Acute pancreatitis induced by telmisartan overdoseTO THE EDITOR: Angiotensin II receptor antagonists (ARBs) are widely used for the management of hypertension and heart failure because of their proven efficacy and high tolerability. In most randomized clinical trials, the proportion of patients reporting adverse effects or being withdrawn because of them was similar to that with placebo. 1 However, postmarketing surveillance has revealed the occurrence of some adverse events with ARBs. Mild acute pancreatitis has been reported with both irbesartan and losartan in 1 and 3 cases, respectively. 2 As far as we are aware, as of April 15, 2004, pancreatitis has previously never been reported with telmisartan. We describe a patient who developed biochemical alterations, suggesting acute pancreatitis, after a suicidal attempt with high doses of telmisartan and oxazepam.Case Report. A 77-year-old white man diagnosed with mild hepatitis C virusrelated chronic liver disease, hypertension, and depression was admitted to the emergency department because he had taken 28 tablets of telmisartan 80 mg and 20 tablets of oxazepam 30 mg 8 hours earlier. On admission, he reported only mild and transient abdominal pain, and his wife observed that he had slept all afternoon. The patient exhibited a depressed mood without impairment of cognitive function or signs of neurologic deficits.Physical examination was unremarkable, and vital signs were stable except for blood pressure 90/65 mm Hg; electrocardiogram and chest X-ray were normal. Baseline laboratory investigations showed normal levels of leukocytes, aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, triglycerides, creatinine, and electrolytes, but a marked increase of amylase blood levels ( Table 1). The patient denied past or recent alcohol abuse or abdominal trauma, and an ultrasound ruled out gallstones and biliary tract or pancreatic abnormalities. Normal results from a routine biochemistry evaluation, performed 10 days before, excluded other diseases.The patient was admitted, and activated charcoal 30 g and magnesium sulfate 30 g were immediately administered, but a gastric lavage was not performed because of the time that had passed since drug ingestion. Hypotension was treated with intravenous fluids. An infusion of gabexate mesilate 900 mg/day was started and continued for 3 days. Subsequent laboratory investigations were negative for autoantibodies or signs of hyperparathyroidism. The patient remained asymptomatic, and the biochemical alterations were normal at discharge (3 days later).
