Suicide attempt with an overdose of sunitinib

Sunitinib is an oral multi-target tyrosine kinase inhibitor approved for treating metastatic renal cell carcinoma (RCC). It is metabolized mainly by CYP3A4 to the pharmacologically active N-desethyl metabolite SU12662 [1]. In a phase I clinical trial, the recommended dose of sunitinib with manageable toxicity was determined to be 50 mg day−1 (4 weeks on, 2 weeks off; 4/2 schedule) [1]. Although a single dose of up to 350 mg was well tolerated [1], a case of sunitinib overdose has never been reported. Here, we report the pharmacokinetic analysis of sunitinib and a life-threatening adverse event in a patient with metastatic RCC who took 450 mg of sunitinib as a single dose together with brotizolam.