Two sirolimus overdoses were judged to have caused or contributed to symptoms or abnormal clinical findings (Table 2). Patient 1 developed one minor and two moderate symptoms (increased liver enzymes, fever and gastroenteritis) two days after the event. Patient 3 complained of tiredness and showed a spontaneous decline in total cholesterol levels several days after overdose which implied that overdose was associated with an elevation in total cholesterol (Fig 2).Triglyceride concentrations were not above the normal range and did not change significantly from day 4 to day 67 post-overdose (data not shown).