What is trandolapril, and how does it work (mechanism of action)?
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.
What brand names are available for trandolapril?
Is trandolapril available as a generic drug?
Do I need a prescription for trandolapril?
What are the side effects of trandolapril?
Trandolapril is generally well tolerated. The most
common side effects are:
- 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,
What is the dosage for trandolapril?
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.
Salt and sodium are the same.
Which drugs or supplements interact with trandolapril?
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,
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.
Is trandolapril safe to take if I’m pregnant or breastfeeding?
ACE inhibitors, including trandolapril, can be harmful to
the fetus and should not be taken by
Trandolapril is secreted in
breast milk and is not
recommended for nursing mothers.
What else should I know about trandolapril?
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).