title: Angiotensin II antagonists - an assessment of their acute toxicity.
abstract: OBJECTIVE
  In Germany, increasing prescription rates of angiotensin II antagonists resulted in rising enquiries to Poisons Information Centres (PICs) during the last decade. Therefore, we aimed to assess their acute toxicity for deriving triage recommendations.
  
  
  METHODS
  An observational case series with data collected retrospectively from eight PICs in Austria, Germany and Switzerland. Inclusion criteria were monoexposure, defined dose, and documented follow-up.
  
  
  RESULTS
  In total, 206 cases of exposures to angiotensin II antagonists were included (candesartan, 94; eprosartan, 3; irbesartan, 20; losartan, 26; olmesartan, 16; telmisartan, 18; and valsartan, 29). The median dose expressed as a multiple of their maximum daily dose for adults adjusted to body weight (MDDw) was 2.3 in children and 6.8 in adults. Patients involved were 150 children with a median age of 2 years and a median body weight of 13 kg and 56 adults with a median age of 47 years and a median body weight of 70 kg. Most children remained asymptomatic (82.7%), 16.7% developed minor symptoms. Only once, a low blood pressure of 60/40 mm Hg required intravenous fluids after ingestion of a 8.75-fold MDDw of candesartan by a 2.5-year-old toddler. Among adults, 53.6% remained asymptomatic while almost half of the patients suffered from minor (37.5%) or moderate (8.9%) symptoms.
  
  
  CONCLUSIONS
  As no or only minor symptoms were observed after ingestion of less than a fivefold MDDw in both children and adults, only symptomatic patients and those who have ingested a fivefold MDDw or higher dose should be referred for medical assessment.
authors.affiliation: Poisons Information Centre, 99089 Erfurt, Germany.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Prasa
authors.forename: Petra
authors.initials: P
authors.lastname: Hoffmann-Walbeck
authors.forename: Susanne
authors.initials: S
authors.lastname: Barth
authors.forename: Uwe
authors.initials: U
authors.lastname: Stedtler
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ceschi
authors.forename: Elke
authors.initials: E
authors.lastname: Färber
authors.forename: Dieter
authors.initials: D
authors.lastname: Genser
authors.forename: Carola
authors.initials: C
authors.lastname: Seidel
authors.forename: Michael
authors.initials: M
authors.lastname: Deters
mesh_terms: D000328:Adult; D047228:Angiotensin II Type 1 Receptor Blockers / Q000633:toxicity*; D000959:Antihypertensive Agents / Q000633:toxicity*; D002675:Child, Preschool; D062787:Drug Overdose; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011039:Poison Control Centers; D011041:Poisoning / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents