Trandolapril / Verapamil Dosage

Usual Adult Dose for Hypertension

Initial dose: The initial dosage of trandolapril-verapamil recommended for this patient should be based on this patient's requirements for each drug. The usual recommended dosage range for hypertension for trandolapril and verapamil (sustained-release) is 1 to 4 mg (trandolapril) and 120 to 480 mg (verapamil) per day.

Renal Dose Adjustments

Trandolapril-verapamil has not been evaluated in patients with impaired renal function. Compared to normal subjects, the plasma concentrations of trandolapril and trandolaprilat are approximately 2-fold greater and renal clearance is reduced by about 85% in patients with creatinine clearance below 30 mL/min and in patients on hemodialysis. Dosage adjustment is recommended in renally impaired patients. Trandolapril-verapamil should be administered cautiously to patients with impaired renal function.

Liver Dose Adjustments

Because both trandolapril and verapamil undergo significant hepatic metabolism, higher doses of either of these drugs or of their combination are not recommended. This combination drug is certainly not recommended as initial therapy, particularly in patients with liver disease.

Precautions

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Compared to normal subjects, the plasma concentrations of trandolapril and trandolaprilat are approximately 2-fold greater and renal clearance is reduced by about 85% in patients with on hemodialysis.

Other Comments

Trandolapril-verapamil should be taken with food.

Periodic monitoring of renal function and serum electrolytes (i.e., potassium) is recommended, particularly in patients with renal dysfunction.

Any volume or electrolyte abnormalities should be corrected prior to initiating therapy.

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