Formulary
Trandolapril: Indications, Dosing, Side Effects and Interactions
Trandolapril clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 5 min read
Trandolapril: Indications, Dosing, Side Effects and Interactions
Trandolapril clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Mild to moderate hypertension**
- **Adult** (By Mouth): Initially 500 micrograms once daily; increased to 1-2 mg once daily, dose to be increased at intervals of 2-4 weeks; maximum 4 mg per day.
**Prophylaxis after myocardial infarction in patients with left ventricular dysfunction (starting as early as 3 days after infarction)**
- **Adult** (By Mouth): Initially 500 micrograms once daily, then increased to up to 4 mg once daily, doses to be increased gradually.
Cautions
For all angiotensin-converting enzyme inhibitors Concomitant diuretics; diabetes (may lower blood glucose; increased risk of hyperkalaemia); first dose hypotension (especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with cerebrovascular disease, ischaemic heart disease, or heart failure); patients of black African or African-Caribbean origin (may respond less well to ACE inhibitors); peripheral vascular disease or generalised atherosclerosis (risk of clinically silent renovascular disease); primary aldosteronism (patients may respond less well to ACE inhibitors); the risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended); use with care in patients with aortic or mitral valve stenosis (risk of hypotension); use with care in patients with hypertrophic cardiomyopathy Cautions, further information Anaphylactoid reactions To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux membranes (e.g. polyacrylonitrile) and during low-density lipoprotein apheresis with dextran sulfate; they should also be withheld before desensitisation with wasp or bee venom. M Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: with hyperkalaemia with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls)
Contraindications
For all angiotensin-converting enzyme inhibitors Hereditary or idiopathic angioedema; history of angioedema associated with prior ACE inhibitor therapy; the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with an eGFR less than 60 mL/minute/1.73 m 2 ; the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with diabetes mellitus
Side effects
For all angiotensin-converting enzyme inhibitors Common or very common Alopecia; angina pectoris; angioedema (can be delayed; more common in black patients); arrhythmias; asthenia; chest pain; constipation; cough; depression; diarrhoea; dizziness; drowsiness; dry mouth; dyspnoea; electrolyte imbalance; gastrointestinal discomfort; headache; hypotension; myalgia; nausea; palpitations; paraesthesia; renal impairment; rhinitis; skin reactions; sleep disorder; syncope; taste altered; tinnitus; vertigo; vomiting Uncommon Arthralgia; confusion; eosinophilia; erectile dysfunction; fever; haemolytic anaemia; hyperhidrosis; myocardial infarction; pancreatitis; peripheral oedema; photosensitivity reaction; respiratory disorders; stroke Rare or very rare Agranulocytosis; hepatitis; leucopenia; neutropenia; pancytopenia; Stevens-Johnson syndrome; thrombocytopenia Side-effects, further information In light of reports of cholestatic jaundice, hepatitis, fulminant hepatic necrosis, and hepatic failure, ACE inhibitors should be discontinued if marked elevation of hepatic enzymes or jaundice occur. Side-effects For trandolapril Uncommon Feeling abnormal; gastrointestinal disorders; hot flush; increased risk of infection; insomnia; libido decreased; malaise; muscle spasms; pain; rhinorrhoea Rare or very rare Anaemia; anxiety; appetite abnormal; azotaemia; cerebrovascular insufficiency; enzyme abnormality; eye disorder; eye inflammation; gout; haemorrhage; hallucination; hyperbilirubinaemia; hyperglycaemia; hypersensitivity; hyperuricaemia; migraine; movement disorders; myocardial ischaemia; oedema; osteoarthritis; platelet disorder; throat irritation; urinary disorders; vascular disorders; visual impairment; white blood cell disorder Frequency not known Atrioventricular block; cardiac arrest; jaundice; proteinuria; toxic epidermal necrolysis Side-effects, further information If symptomatic hypotension develops during titration, do not increase dose further; if possible, reduce dose of any adjunctive treatment and if this is not effective or feasible, reduce dose of trandolapril.
Interactions
**Severe interactions:**
- Potassium sparing diuretics (e.g.
- Combination requiring a precaution for use Thiazide and loop diuretics: Patients in diuretic treatment, especially patients who have recently begun treatment or patients with volume and/or salt...
**Other interactions (27):**
- Concomitant use of ACE inhibitors with racecadotril, mTOR inhibitors (e.g.
- Concomitant use of other NEP inhibitors (e.g.
- Potassium sparing diuretics, potassium supplements or potassium-containing salt substitutes Although serum potassium usually remains within normal limits, hyperkalaemia may occur in some patients...
- Care should also be taken when trandolapril is co-administered with other agents that increase serum potassium, such as trimethoprim and cotrimoxazole (trimethoprim/sulfamethoxazole) as trimethoprim...
- Therefore, the combination of trandolapril with the above-mentioned drugs is not recommended.
- Concurrent administration of potassium or potassium-sparing diuretics increases the risk of hyperkalaemia, particularly in renal failure, diabetes mellitus, and/or left ventricular dysfunction after...
Pregnancy
Important safety information For all angiotensin-converting enzyme inhibitors MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: not for use in pregnancy (December 2014) See Conception and contraception and Pregnancy . MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: recommendations on how to use for breastfeeding (December 2014) See Breast feeding .
Breast feeding
For all angiotensin-converting enzyme inhibitors Information on the use of ACE inhibitors in breast-feeding is limited. Breast feeding For trandolapril Not recommended; alternative treatment options, with better established safety information during breast-feeding, are available.
Hepatic impairment
Trandolapril is a prodrug. Manufacturer advises caution. Dose adjustments Manufacturer advises initiate under close supervision and adjust dose according to blood pressure response in severe impairment.
Renal impairment
For all angiotensin-converting enzyme inhibitors Caution (hyperkalaemia and other side-effects of ACE inhibitors are more common in those with impaired renal function). M Dose adjustments Start with low dose and adjust according to response. M Renal impairment For trandolapril Dose adjustments Max. 1 mg once daily if creatinine clearance 10-30 mL/minute; max. 500 micrograms once daily if creatinine clearance less than 10 mL/minute. M See Prescribing in renal impairment .
Medicinal forms
Suspension
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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