trandolapril

trandolapril /tran·do·la·pril/ (tran-do´lah-pril?) an angiotensin-converting enzyme inhibitor used in the treatment of hypertension and post–myocardial infarction congestive heart failure or left ventricular dysfunction.

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trandolapril

Goptin (UK), Mavik

Pharmacologic class: Angiotensin-converting enzyme (ACE) inhibitor

Therapeutic class: Antihypertensive

Pregnancy risk category C (first trimester), D (second and third trimesters)

FDA Boxed Warning

• When used during second or third trimester of pregnancy, drug may cause fetal harm or death. Discontinue as soon as pregnancy is detected.

Action

Inhibits conversion of angiotensin I to the potent vasoconstrictor angiotensin II, promoting vasodilation. Also increases plasma renin and stimulates aldosterone secretion, inducing diuresis.

Availability

Tablets: 1 mg, 2 mg, 4 mg

⊘Indications and dosages

➣ Hypertension

Adults: For patients not receiving diuretics, 1 mg/day P.O. in nonblack patients or 2 mg/day P.O. in black patients. If response inadequate, may increase at weekly intervals up to 4 mg/day. For patients receiving diuretics, start with 0.5 mg/day P.O.

➣ Heart failure or left ventricular dysfunction after myocardial infarction

Adults: Initially, 1 mg P.O. daily. Titrate up to 4 mg daily, if tolerated.

Dosage adjustment

• Renal or hepatic impairment

Contraindications

• Hypersensitivity to drug or other ACE inhibitors
• Angioedema with previous ACE inhibitor use
• Pregnancy (second and third trimesters)

Precautions

Use cautiously in:
• renal or hepatic impairment, hypovolemia, hyponatremia, aortic stenosis or hypertrophic cardiomyopathy, cerebrovascular or cardiac insufficiency, surgery and anesthesia
• family history of angioedema
• concurrent diuretic therapy
• black patients with hypertension
• elderly patients
• pregnant patients (first trimester) or breastfeeding patients
• children (safety not established).

Administration

• Give once or twice daily as prescribed, with or without food.

Route	Onset	Peak	Duration
P.O.	Within 1 hr	4-10 hr	Up to 24 hr

Adverse reactions

CNS: insomnia, paresthesia, dizziness, drowsiness, asthenia, syncope, cerebrovascular accident

CV: chest pain, hypotension, palpitations, intermittent claudication, bradycardia, first-degree atrioventricular block, cardiogenic shock

EENT: epistaxis, sinusitis, throat inflammation

GI: vomiting, diarrhea, constipation, abdominal pain or distention, gastritis, dyspepsia, pancreatitis

GU: urinary tract infection, erectile dysfunction, decreased libido

Hematologic: agranulocytosis, neutropenia

Metabolic: hypocalcemia, gout, hyperkalemia

Musculoskeletal: muscle cramps, myalgia, extremity pain

Respiratory: cough, dyspnea, upper respiratory infection

Skin: rash, flushing, pruritus, angioedema

Other: edema

Interactions

Drug-drug. Antacids: decreased trandolapril absorption

Digoxin: increased digoxin blood level, greater risk of toxicity

Diuretics, general anesthetics, nitrates, other antihypertensives: additive hypotension

Indomethacin: reduced hypotensive effect of trandolapril

Lithium: increased lithium blood level, greater risk of toxicity

Phenothiazines: increased trandolapril effects

Potassium-sparing diuretics, potassium supplements, salt substitutes containing potassium: additive hyperkalemia

Drug-diagnostic tests. Neutrophils, platelets: decreased counts

Potassium: increased level

Drug-food. Salt substitutes containing potassium: hyperkalemia

Drug-herbs. Capsaicin: increased incidence of cough

Ephedra (ma huang), yohimbine: antagonism of trandolapril effects

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Patient monitoring

• Monitor vital signs, especially for hypotension and bradycardia when therapy begins.
• Assess CBC with white cell differential. Watch for signs and symptoms of bleeding and infection.
• Monitor electrolyte levels, especially potassium. Stay alert for hyperkalemia.
• Assess renal function tests and fluid intake and output.

Patient teaching

• Tell patient drug may cause bleeding tendency or increase his infection risk. Teach him which warning signs to report.
• Teach patient to recognize and report signs or symptoms of hyperkalemia.
• Instruct patient to move slowly when sitting up or standing, to avoid dizziness from sudden blood pressure drop.
• Caution patient not to exercise vigorously in hot environments.
• Advise patient not to use salt substitutes containing potassium. Tell him to avoid high-potassium foods.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.