Overdose : מינון יתר

4.9   Overdose

Symptoms of intoxication
A chronic overdose may lead to severe bone marrow depression, which may cause massive haemorrhages and life-threatening infections, as well as neurotoxicity.

The myelotoxicity of cytarabine is dose-limiting. Even within a high-dose treatment with cumulative doses of approximately 18 to 36 g of cytarabine per treatment cycle, severe bone marrow toxicity up to myelophthisis should be expected. This is only fully clinically identifiable after 1 to 2 weeks. It depends on both the dose and other factors, such as age, the clinical condition and bone marrow reserves of the patient, and on additional myelotoxic therapy.

Twelve doses of 4.5 mg/m2 by intravenous infusion, administered over the course of one hour every 12 hours, led to irreversible and fatal CNS toxicity.

Treatment of intoxication
There is no known specific antidote to cytarabine.
If intoxication occurs, immediate discontinuation of the cytarabine therapy and careful monitoring of the patient is required.
An accidental severe overdose during intrathecal use requires immediate replacement of the cerebrospinal fluid with isotonic sodium chloride solution.
Even if an overdose is only suspected, blood counts must be closely monitored for a long period.
Corresponding supportive measures should be taken (e.g. blood transfusion or platelet transfusion, antibiotics).

Cytarabine can be removed by haemodialysis. There is no information available regarding the effect in cases of overdose.