trandolapril, Mavik

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GENERIC NAME: trandolapril


DRUG CLASS AND MECHANISM: Trandolapril is an oral drug that is used to treat high blood pressure. It belongs to a class of drugs called angiotensin converting enzyme (ACE) inhibitors. Other ACE inhibitors include enalapril (Vasotec), captopril (Capoten), lisinopril (Zestril; Prinivil), benazepril (Lotensin), ramipril (Altace), and quinapril (Accupril). Blood pressure is dependent on the degree of constriction (narrowing) of the arteries and veins; the narrower the arteries and veins, the higher the blood pressure. Angiotensin II is a chemical substance made in the body that causes the muscles in the walls of arteries and veins to contract, narrowing the arteries and veins and thereby elevating blood pressure. Angiotensin II is formed by ACE. Trandolapril is an inhibitor of ACE and blocks the formation of angiotensin II thereby lowering blood pressure. The drop in blood pressure also means that the heart doesn't have to work as hard because the pressure it must pump blood against is less. The efficiency of a failing heart improves, and the output of blood from the heart increases. Thus, ACE inhibitors such as trandolapril in addition to high blood pressure, are also useful in treating heart failure. Trandolapril was approved by the FDA in 1996.



PREPARATIONS: Tablets: 1, 2, and 4 mg.

STORAGE: Tablets should be stored at room temperature, 15-30 C (59-86 F).

PRESCRIBED FOR: Trandolapril can be used alone in treating high blood pressure. Its blood pressure lowering effect can be further enhanced by the addition of a diuretic medication ("water pill"), such as hydrochlorothiazide, or other antihypertensive medications. Trandolapril also is used for treating congestive heart failure. Use of trandolapril after a heart attack decreases the risk of death and hospitalizations related to heart failure.

DOSING: The recommended starting dose for treating high blood pressure in patients not receiving a diuretic is 1 mg once daily in Caucasian patients and 2 mg in black patients. Doses may be increased at weekly intervals. Most patients require 2 to 4 mg daily, and there is no additional benefit from doses larger than 8 mg daily. Patients receiving a diuretic should start at 0.5 mg daily if the diuretic cannot be stopped for 2 to 3 days before starting trandolapril. For heart failure the starting dose is 1 mg once daily. The dose should be increased to 4 mg once daily or the largest tolerated dose.

DRUG INTERACTIONS: Although the combination of ACE inhibitors and diuretics is generally beneficial (see above), trandolapril and other ACE inhibitors can interact with diuretics to cause an excessive drop in blood pressure, causing symptoms of weakness, dizziness, and lightheadedness. This is most likely to occur when patients who are already taking a diuretic are started on an ACE inhibitor.

Combining trandolapril with potassium supplements, potassium containing salt substitutes, or potassium-conserving diuretics such as amiloride (Moduretic), spironolactone (Aldactone), and triamterene (Dyazide, Maxzide), can lead to dangerously high blood levels of potassium. It is recommended that trandolapril not be taken at the same time as aluminum- or magnesium- based antacids, such as Mylanta or Maalox; these antacids bind to trandolapril in the intestine and decrease its absorption into the body. Therefore, patients should separate doses of antacids and trandolapril by at least two hours.

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