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Exchange transfusions or dialysis may be required as a means of reversing hypotension and substituting for disordered renal function. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. Hepatic Impairment No dose adjustment is necessary for patients with mild-to-severe liver disease. Hydrochlorothiazide Minor alterations of fluid and electrolyte balance may precipitate hepatic coma in patients with impaired hepatic function or progressive liver disease. The most likely manifestations of overdosage would be hypotension and tachycardia ; bradycardia could be encountered if parasympathetic vagal stimulation occurs. If symptomatic hypotension should occur, supportive treatment should be initiated. The dialyzability of olmesartan is unknown.

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