Trandolapril
Trandolapril (Mavik)
Trandolapril
(tran-DOHL-ah-pril)
Pregnancy Category: C (first trimester); D (second and third trimesters) Mavik (Rx)

Classification: Antihypertensive

See Also: See also Angiotensin Converting Enzyme (ACE) Inhibitors.

Action/Kinetics: Rapidly absorbed; food slows rate, but not amount absorbed. Onset: 2-4 hr. Peak plasma levels, trandolapril: 30-60 min; trandolaprilat: 4-10 hr. t1/2, trandolapril: About 5 hr; t1/2, trandoprilat: About 10 hr. Peak effect: 4-10 hr. Metabolized in liver to active trandolaprilat. Duration: 24 hr. About 1/3 trandolaprilat is excreted in urine and 2/3 in feces.

Uses: Hypertension, alone or in combination with other antihypertensives such as hydrochlorothiazide. To treat heart failure after MI or ventricular dysfunction after MI.

Contraindications: In those with history of angioedema with ACE inhibitors.

Special Concerns: Safety and efficacy have not been determined in children.

Side Effects: See also ACE Inhibitors. Hypersensitivity: Angioedema. CNS: Dizziness, headache, fatigue, insomnia, paresthesias, drowsiness, vertigo, anxiety. GI: Diarrhea, dyspepsia, gastritis, abdominal pain, vomiting, constipation, pancreatitis. CV: Hypotension, bradycardia, chest pain, cardiogenic shock, intermittent claudication, stroke. Respiratory: Cough, dyspnea, URTI, epistaxis, throat inflammation. Hepatic: Hepatic failure including cholestatic jaundice, fulminant hepatic necrosis, death. Dermatologic: Photosensitivity, pruritus, rash. GU: UTI, impotence, decreased libido. Miscellaneous: Neutropenia, syncope, myalgia, asthenia, muscle cramps, hypocalemia, intermittent claudication, edema, extremity pain, gout.

Laboratory Test Alterations: Hyperkalemia, hypocalcemia. Serum uric acid, BUN, creatinine.

Drug Interactions: Diuretics / Excessive hypotensive effects Diuretics, potassium-sparing: Risk of hyperkalemia Lithium / Risk of lithium toxicity

How Supplied: Tablet: 1 mg, 2 mg, 4 mg.

Dosage
•Tablets Hypertension.
Initial: 1 mg once daily in nonblack clients and 2 mg once daily in black clients. Adjust dosage according to response; usually, adjustments are made at intervals of 1 week. Maintenance, usual: 2-4 mg once daily. Those inadequately treated with once-daily dosing can be treated with twice-daily dosing. If BP is still not adequately controlled, diuretic may be added.
Heart failure post-MI/Left ventricular dysfunction post-MI.
Initial: 1 mg/day. Then, increase the dose, as tolerated, to a target dose of 4 mg/day. If 4 mg is not tolerated, continue with the highest tolerated dose.

If C_CR is less than 30 mL/min or if there is hepatic cirrhosis, initial dose is 0.5 mg daily.