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Symptoms: Overdose effects are expected to be an extension of adverse events and include bone marrow suppression, peripheral neurotoxicity, and mucositis.
Mild to moderate toxicity: Early symptoms may include: nausea, vomiting and diarrhea.
Severe toxicity: Myelosuppression (neutropenia and febrile neutropenia) is likely to develop and can be severe. Anemia and thrombocytopenia may develop. Other potentially serious events include: liver function impairment; fluid retention leading to edema, dyspnea, cardiac tamponade, or pleural effusion; and severe stomatitis. Patients with abnormal liver function are at increased risk of toxicity.
Treatment: Treatment is primarily symptomatic and supportive, there is no antidote. Colony stimulating factor (filgrastim or sargramostim) should be initiated as soon as possible. Patients with severe neutropenia should be in protective isolation. Platelet and red cell transfusions may be necessary. In case of emesis, aggressively treat with antiemetics and fluid and electrolyte replacement as indicated. Closely monitor patients for hypotension, bradycardia, and other cardiac dysrhythmias. Monitor liver enzymes and renal function.
