Trandolapril and Verapamil

ACE Inhibitor · ACE inhibitor/Calcium antagonist

Indications

Hypertension.

Dosage

Adults: 1 tab daily in the morning. If on diuretics, discontinue first and initiate therapy under close supervision. Children: Not applicable.

Adverse Effects

Trandolapril: Cough, headache, asthaenia, dizziness, rash, symptomatic hypotension, palpitations. Reports of angioedema (discontinue), bone marrow depression, agranulocytosis, hepatic failure, Steven's Johnson syndrome, toxic epidermal necrolysis. Verapamil: Constipation, flushes. Rarely flushes, dizziness, vomiting, fatigue, ankle oedema, GI upset, paraesthesia, extrapyramidal syndrome, skin reactions, tremor, vertigo, tinnitus, muscle weakness, myalgia, arthralgia, bradycardia, asystole, tachycardia, headaches, nausea, allergies, reversible liver function impairment, gynaecomastia, gingival hyperplasia. Decreased heart rate, hypotension, decreased myocardial contractability, 2nd or 3rd degree AV block.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Contraindicated or not recommended. Contraindications: Trandolapril: Angioneurotic oedema: hereditary, idiopathic or related to previous ACE inhibitor therapy. Aortic stenosis or outflow obstruction. Renal transplantation. Verapamil: Cardiogenic shock. 2nd or 3rd degree AV block, SA block. Severe bradycardia, sick sinus syndrome. Uncompensated heart failure. Acute phase of MI. Hypotension of less than 90 mmHg systolic. Precautions: Trandolapril: Monitor renal function and serum electrolytes. Hyperkalaemia, renal or hepatic impairment, renal artery stenosis, CHF, angina, cerebrovascular disorders, collagen vascular diseases, haemodialysis, apheresis, surgery, anaesthesia. Correct salt or volume depletion before starting therapy. Verapamil: 1st degree AV block, poor cardiac reserve should be controlled with digitalis and diuretics.…

Interactions

Trandolapril: Potassium sparing diuretics or potassium supplements, NSAIDs, lithium, antidiabetic agents, neuroleptics, TCADs, antihypertensive, trimethoprim, heparin, antacids, antipsychotics, hyposensitising agents, allopurinol, procainamide, cytostatics, immunosuppressants, corticosteroids, sympathomimetics, anaesthetics, everolimus, temsirolimus, high-flux dialysis membranes, alcohol. Verapamil: Beta-blockers, digoxin or antiarrhythmics, cyclosporin, theophylline, muscle relaxants, carbamazepine, rifampicin, lithium, phenobarbitone, phenytoin, cimetidine, inhaled anaesthetics, alcohol, antihypertensives, grapefruit juice, CYP3A4 inhibitors or inducers (e.g., ketoconazole, erythromycin, ritonavir), immunosuppressants, statins, St John's wort, dantrolene, aspirin, alpha blockers, imipramine, glibenclamide, other antihypertensives, doxorubicin, buspirone, midazolam, colchicine,…

Advice to Patient

Swallow whole tablet with a glass of water. Contact prescriber if there is slow, fast or irregular heartbeat; difficulty in breathing; unusual tiredness; weakness; fever; nausea; headache; dizziness; yellowing of skin or white part of eyes; constipation or severe abdominal pain. Avoid grapefruit and grapefruit juice during therapy. Avoid alcohol during therapy. Change position slowly from sitting or lying to standing.

Pharmacokinetics

TRANDOLAPRIL: Onset: 1-2 hrs. Duration: 72 hrs after single dose. Absorption: Rapid. Approx. 40%-60% absorbed. Metabolism: Hepatic; 36% of the absorbed amount is converted to active metabolite Trandolaprilat. Bioavailability: Trandolapril: 4%-14%. Trandolaprilat: 40%-60%. Half-life elimination: Trandolapril: 6 hrs. Trandolaprilat: After multiple doses of trandolapril, 16-24 hrs. Time to peak, plasma: Oral: Trandolapril: 1 hr. Trandolaprilat: 4-6 hrs. Excretion: Oral: Urine (33%). Faeces (66%). VERAPAMIL: Note: Lean body wt affects verapamil pharmacokinetics inversely. Onset of action: Peak effect: Oral: Immediate release: 1-2 hrs. IV bolus: 3-5 min. Duration: Oral: Immediate release tabs: 6-8 hrs. IV: 0.5-6 hrs. Absorption: Oral: Well absorbed (>90%). Metabolism: Hepatic (extensive first-pass effect). Bioavailability: Oral: 20%-35%. Half-life elimination: Inj: Terminal: 2-5 hrs. Oral:…

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.