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Trandolapril (Mavik) Uses, Dosage, Side Effects

Trandolapril

(tran-do′la-pril)

Mavik

Classifications: ANGIOTENSINCONVERTING ENZYME (ACE) INHIBITOR; ANTIHYPERTENSIVE

Therapeutic: ANTIHYPERTENSIVE; ACE INHIBITOR

Prototype: Enalapril

Pregnancy Category: D

AVAILABILITY

Tablet

ACTION & THERAPEUTIC EFFECT

Inhibits ACE and interrupts conversion by renin which leads to the formation of angiotensin II from angiotensin I. Inhibition of ACE leads to vasodilation as well as to decreased 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.

USES

Treatment of hypertension, reduction of CV morbidity/ mortality post MI in patients with heart failure.

CONTRAINDICATIONS

Hypersensitivity to trandolapril or ACE inhibitors; history of angioedema related to previous treatment with an ACE inhibitor; idiopathic angioedema; pregnancy (category D).

CAUTIOUS USE

Renal impairment, hepatic insufficiency; patients prone to hypotension (e.g., CHF, ischemic heart disease, aortic stenosis, CVA, dehydration); SLE, scleroderma; lactation. Safety and effectiveness in children younger than 18 y are not established.

ROUTE & DOSAGE

Hypertension

Adult: PO 1 mg (2 mg in black patients) once daily, may increase weekly to 2–4 mg once daily (max: 8 mg/day). Lower dose used in patients also taking a diuretic.

Post MI

Adult: PO 1 mg daily for 2 days then increase to 4 mg daily for 2–4 years

Renal Impairment Dosage Adjustment

CrCl less than 30 mL/min: Start with 0.5 mg once daily

Hepatic Impairment Dosage Adjustment

Hepatic cirrhosis: Start with 0.5 mg once daily

ADMINISTRATION

Oral

Note: If concurrently ordered diuretic cannot be discontinued 2–3 days before beginning trandolapril therapy, initial dose is usually reduced to 0.5 mg.
Dosage adjustments are typically made at intervals of at least 1 wk.
Store at 15°–30° C (59°–86° F).

ADVERSE EFFECTS (≥1%)

Body as a Whole: Fatigue, angioedema, fever, malaise. CNS: Dizziness, drowsiness. CV: Hypotension, bradycardia, edema, palpitations. GI: Diarrhea. Respiratory: Cough. Skin: Rash, pruritus. Metabolic: Hyperkalemia, increased liver enzymes.

Related for Nursing Implications and Drugs Guide Information

INTERACTIONS

Drug: DIURETICS, rituximab may enhance hypotensive effects. POTASSIUM-SPARING DIURETICS (amiloride, spironolactone, triamterene), POTASSIUM SUPPLEMENTS, POTASSIUM-CONTAINING SALT SUBSTITUTES, aliskiren, may increase risk of hyperkalemia. May increase serum levels and toxicity of lithium. NSAIDs may reduce the therapeutic response. Avoid use with cyclosporine.

PHARMACOKINETICS

Absorption: Rapidly absorbed from GI tract and converted to active form, trandolaprilat, in liver; 70% of dose reaches systemic circulation as trandolaprilat. Peak: 4–10 h. Distribution: 80% protein bound; crosses placenta, secreted into breast milk of animals (human secretion unknown). Metabolism: In liver to trandolaprilat. Elimination: 33% in urine, 66% in feces. Half-Life: 6 h trandolapril, 22.5 h trandolaprilat.

NURSING IMPLICATIONS

Black Box Warning
Trandolapril has been associated with fetal toxocity.

Assessment & Drug Effects

Monitor BP carefully for 1–3 h following initial dose, especially in patients using concurrent diuretics, on salt restriction, or volume depleted.
Monitor serum lithium levels frequently with concurrent lithium therapy and assess for S&S of lithium toxicity; increase caution when diuretic therapy is also used.
Monitor lab tests: Baseline LFTs and kidney function tests; periodic serum potassium and sodium.

Patient & Family Education

Discontinue drug and immediately report S&S of angioedema of face or extremities to prescriber. Seek emergency help for swelling of the tongue or any other sign of potential airway obstruction.
Be aware that lightheadedness can occur, especially during early therapy. Excess fluid loss of any kind will increase risk of hypotension and syncope.
Report promptly if you are or suspect you are pregnant.

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