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,

an antihypertensive. Its prototype is enalapril.

indications It is used to treat hypertension, heart failure, and postmyocardial infarction/left ventricular dysfunction.

contraindications Factors that prohibit its use include known hypersensitivity, a history of angioedema, and second- or third-trimester pregnancy.

adverse effects Life-threatening effects include myocardial infarction, stroke, agranulocytosis, neutropenia, leukopenia, anemia, proteinuria, and renal failure. Other adverse effects include palpitations, angina, transient ischemic attacks, bradycardia, arrhythmias, paresthesias, headache, fatigue, drowsiness, depression, sleep disturbances, nausea, vomiting, cramps, diarrhea, constipation, ileus, pancreatitis, hepatitis, rash, purpura, dyspnea, hyperkalemia, hyponatremia, and impotence. Common side effects include hypotension, dizziness, dyspepsia, cough, and myalgia.

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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.

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trandolapril

Mavik^® An ACE inhibitor indicated as maintenance of Pts with post-MI left ventricular dysfunction, post-MI heart failure. See TRACE.