Chemotherapy Overdose: Understanding the Risks

Introduction

Chemotherapy is the most prototypical cancer care, but it is significant to recognize that the drugs delivered into the body are intentional toxins. As these chemicals eradicate cancerous cells, they also can impact other organs and tissues. Specific side effects such as fatigue, hair loss, nerve issues, infection, kidney and bladder issues, and fertility issues may be experienced.

Nevertheless, there are chances that chemotherapy's side effects may lead to the additional manifestation of some other symptoms in addition to discomfort and nominal ache. These involve severe medical illnesses. In such circumstances, the patient may have undergone a chemo overdose due to a physician’s mistake.

What Is Chemotherapy Overdose?

Chemotherapy overdose happens when a patient has a highly toxic response to certain chemotherapy medications or in some patients, is delivered without the intention of an unreasonable dose. Both options are intensely infrequent. Symptoms present as reduced or even arrested heart rate, difficulty breathing, and reduced level of consciousness. Medicines like Uridine triacetate support the reversal of reaction of chemotherapy medications, thus obstructing cell death and arresting damages, and saving lives if delivered instantly.

What Are the Symptoms of Chemo Overdose?

Any chemotherapy side effects can be a problem, but they are expected in most circumstances. Nevertheless, the patient could be undergoing chemo overdose if presents with the following symptoms:

• Extremely decreased heart rate.

• Acute myocardial infarction, like a heart attack.

• Convulsions.

• Discomfort or ache in urination.

• Unusually reduced breathing rate.

• Coma.

• Agonizing ache.

• Extreme diarrhea, nausea, and vomiting.

• Elevated fever.

• Extreme bleeding.

It is important to pursue appropriate medical alerts in the event of developing any of these manifestations, either at a critical care center or at the emergency room. There are diverse forms of therapy to counter the consequences, involving an antidote for chemotherapy overdose.

What Are Antidotes for Chemotherapy Overdoses?

• The oncology pharmacotherapy delivery needs procedures assuring accurate, meticulous, and careful care. The limited therapeutic range of oncology drugs causes it to confirm the proper dosage is delivered. Chemotherapy drugs have a limited therapeutic index and are frequently given through complex dosing calculations to ensure the patient is managed correctly. Despite all the precautions and care to secure safe oncology pharmacotherapy, mistakes happen.

• If a chemotherapy overdose does happen, one method to fight toxicities and control permanent sequelae is administering antidotes. Unfortunately, direct antidotes are not available for most chemotherapies, but it is important for pharmacists to know the diverse agents that can be utilized if the requirement for one does arise. Except for Uridine triacetate, a U.S. Food and Drug Administration (FDA) authorized antidote for Fluorouracil, and Capecitabine overdosage and earlier-onset toxicity, information concerning antidotes for chemotherapy overdoses are confined to short studies and case information.

Uridine Triacetate for Fluorouracil or Capecitabine Overdose or Earlier Onset Toxicity

• Uridine triacetate is presently suggested for managing Fluorouracil or Capecitabine overdose and for managing cases that develop earlier, life-threatening toxicities with these medicines. Overdoses from these medicines may be unexpected or intended. The possibility for error is connected to Fluorouracil chemotherapy pump malfunctions and accidental intake of Capecitabine tablets. Extreme toxicities are noticed in acute overdose involving acute cardiomyopathy, altered mental level, mucositis, severe nausea, and diarrhea. Also, genetic enzyme variants might improve toxic consequences in certain patients at typically well-tolerated amounts.

• Uridine triacetate was examined in two open-label compassionate-use experiments. The objective of these analyses was to assess the influence of Uridine triacetate on case results in the set of either an overt overdose, described as intake of a more extensive dose of Fluorouracil than scheduled, or earlier-onset severe toxicity, described as a patient’s evolution of extreme toxicities within 96 hours of a Fluorouracil infusion or the normal14-day course of Capecitabine therapy. This is because involving a placebo arm in the practice was thought unethical. Consequences for Uridine triacetate therapy for overdose corresponded with those for a recorded cohort managed with the best supportive care. Adult dosage consisted of Uridine triacetate 10 grams orally every six hours. In pediatric cases, given 6.2 g/m2 maximum of 10 grams by oral route every six hours. A complete therapy period comprises 20 doses, typically started within 96 hours of the last Fluorouracil or Capecitabine dosage. Survival of the patient or chemotherapy resumption following 30 days was the primary endpoint and side effects were registered to evaluate safety. Uridine triacetate dosages should be administered again if the patient vomits within two hours of intake.

Glucarpidase for Intravenous and Intrathecal Methotrexate Overdose

• Elevated-dose Methotrexate (HDMTX), typically described as intravenous doses of at least 500 mg/m2 delivered over two to thirty-six hours, is an essential treatment for managing numerous malignancies. Even though Folinic acidrescue, urine alkalinization, and avoidance of simultaneous Nephrotoxins decrease the hazard of acute kidney damage related to Methotrexate, in some instances may require the recovery agent Glucarpidase to reduce Methotrexate levels and control enduring sequelae of toxicities quickly. Glucarpidase is FDA-approved for cases who undergo toxic levels of systemic Methotrexate secondary to intense Methotrexate-induced renal impairment. The medication is a recombinant bacterial enzyme that acts by deactivating Methotrexate into two passive metabolites. It functions fast, reducing serum Methotrexate levels by over 97 percent within 15 minutes of administration. Even though the typical route of administration is intravenous, analyses examining administration through the intrathecal route in the background of acute intrathecal Methotrexate overdose have been shown.

Sodium Thiosulfate for Cisplatin Overdose

• Cisplatin overdoses have multi-organ system consequences, involving but not restricted to acute renal failure, myelosuppression, vomiting, and neurological consequences like ototoxicity and seizures. No typical antidote is available for Cisplatin overdose, and existing therapy choices are restricted to aggressive supportive maintenance.

• Sodium thiosulfate, a drug initially utilized to manage acute cyanide poisoning, has been used to control Cisplatin renal toxicity. The content is hypothesized to have renal-protective outcomes by attaching free serum platinum and enhancing the renal clearance of passive metabolites. However, proof concerning the usage of Sodium thiosulfate for reversal of acute kidney injury secondary to Cisplatin overdose is restricted to patient reports.

Conclusion

Oncology pharmacotherapy aims to deliver potentially fatal medicines securely that will optimize medicinal advantage and reduce harm. Nevertheless, pharmaceutical errors can still happen, and this strategy's objective is to control toxicity to reduce disadvantages to patients instantly. Following the FDA approval of Uridine triacetate, the Institute of Safe Medication Practices (ISMP) issued an article outlining case reports of 5-FU overdoses and suggestions for managing these circumstances. Pharmacists are uniquely placed to perform as subject matter specialists on chemotherapy agents and their separate antidotes and should be concerned with developing chemotherapy antidote protocols.