Trandolapril

Indications
 Oral
Hypertension
Adult: Initially, 0.5 mg once daily. First dose preferably given at bedtime. Maintenance: 1-2 mg once daily. Max: 4 mg daily in 1-2 divided doses. In patients with co-existing heart failure, start treatment under close medical supervision.
CrCl (ml/min)Dosage Recommendation
<10Initially, 0.5 mg daily. Max: 2 mg/day.
Hepatic impairment: Hepatic cirrhosis: Initially, 0.5 mg once daily and titrate accordingly.
Oral
Heart failure post myocardial infarction
Adult: Initially, 0.5 mg once daily, may increase dose gradually to a target dose of 4 mg once daily. Patient may continue at the max tolerated dose if patient is unable to tolerate 4 mg/day dose.
CrCl (ml/min)Dosage Recommendation
<10Initially, 0.5 mg daily. Max: 2 mg/day.
Hepatic impairment: Hepatic cirrhosis: Initially, 0.5 mg once daily and titrate accordingly.
Oral
Left ventricular dysfunction post myocardial infarction
Adult: Initially, 0.5 mg once daily, may increase dose gradually to a target dose of 4 mg once daily. Patient may continue at the max tolerated dose if patient is unable to tolerate 4 mg/day dose.
CrCl (ml/min)Dosage Recommendation
<10Initially, 0.5 mg daily. Max: 2 mg/day.
Hepatic impairment: Hepatic cirrhosis: Initially, 0.5 mg once daily and titrate accordingly.

Special Populations: Renal impairment: CrCl ≤30 mL/min: Recommended starting dose of 0.5 mg/day. Hepatic impairment: Cirrhosis: Recommended starting dose of 0.5 mg/day.
Contraindications
 Aortic stenosis or outflow tract obstruction; renovascular disease; ascites. Pregnancy and lactation. Hypersensitivity or history of angioedema related to previous treatment with an ACE inhibitor, unilateral or bilateral renal artery stenosis.
Warnings / Precautions
 Renal and hepatic impairment, idiopathic or hereditary angioedema, severe heart failure, patients likely to be salt or water depleted, liver cirrhosis. Conduct regular WBC counts in patient with collagen vascular disease. Monitor renal function during first few wk and then periodically. Discontinue if jaundice develops or marked increase in LFT. Discontinue diuretics 2-3 days before starting therapy and resume later if necessary. Elderly.
Adverse Reactions
 Dizziness, headache, fatigue, GI disturbances, diarrhoea, taste disturbances, persistent dry cough and other upper respiratory tract symptoms, skin rashes, angioedema, hypersensitivity reactions, renal impairment, hyperkalaemia, hyponatraemia, chest pain, palpitations, tachycardia, pancreatitis, cholestatic jaundice, alopecia, paraesthesias, impotence, eosinophilic pneumonitis, hypotension, hyperuricaemia.
Potentially Fatal: Fulminant hepatic necrosis, blood dyscrasias especially neutropenia.
Overdose Reactions
 Symptoms: Severe hypotension. Management: Treatment is symptomatic. Activated charcoal may be used in severe overdose if presented within 1 hr of ingestion. If hypotension persists, sympathomimetics may be given, although they may not be required. Infusion of normal saline solution and haemodialysis may also be helpful.
Drug Interactions
 Additive hyperkalaemic effects with potassium-sparing diuretics, potassium supplements, heparin, LMWH and other drugs that can cause hyperkalaemia. Diminished antihypertensive effects with NSAIDs. Increased risk of lithium toxicity with concurent use. Increased risk of hypotension with alcohol, diuretics and other agents that lowerBP. Increased risk of nephrotoxicity and hyperkalaemia with ciclosporin, tacrolimus. Increased risk of granulocytopenia with interferon.
See Below for More trandolapril Drug Interactions
Mechanism of Actions
 Trandolapril is a prodrug of trandolaprilat, which is a inhibitor of angiotensin-converting enzyme (ACE). It prevents conversion of angiotensin I to angiotensin II, a potent peripheral vasoconstrictor. Lower levels of angiotensin II results in an increase in plasma renin activity and reduction in aldosterone secretion. Reduced aldosterone leads to diuresis, natriuresis and a small increase in serum potassium. Trandolapril can also minimise or prevent the development of left ventricular dilatation and dysfunction following acute MI.
Onset: 1 hr.
Duration: At least 24 hr.
Absorption: Bioavailability: 40-60%. Peak plasma concentrations in 4-6 hr. Food may decrease the rate but not extent of absorption.
Distribution: Plasma protein-binding: >80%. Volume of distribution: 18 L.
Metabolism: Metabolised in liver to active and inactive metabolites.
Excretion: Excreted via urine (33%) and faeces (66%).
Administration
 May be taken with or without food.
Storage Conditions
 Oral: Store at 20-25°C (68-77°F).
ATC Classification
 C09AA10 - trandolapril ; Belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease.
Storage
 Oral: Store at 20-25°C (68-77°F).
Available As
  • Trandolapril 1 mg
  • Trandolapril 2 mg

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