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trandolapril, Mavik

GENERIC NAME: trandolapril

BRAND NAME: Mavik

DRUG CLASS AND MECHANISM: Trandolapril is a drug that is used to lower blood pressure. 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 an enzyme called angiotensin converting enzyme (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 are useful in treating heart failure. Other ACE inhibitors include enalapril (Vasotec), captopril (Capoten), lisinopril (Zestril; Prinivil), benazepril (Lotensin), ramipril (Altace), and quinapril (Accupril). Trandolapril was approved by the FDA in 1996.

GENERIC AVAILABLE: no

PRESCRIPTION: yes

PREPARATIONS: Tablets: 1mg (salmon), 2mg (yellow), 4mg (rose).

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. Trandolapril also can be useful in the treatment of congestive heart failure, and ACE inhibitors have been shown to reduce symptoms and hospitalization and improve survival in patients with heart failure. After a heart attack, ACE inhibitors have been found to be effective in improving the function of the damaged heart, and in reducing symptoms and hospitalizations related to heart failure.

DOSING: Trandolapril is taken once or twice daily. African-American patients generally require higher doses than do Caucasians. Food reduces the amount of trandolapril that is absorbed, so it is best to take this medication one hour before or two hours after meals. Patients with advanced renal or liver diseases may need to take lower doses.

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 blood 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. Trandolapril can cause an increase in the amount of lithium in the body in patients taking lithium, sometimes with associated side effects of lithium toxicity. Nitritoid reactions (with symptoms of facial flushing, nausea, vomiting and low blood pressure) may occur when injectable gold (sodium aurothiomalate) for the treatment of rheumatoid arthritis is combined with ACE inhibitors including trandolapril.

PREGNANCY: ACE inhibitors, including trandolapril, can be harmful to the fetus and should not be taken by pregnant women.

NURSING MOTHERS: Trandolapril is secreted in breast milk and is not recommended for nursing mothers.

SIDE EFFECTS: Trandolapril is generally well tolerated. The most common side effects are headache, cough, dizziness, diarrhea, fatigue, nausea, vomiting, complaints of sexual dysfunction, and abnormal liver tests. Impairment of kidney function has been reported with ACE inhibitors, especially in patients with severe heart failure or pre-existing kidney disease. In rare instances, low white blood cell counts have been reported with the use of captopril, another ACE inhibitor. Low white blood cells increase the risk of infections.

Reference: FDA Prescribing Information

Last Editorial Review: 2/6/2000 10:53:00 PM

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