Because of the inherently cytotoxic nature of most chemotherapeutic antineoplastic agents, overdoses are likely to be extremely serious. These agents are classified into ten categories (Table II–10). Other than iatrogenic errors, relatively few acute overdoses have been reported for these agents. Radiologic agents are not included in this chapter, and arsenic is discussed in Arsenic.
Table II-10 Antineoplastic Drugs |Favorite Table|Download (.pdf)
Table II-10 Antineoplastic Drugs
Major Site(s) of Toxicitya
G+, N+, M+
Reversible peripheral sensory neuropathy.
An+, D++, G+, M++
Potentially fatal dermatologic reactions. Watch for tumor lysis syndrome.
D+, En+, G+, M+, N+, P++
Pulmonary fibrosis, adrenal insufficiency with chronic use. Acute overdose of 2.4 g was fatal in a 10-year-old, and 140 mg resulted in pancytopenia in a 4-year-old. High doses cause coma, seizures. Hemodialysis may be effective.
D+, Ex+, G++, H+, M+, P+
Flushing, hypotension, and tachycardia with rapid IV injection.
D+, G+, H+, M+, N++
Seizures, confusion, coma reported after overdose. Acute overdoses of 0.125–6.8 mg/kg in children caused seizures up to 3–4 hours after ingestion. Bone marrow suppression with >6.5 mg/kg. Peak serum level 0.8 hours after oral dose. Not dialyzable.
Al++, C+, D+, En+, G++, M++, R+
Severe left ventricular dysfunction, moderate transaminitis after 16,200 mg over 3 days. Hemodialysis may be effective. Mesna and N-acetylcysteine have been used investigationally to reduce hemorrhagic cystitis.
Al+, An+, En+, G++, H+, M+, N++
May produce flulike syndrome. Photosensitivity reported.
En±, G±, H±, M±
Has weak estrogenic and alkylating activity.
AI++, M++, N++, G++, R++
Hemorrhagic cystitis, somnolence, confusion, hallucinations, status epilepticus, coma seen during therapy. Combined hemodialysis and hemoperfusion reduced serum levels by 84%. Methylene blue may protect against and treat encephalopathy.
Al+, G+, H+, M+, P+
Thrombocytopenia, leukopenia, liver and lymph node enlargement seen after overdose. 1400 mg taken over one week was fatal in an adult. Peak level 1–4 hours after oral dose.
D+, Ex++, G++, M++, N+
Lymphocytopenia may occur within 24 hours. Watch for hyperuricemia.
An+, G+, M+, N+, P+
Hemodialysis may be effective although of questionable need (normal half-life only 90 minutes). Peak level at 1 hour after oral dose.
Thiotepa (triethylene-thiophosphoramide, TSPA, TESPA)
An+, G++, M++
Bone marrow suppression usually very severe.
Al+, G+, M+, N+
Overdose of 5500 mg over 2 days caused pancytopenia between 1 and 4 weeks. Peak plasma level at 1 hour after oral dose.
An++, D++, G+, P++
Pulmonary toxicity (eg, pneumonitis, fibrosis) in about 10% of patients. High concentration of inhaled oxygen may worsen injury. Febrile reaction in 20–25% of patients.
Dactinomycin (actinomycin D)
Al++, D+, Ex++, G++, M++, N+
A 10-fold overdose in a 1-year-old child resulted in severe hypotension, pancytopenia, acute renal failure, choreoathetosis. Highly corrosive to soft tissue.
Al+, An+, C++, Ex++, G++, M++
Congestive cardiomyopathy may occur ...