Nurses Compass
Drug Guide
Trandolapril
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.