title: Acute mycophenolate overdose: case series and systematic literature analysis.
abstract: BACKGROUND
  Literature regarding acute human toxicity of mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS) is limited.
  
  
  OBJECTIVE
  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.
authors.affiliation: 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.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ceschi
authors.forename: Claudia
authors.initials: C
authors.lastname: Gregoriano
authors.forename: Christine
authors.initials: C
authors.lastname: Rauber-Lüthy
authors.forename: Hugo
authors.initials: H
authors.lastname: Kupferschmidt
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Banner
authors.forename: Stephan
authors.initials: S
authors.lastname: Krähenbühl
authors.forename: Anne B
authors.initials: AB
authors.lastname: Taegtmeyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000931:Antidotes / Q000627:therapeutic use; D002606:Charcoal / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D062787:Drug Overdose / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000633:toxicity; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000633:toxicity; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000931:Antidotes; D007166:Immunosuppressive Agents; D002606:Charcoal; D009173:Mycophenolic Acid