Trandolapril Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Hypertension

Initial dose: 1 mg orally once a day in nonblack patients not receiving a diuretic (2 mg in black patients).
Maintenance dose: 2 to 4 mg orally once a day.
There is little clinical experience with doses above 8 mg.

Usual Adult Dose for Congestive Heart Failure

Initial dose: 1 mg orally once a day
Maintenance dose: 4 mg orally once a day is the target dose. If this dose is not tolerated, patients can continue therapy with the greatest tolerated dose.

Usual Adult Dose for Left Ventricular Dysfunction

Initial dose: 1 mg orally once a day
Maintenance dose: 4 mg orally once a day is the target dose. If this dose is not tolerated, patients can continue therapy with the greatest tolerated dose.

Usual Adult Dose for Myocardial Infarction

Initial dose: 1 mg orally once a day
Maintenance dose: 4 mg orally once a day is the target dose. If this dose is not tolerated, patients can continue therapy with the greatest tolerated dose.

Usual Adult Dose for Diabetic Nephropathy

Initial dose: 1 to 2 mg orally once a day
Maintenance dose: 2 to 4 mg orally once a day

Renal Dose Adjustments

CrCl less than 30 mL/min:
Initial dose: 0.5 mg orally once a day
Maintenance dose: 1 to 4 mg orally once a day

Liver Dose Adjustments

Initial dose: 0.5 mg orally once a day
Maintenance dose: 1 to 4 mg orally once a day

Dose Adjustments

Generally, dosage adjustments should be made at intervals of at least 1 week. Patients inadequately treated with once daily dosing at 4 mg may be treated with twice daily dosing. If blood pressure is not adequately controlled with monotherapy, a diuretic may be added.

Precautions

In patients who are currently being treated with a diuretic, symptomatic hypotension occasionally can occur following the initial dose of trandolapril. To reduce the likelihood of hypotension, the diuretic should, if possible, be discontinued 2 to 3 days prior to beginning therapy with trandolapril. Then, if blood pressure is not controlled with trandolapril alone, diuretic therapy should be resumed. If diuretic therapy cannot be discontinued, an initial dose of 0.5 mg of trandolapril should be used with careful medical supervision for several hours and until blood pressure has stabilized.

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

Dialysis

Trandolapril is removed by hemodialysis.

Other Comments

Trandolapril in similar doses has been used in the treatment of Congestive Heart Failure, Myocardial Infarction, Diabetic Nephropathy, and Left Ventricular Dysfunction.

Compared with Caucasian patients, Black patients have a reduced blood pressure response to monotherapy with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers; however, the reduced response is largely eliminated if combination therapy that includes an adequate dose of a diuretic is instituted.

Following first time MI, all ACE inhibitors, at comparable appropriate dosages, appear to be equally effective for reducing mortality and recurrent MI rates.

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