/mL, consistent with acute cyclosporine toxicity.
Cyclosporine was immediately discontinued, and serum levels were closely monitored. Upon normalization, standard dosing was cautiously reinitiated. Antihypertensive therapy was administered to control blood pressure. The patient’s clinical symptoms improved, and serum creatinine returned to baseline within five days, allowing for discharge.
Acute cyclosporine toxicity can manifest with a spectrum of complications, including gastrointestinal disturbances, neurological symptoms, cardiovascular effects, and renal and hepatic dysfunction, ranging from mild to life-threatening. This case underscores the critical importance of accurate dosing, therapeutic drug monitoring, and patient education in the administration of immunosuppressive agents. It also highlights the need for vigilance among healthcare providers to prevent medication errors and to ensure prompt recognition and management of drug-related toxicities.
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Article number: 4 |
| Keywords: Acute toxicity, Cyclosporine, Hypertension, Tremor, Renal dysfunction |
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Full-Text [PDF 656 kb]
(25 Downloads)
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Type of Study: case report |
Subject:
Special
Received: 2025/09/3 | Accepted: 2026/06/17 | Published: 2026/06/25
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