Sinus bradycardia associated with cyclosporine following allogeneic hematopoietic stem cell transplantation

Fujisaki, G.; Kami, Masahiro; Murashige, Naoko; Kishi, Yukiko; Inokuchi, Chiho; Tanosaki, Ryuji; Momomura, Shin‐ichi

doi:10.1038/sj.bmt.1704747

Cited by 7 publications

(4 citation statements)

References 4 publications

(3 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Contrary to the multidrug intoxication theory, Fujisaki G. et al suggested that CSA itself could be the cause of bradycardia in a patient who underwent alloHSCT. 14 However, the authors proposed a dosage-dependent cause of arrythmia, which was not observed in our study. A series of cases presented by Moulin D. et al also indicated cyclosporine as a single agent causing side effects, including bradycardia.…”

Section: Discussioncontrasting

confidence: 81%

Sinus bradycardia as a rare adverse event in patients receiving cyclosporine A after allogeneic hematopoietic stem cell transplantation.

Karasek,

Majcherek,

Kuszczak

et al. 2024

Clinical Hematology International

View full text Add to dashboard Cite

Cyclosporine A (CSA) is a commonly used immunosuppressive agent for the prophylaxis of graft-versus-host disease following allogeneic hematopoietic stem cell transplantation (alloHSCT). While tachycardia is a known adverse effect of CSA, bradycardia remains a phenomenon rarely described in the literature. We conducted a retrospective evaluation of the incidence of bradycardia in patients after alloHSCT treated with CSA between January 2020 and February 2023 at our center. Out of 206 patients, sinus bradycardia following the administration of CSA was observed in 6 (2.9%), comprising 3 women and 3 men, with the median age of 55 years (range: 20-65). The underlying diseases were myeloid malignancies in 4 and aggressive lymphoma in 2 patients. The patients received grafts from a matched unrelated (n=5) or a haploidentical family donor (n=1) following various conditioning regimens. Coexisting cardiovascular disorders were found in 5 of the 6 patients. All patients experienced symptomatic bradycardia within 1-4 days (median 2 days) after CSA introduction, which persisted until CSA withdrawal. One patient required treatment with atropine. All patients continued their immunosuppressive therapy with tacrolimus, which was well-tolerated Our study indicates CSA as a causative factor of sinus bradycardia in a small percentage of alloHSCT patients receiving CSA as graft-versus host disease (GvHD) prophylaxis. Importantly, these patients did not experience any cardiac complications when switched to tacrolimus. Although further research on the effects of CSA on heart automatation is needed, our single-center experience can help prompt diagnosis and therapeutic intervention in daily clinical practice.

show abstract

Section: Discussioncontrasting

confidence: 81%

Sinus bradycardia as a rare adverse event in patients receiving cyclosporine A after allogeneic hematopoietic stem cell transplantation.

Karasek,

Majcherek,

Kuszczak

et al. 2024

Clinical Hematology International

View full text Add to dashboard Cite

show abstract

“…Cardiovascular adverse effects include hypertension and bradycardia after transplantation. 3,4 In our case, we observed bradycardia attacks caused by the medication. The patient had no structural/ arrhythmogenic heart disease and no drug interactions.…”

Section: Discussionsupporting

confidence: 49%

“…The first theory suggests that the drug can suppress nodal automaticity leading to sinus exit block. 7 The following less likely theory suggests bradycardia resulted from the medication's parasympathomimetic activity. 8 The bradycardia side effect was determined as dose-dependent, 4,9 which is consistent with our case.…”

Section: Discussionmentioning

confidence: 99%

Cyclosporine induced bradycardia: is it rarely seen?

Mutlu¹,

Kültürsay²,

Akman³

et al. 2023

JCCVS

View full text Add to dashboard Cite

show abstract

“…Even the coronary and cerebral vascular systems are affected by this medication, which can result in hazardous outcomes. Also, direct cardiotoxic effects have been reported with CsA, such as sinus bradycardia [17] or decreased myocardial contractile force [18]. In a report of a 61-year-old candidate for kidney transplantation, inadvertent preoperative administration of CsA 1000 mg instead of mycophenolate caused atrial fibrillation.…”

Section: Resultsmentioning

confidence: 99%

Accidental Overdose of Oral Cyclosporine in Haematopoietic Stem Cell Transplantation: A Case Report and Literature Review

Tafazoli

2015

Drug Saf - Case Rep

View full text Add to dashboard Cite

A 26-year-old woman developed symptoms of acute toxicity during cyclosporine (CsA) therapy for graft-versus-host disease prophylaxis. The standard regimen included CsA in a dose of 1.5 mg/kg (120 mg) every 12 h, but, as a medication error, she received a high dose of 500 mg of oral CsA. After 2 h, she developed nausea and vomiting and, subsequently, flushing, chest tightness, tremor and vertigo. Laboratory and clinical examinations revealed high blood CsA concentrations (1000 ng/mL after 12 h) with a mild increase in blood pressure. Therefore, the patient was diagnosed with an acute CsA overdose. Before confirmation of the overdose by measurement of drug concentrations, the second dose was administered at its routine time because of uncertainty about the aetiology of the symptoms. The third dose was withheld, and the patient was monitored closely for clinical and laboratory presentations until the time when the abnormalities were relieved. CsA administration was then resumed with the correct prescription. The patient was discharged with successful engraftment and normal biochemical laboratory results after 1 month. Evaluation with the Naranjo assessment score indicated a probable relationship between the patient’s symptoms and overdosage with the suspected drug. Currently, detailed presentations of acute CsA toxicity cases due to overdose are limited in the medical literature. Evaluation of the patient’s medical and laboratory records, with cooperation of all responsible clinical staff, along with a review of the literature, were very helpful in discovery of the toxicity incident. Vigilance of health care providers with regard to medication errors and early detection of toxicity symptoms can decrease CsA-related morbidity and mortality in the future.

show abstract

Sinus bradycardia associated with cyclosporine following allogeneic hematopoietic stem cell transplantation

Cited by 7 publications

References 4 publications

Sinus bradycardia as a rare adverse event in patients receiving cyclosporine A after allogeneic hematopoietic stem cell transplantation.

Sinus bradycardia as a rare adverse event in patients receiving cyclosporine A after allogeneic hematopoietic stem cell transplantation.

Cyclosporine induced bradycardia: is it rarely seen?

Accidental Overdose of Oral Cyclosporine in Haematopoietic Stem Cell Transplantation: A Case Report and Literature Review

Contact Info

Product

Resources

About