Therapeutic Classification: antihypertensives
Pharmacologic Classification: ace inhibitors
Absorption: 70% absorbed following oral administration.
Distribution: Crosses the placenta; enters breast milk.
Metabolism/Excretion: Converted by the liver to trandolaprilat, the active metabolite; 33% excreted in urine, 66% in feces.
Half-Life: Trandolapril: 6 hr; Trandolaprilat: 22.5 hr (↑ in renal impairment).
(antihypertensive effect)
ROUTE | ONSET | PEAK | DURATION |
---|
PO | within 12 hr* | within 1 wk‡ | up to 24 hr‡ |
Contraindicated in:
- Hypersensitivity;
- History of angioedema with previous use of ACE inhibitors;
- Concurrent use with aliskiren in patients with diabetes or moderate to severe renal impairment (CCr <60 mL/min);
- Concurrent use with sacubitril/valsartan; must be a 36-hr washout period after switching to/from sacubitril/valsartan;
- OB: Pregnancy;
- Lactation: Lactation.
Use Cautiously in:
- Black patients (monotherapy for hypertension less effective, may require additional therapy; higher risk of angioedema);
- Surgery/anesthesia (hypotension may be exaggerated);
- Renal impairment, hypovolemia, hyponatremia, and concurrent diuretic therapy (initial dose ↓ recommended);
- Rep: Women of reproductive potential;
- Pedi: Safety and effectiveness not established in children;
- Geri: Initial dose ↓ recommended in older adults.
Exercise Extreme Caution in:
- Family history of angioedema.
Hypertension
- PO (Adults ): 1 mg once daily (2 mg in Black patients). May be ↑ weekly up to 4 mg once daily; twice-daily dosing may be necessary in some patients (initiate therapy with 0.5 mg/day in patients receiving diuretics).
Renal Impairment
- PO (Adults ): CCr <30 mL/min: Initiate therapy at 0.5 mg once daily; may be slowly titrated upward (max dose = 4 mg/day).
Hepatic Impairment
- PO (Adults ): Initiate therapy at 0.5 mg once daily; may be slowly titrated upward (max dose = 4 mg/day).
Heart Failure Post-MI or Left Ventricular Dysfunction Post-MI
- PO (Adults ): 1 mg once daily; titrate up to 4 mg once daily if possible.
Renal Impairment
- PO (Adults ): CCr <30 mL/min: Initiate therapy at 0.5 mg once daily; may be slowly titrated upward (max dose = 4 mg/day).
Hepatic Impairment
- PO (Adults ): Initiate therapy at 0.5 mg once daily; may be slowly titrated upward (max dose = 4 mg/day).