Trandolapril

DEA Class; Rx

Common Brand Names; Mavik

• ACE Inhibitors

Oral ACE inhibitor; structurally similar to enalapril, requiring hydrolysis for activity; used once daily for HTN and to reduce cardiovascular morbidity and mortality following AMI.

Indicated for the treatment of hypertension.

Hypersensitivity

History of hereditary or angioedema associated with previous ACE inhibitor treatment

Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan

Bilateral renal artery stenosis

Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR <60 mL/min/1.73 m²)

Cough (1.9-35%)

Elevated Uric Acid (15%)

Hypotension (1-11%)

Syncope (5.9%)

Hyperkalemia (5.3%)

Hypocalcemia (4.7%)

Stroke (3.8%)

Bradycardia (1-5%)

Dizziness (1.3-2.3%)

Angioedema

ARF if renal artery stenosis

Less effective in Blacks

Excessive hypotension if concomitant diuretics, hypovolemia, hyponatremia

Renal impairment may occur

Coadministration with mTOR inhibitors (eg, temsirolimus, sirolimus, everolimus) may increased risk for angioedema

Neutropenia/agranulocytosis reported

Cough may occur within the first few months

Cholestatic jaundice may occur

Risk of hyperkalemia, especially in renal impairment, diabetes melliuts, or coadministration with potassium-elevating drugs

ACE inhibition also causes increased bradykinin levels which putatively mediates angioedema; higher incidence of angioedema in black than nonblack patients

Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure) compared to monotherapy

Intestinal angioedema reported in patients treated with ACE inhibitors; it should be included in differential diagnosis of patients, taking ACE inhibitors and presenting with abdominal pain

Pregnancy Category: C (1st trimester); D (2nd/3rd trimesters)

Lactation: possibly excreted in breast milk; nursing not recommended