Drug reference
Mild to moderate hypertension ▶BY MOUTH ▶Adult: 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) ▶BY MOUTH ▶Adult: Initially 500 micrograms once daily, then increased to up to 4 mg once daily, doses to be increased gradually
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The combination of an angiotensin- II receptor antagonist with aliskiren is contra-indicated in patients with an eGFR less than 60 mL/minute/1.73 m2. the combination of an angiotensin-II receptor antagonist with aliskiren is contra-indictated in patients with diabetes mellitus
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Afro-Caribbean patients—particularly those with left ventricular hypertrophy (may not benefit from an angiotensin-II receptor antagonist). aortic or mitral valve stenosis. elderly (lower initial doses may be appropriate). hypertrophic cardiomyopathy. patients with a history of angioedema. patients with primary aldosteronism (may not benefit from an angiotensin-II receptor antagonist). renal artery stenosis CAUTIONS, FURTHER INFORMATION ▶Elderly Prescription potentially inappropriate (STOPP criteria): . with hyperkalaemia . with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls) See also Prescribing in the elderly p. 33. Cardiovascular system
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→Appendix 1: ACE inhibitors
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▶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. Cardiovascular system azotaemia. cerebrovascular insufficiency. depression. 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. ▶Common or very common Abdominal pain. asthenia. back pain. cough. diarrhoea. dizziness. headache. hyperkalaemia. hypotension. nausea. postural hypotension (more common in patients with intravascular volume depletion, e.g. those taking high-dose diuretics). renal impairment. vertigo. vomiting ▶Uncommon Angioedema. myalgia. skin reactions. thrombocytopenia ▶Rare or very rare Arthralgia. hepatic function abnormal
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Not recommended; alternative treatment options, with better established safety information during breast-feeding, are available. Information on the use of angiotensin-II receptor antagonists in breast-feeding is limited. They are not recommended in breast-feeding and alternative treatment options, with better established safety information during breast-feeding, are available.
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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. In general, manufacturers advise caution in mild to moderate impairment (limited information available); avoid in severe impairment (no information available).
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Dose adjustments Max. 2 mg daily if eGFR less than 10 mL/minute/1.73 m2. Dose adjustments Use with caution, starting with low dose, and adjust according to response.
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Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; neonatal skull defects and oligohydramnios have also been reported.
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Monitor plasma-potassium concentration, particularly in the elderly and in patients with renal impairment. eiiii F 185
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension Capsule ▶Trandolapril (Non-proprietary) Trandolapril 500 microgram Trandolapril 500microgram capsules | 14 capsule P £1.68 DT = £1.68 Trandolapril 1 mg Trandolapril 1mg capsules | 28 capsule P £20.20 DT = £20.20 Trandolapril 2 mg Trandolapril 2mg capsules | 28 capsule P £2.94 DT = £2.57 Trandolapril 4 mg Trandolapril 4mg capsules | 28 capsule P £13.39 DT = £13.39 DRUGS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM › ANGIOTENSIN II RECEPTOR ANTAGONISTS Angiotensin II receptor f antagonists
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Initially 500 micrograms once daily; increased to
First-line fragment. Read the complete Indications and Dose section above.
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Initially 500 micrograms once daily, then
First-line fragment. Read the complete Indications and Dose section above.
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