Classifications: angiotensin-converting enzyme (ace) inhibitor; antihypertensive; Therapeutic: antihypertensive; ace inhibitor
Pregnancy Category: C first trimester; D second and third trimester
1 mg, 2 mg, 4 mg tablets
Inhibits ACE and interrupts conversion sequences initiated by renin which leads to the formation of angiotensin II from
angiotensin I. Angiotensin II is a potent endogenous vasoconstrictor. Inhibition of ACE leads to vasodilation and also to
decreased circulating aldosterone. Decreased aldosterone leads to diuresis and a slight increase in serum potassium.
Lowers blood pressure by specific inhibition of ACE. Unlike other ACE inhibitors, all racial groups respond to trandolapril,
including low-renin hypertensives.
Treatment of hypertension, alone or in combination with other antihypertensive agents.
Hypersensitivity to trandolapril or ACE inhibitors; history of angioedema related to previous treatment with an ACE inhibitor;
pregnancy (category C, first trimester; category D, second and third trimesters), lactation.
Renal impairment, hepatic insufficiency; patients prone to hypotension (e.g., CHF, ischemic heart disease, aortic stenosis,
CVA, dehydration); SLE, scleroderma. Safety and effectiveness in children <18 y are not established.
Route & Dosage
Note: Discontinue diuretics 23 d before starting trandolapril. Hypertension
Adult: PO 1 mg in nonblack patients, 2 mg in black patients once daily, may increase weekly to 24 mg once daily (max: 8 mg/d)
Clcr <30 mL/min: start with 0.5 mg once daily
Hepatic cirrhosis: start with 0.5 mg once daily
- Note: If concurrently ordered diuretic cannot be discontinued 23 d before beginning trandolapril therapy, reduce initial
dose to 0.5 mg.
- Make dosage adjustments generally at intervals of at least 1 wk.
- Store at 15°30° C (59°86° F).
Adverse Effects (≥1%) Body as a Whole: Fatigue
, angioedema. CNS:
Dizziness, headache. CV:
Rash, pruritus. Metabolic:
may enhance hypotensive effects. potassium-sparing diuretics
, triamterene), potassium supplements
, potassium-containing salt substitutes
may increase risk of hyperkalemia. May increase serum
levels and toxicity of lithium.
Rapidly absorbed from GI tract and converted to active form, trandolaprilat, in liver; 70% of dose reaches systemic
circulation as trandolaprilat. Peak:
410 h. Distribution:
80% protein bound; crosses placenta, secreted into breast milk of animals (human secretion unknown). Metabolism:
In liver to active metabolite, trandolaprilat. Elimination:
33% in urine, 66% in feces. Half-Life:
6 h trandolapril, 10 h trandolaprilat.
Assessment & Drug Effects
- Monitor BP carefully for 13 h following initial dose, especially in patients using concurrent diuretics, on salt restriction,
or volume depleted.
- Lab tests: Monitor BP and cardiac status; serum potassium, sodium, creatinine, and ALT/SGTP; and WBC with differential periodically.
- Monitor serum lithium levels frequently with concurrent use and assess for S&S of lithium toxicity; increase caution when
diuretic therapy is also used.
Patient & Family Education
- Discontinue drug and immediately report S&S of angioedema of face or extremities to physician. Advise to seek emergency
help for swelling of the tongue or any other sign of potential airway obstruction.
- Be aware that light-headedness can occur, especially during early therapy. Excess fluid loss of any kind will increase risk
of hypotension and syncope.