What if a patient takes an extra dose of telmisartan (angiotensin II receptor antagonist) tonight?

Management of Telmisartan Overdose

If a patient has taken an extra dose of telmisartan, monitor for symptoms of hypotension including dizziness and tachycardia, and provide supportive care if symptomatic hypotension occurs. 1

Clinical Manifestations of Telmisartan Overdose

• The most likely manifestations of telmisartan overdose are hypotension, dizziness, and tachycardia; bradycardia could also occur from parasympathetic (vagal) stimulation 1
• Symptoms may be more pronounced in elderly patients, who tend to have greater sensitivity to the blood pressure-lowering effects of medications 1
• The risk of adverse effects may be higher in patients with pre-existing liver disorders or biliary obstructive disorders 1

Immediate Management

• If the patient is asymptomatic, close monitoring is recommended without specific intervention 1
• For symptomatic hypotension:
  • Have the patient lie down immediately 1
  • Provide supportive treatment including IV fluids if needed 1
  • Monitor vital signs, particularly blood pressure and heart rate 1

Important Considerations

• Telmisartan is not removed by hemodialysis, so this intervention would not be helpful in cases of overdose 1
• The long elimination half-life of telmisartan means that blood pressure effects can persist for 24-48 hours after dosing 2
• Telmisartan 80 mg is the maximum recommended daily dose for hypertension 3
• A single extra dose is unlikely to cause severe toxicity in most patients with normal renal and hepatic function 1

Special Populations

• For patients with kidney disease, monitor renal function as ARBs can affect renal perfusion 1
• For elderly patients, observe more carefully as they may have increased sensitivity to blood pressure-lowering effects 1
• For patients with hepatic insufficiency, monitor more carefully as drug metabolism may be affected 1

Follow-up Recommendations

• Ensure proper medication administration going forward:
  • Take telmisartan one time each day at the same time 1
  • If a dose is missed, take it as soon as remembered unless it's close to the next scheduled dose 1
  • Do not double up on doses to make up for a missed dose 1
• Consider medication organizers or reminders to prevent future dosing errors 1
• Review proper dosing with the patient at the next visit 4

When to Seek Immediate Medical Attention

• Advise patients to seek immediate medical attention if they experience:
  • Severe dizziness or fainting 1
  • Persistent symptoms of hypotension 1
  • Unexplained swelling in feet, ankles, or hands 1
  • Any other concerning symptoms 1