Home Drug Guide Trandolapril

Drug Guide

Generic Name

Trandolapril

Brand Names Mavik

Classification

Therapeutic: Antihypertensive, ACE inhibitor

Pharmacological: ACE (angiotensin-converting enzyme) inhibitor

FDA Approved Indications

  • Hypertension
  • Reduction of cardiovascular mortality in patients with left ventricular dysfunction following myocardial infarction

Mechanism of Action

Trandolapril inhibits ACE, decreasing angiotensin II levels, leading to vasodilation, reduced aldosterone secretion, and decreased blood pressure.

Dosage and Administration

Adult: Typically 2 mg once daily, titrate up to 4-8 mg daily according to response.

Pediatric: Not approved for use in children.

Geriatric: Start at lower doses due to increased sensitivity; monitor renal function and electrolytes.

Renal Impairment: Adjust dose based on severity; start at lower doses and titrate carefully.

Hepatic Impairment: Use with caution; no specific dose adjustments but monitor closely.

Pharmacokinetics

Absorption: Well absorbed orally, bioavailability approximately 50%.

Distribution: Vastly protein-bound (~97%).

Metabolism: Metabolized in the liver to active metabolite (trandolaprilat).

Excretion: Excreted primarily via kidneys; also fecal excretion.

Half Life: Approximately 20 hours for trandolaprilat.

Contraindications

  • Pregnancy (especially second and third trimesters)
  • History of angioedema related to previous ACE inhibitor therapy
  • Hypersensitivity to ACE inhibitors

Precautions

  • Use in patients with renal artery stenosis, electrolyte imbalances, or bilateral renal artery stenosis.
  • Monitor renal function and electrolytes regularly.
  • Pregnancy category D; contraindicated in pregnancy.

Adverse Reactions - Common

  • Dizziness (Common)
  • Cough (Common)
  • Headache (Common)
  • Fatigue (Common)

Adverse Reactions - Serious

  • Angioedema (Rare)
  • Hyperkalemia (Uncommon)
  • Hypotension, especially after initial dose (Uncommon)
  • Acute renal failure (Rare)

Drug-Drug Interactions

  • Diuretics, especially potassium-sparing diuretics
  • Other antihypertensives
  • Potassium supplements
  • NSAIDs

Drug-Food Interactions

  • Salt substitutes containing potassium

Drug-Herb Interactions

  • Potential interactions with herbal supplements that affect blood pressure or potassium levels

Nursing Implications

Assessment: Monitor blood pressure, renal function, serum electrolytes, and signs of angioedema.

Diagnoses:

  • Risk for falls due to hypotension
  • Altered electrolyte balance
  • Risk for renal impairment

Implementation: Administer as prescribed, monitor for adverse effects, educate patient on rise gradually from sitting/supine position.

Evaluation: Assess blood pressure response, renal function, and electrolyte levels regularly.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report symptoms of swelling, difficulty breathing, or signs of hyperkalemia.
  • Avoid salt substitutes containing potassium.
  • Be cautious when standing up quickly to prevent dizziness.

Special Considerations

Black Box Warnings:

  • Fetal injury and death when used during pregnancy

Genetic Factors: Sensitivity may vary; monitor closely in populations with certain genetic predispositions.

Lab Test Interference: ACE inhibitors may increase serum potassium and serum creatinine levels.

Overdose Management

Signs/Symptoms: Hypotension, hyperkalemia, renal impairment.

Treatment: Discontinue medication, provide supportive therapy, administer intravenous fluids for hypotension, and manage hyperkalemia with appropriate interventions.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable for the duration of the shelf life as indicated on the packaging.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.