trandolapril

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.

Trandolapril is generally well tolerated. The most common side effects are:

• headache,
• cough,
• dizziness,
• diarrhea,
• fatigue,
• nausea,
• vomiting,
• 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 trandolapril. Low white blood cells increase the risk of infections. Trandolapril may cause hypersensitivity reactions and angioedema (swelling of face, lips, tongue, throat).

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.

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.

Trandolapril can cause an increase in the amount of lithium (Lithobid, Eskalith) 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.

There have been reports that aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, etc.), indomethacin (Indocin, Indocin-SR), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve) may reduce the effects of ACE inhibitors. Combining trandolapril or other ACE inhibitors with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients who are elderly, volume-depleted (including those on diuretic therapy), or with poor kidney function may result in reduced kidney function, including kidney failure. These effects usually are reversible.

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

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

What preparations of trandolapril are available?

Tablets: 1, 2, and 4 mg.

How should I keep trandolapril stored?

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