TRANDOLAPRILAND VERAPAMIL (Systemic)?
Some commonly used brand names are:
In the U.S.?
? Not commercially available in Canada.
Category
Description
Trandolapril (tran-DOHL-a-pril) and verapamil (ver-AP-a-mil) combination belongs to the class of medicines called highblood pressure medicines (antihypertensives). It is used to treat high bloodpressure (hypertension).
High blood pressure adds to the workload of the heart and arteries. Ifit continues for a long time, the heart and arteries may not function properly.This can damage the blood vessels of the brain, heart, and kidneys, resultingin a stroke, heart failure, or kidney failure. High blood pressure may alsoincrease the risk of heart attacks. These problems may be less likely to occurif blood pressure is controlled.
The exact way in which this medicine works is not known. Trandolapril isa type of medicine known as an angiotensin-converting enzyme (ACE) inhibitor.It blocks an enzyme in the body that is necessary in producing a substancethat causes blood vessels to tighten. Verapamil is a type of medicine knownas a calcium channel blocker. Calcium channel blocking agents affect the movementof calcium into the cells of the heart and blood vessels. The actions of bothmedicines relax blood vessels, lower blood pressure, and increase the supplyof blood and oxygen to the heart.
This medicine is available only with your doctor's prescription, in thefollowing dosage form:
Oral- Extended-release tablets (U.S.)
Before Using This Medicine
In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For trandolapril andverapamil combination, the following should be considered:
Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to trandolapril or to any other ACE inhibitor (benazepril,captopril, enalapril, fosinopril, lisinopril, moexipril, quinapril, or ramipril)or to verapamil. Also tell your health care professional if you are allergicto any other substances, such as foods, preservatives, or dyes.
Pregnancy?Studies with this combination medicine have not beendone in pregnant women. However, use of any of the ACE inhibitors during pregnancy,especially in the second and third trimesters (after the first 3 months) cancause low blood pressure, kidney failure, an underdeveloped skull, or evendeath in newborns. Therefore, it is important that youcheck with your doctor immediately if you think that you may be pregnant.Be sure that you have discussed this with your doctor before taking this combinationmedicine.
Breast-feeding?Verapamil passes into breast milk. It is not knownwhether trandolapril passes into breast milk; however, it does pass into themilk of lactating rats. Breast-feeding is not recommended in women who aretaking this combination medicine.
Children?Studies on this medicine have been done only in adultpatients, and there is no specific information comparing use of trandolapriland verapamil in children with use in other age groups.
Older adults?Although this medicine has not been shown to causedifferent side effects or problems in older people than it does in youngeradults, blood levels of trandolapril and verapamil may be increased in theelderly. Elderly people also may be more sensitive to the effects of thismedicine.
Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takingthis medicine, it is especially important that your health care professionalknow if you are taking any of the following:
- Beta-blockers (acebutolol [e.g., Sectral], atenolol [e.g., Tenormin],betaxolol [e.g., Kerlone], bisoprolol [e.g., Zebeta], carteolol [e.g., Cartrol],carvedilol [e.g., Coreg], labetalol [e.g., Normodyne], metoprolol [e.g., Lopressor],nadolol [e.g., Corgard], oxprenolol [e.g., Trasicor], penbutolol [e.g., Levatol],pindolol [e.g., Visken], propranolol [e.g., Inderal], sotalol [e.g., Sotacor],timolol [e.g., Blocadren])?Effects of these medicines and verapamilon the heart may be increased
- Digitalis glycosides (heart medicine [e.g., Lanoxin])?Effectsof these medicines may be increased
- Disopyramide (e.g., Norpace)?Effects of verapamil on the heartmay be increased
- Diuretics (water pills)?May increase the blood pressure-loweringeffects
- Potassium-containing medicines or supplements or
- Salt substitutes that contain potassium?Use of these substanceswith ACE inhibitors may result in an unusually high potassium level in theblood, which can lead to irregular heart rhythm and other problems
Also, tell your health care professional if you are using any of the followingmedicines in the eye:
- Betaxolol (e.g., Betoptic) or
- Carteolol (e.g., Ocupress) or
- Levobunolol (e.g., Betagan) or
- Metipranolol (e.g., OptiPranolol) or
- Timolol (e.g., Timoptic)?Effects on the heart may be increased
Other medical problems?The presence of other medicalproblems may affect the use of this medicine. Make sure you tell your doctorif you have any other medical problems, especially:
- Bee-sting allergy treatments or
- Dialysis treatments?Increased risk of serious allergic reactionoccurring
- Dehydration?Lowering effects on blood pressure may be increased
- Type 2 diabetes mellitus?Increased risk of potassiumlevels in the body becoming too high
- Duchenne's muscular dystrophy?Verapamil may make this conditionworse
- Heart disease or
- Hypotension (low blood pressure)?Further lowering of bloodpressure may make problems resulting from these conditions worse
- Kidney disease or
- Liver disease?Effects may be increased because of slower removalof the medicine from the body
- Scleroderma or
- Systemic lupus erythematosus (SLE) (or history of)?Increasedrisk of blood problems with ACE inhibitors
- Previous reaction to any ACE inhibitor involving hoarseness; swellingof face, mouth, hands, or feet; or sudden trouble in breathing?Reactionis more likely to occur again with ACE inhibitors
Proper Use of This Medicine
Take this medicine exactly as directed by your doctor, at the same time eachday. Do not take more of it and do not take it more often than directed.
Swallow the tablets whole, without breaking, crushing, or chewing them.
Take this medicine with food or milk.
Dosing?The dose of this medicine will be differentfor different patients. Follow your doctor's orders orthe directions on the label. The following information includes onlythe average doses of this medicine. If your dose is different,do not change it unless your doctor tells you to do so.
The number of tablets that you take depends on the strength of the medicine.Also, the number of doses you take each day, the timeallowed between doses, and the length of time you take the medicine dependon the medical problem for which you are taking it.
- For oral dosage form (extended-releasetablets):
- For high blood pressure:
- Adults?1 or 2 tablets a day.
- Children?Use and dose must be determined by your doctor.
Missed dose?If you miss a dose of this medicine, take it assoon as possible. However, if it is almost time for your next dose, skip themissed dose and go back to your regular dosing schedule. Do not double doses.
Storage?To store this medicine:
- Keep out of the reach of children.
- Store away from heat and direct light.
- Do not store in the bathroom, near the kitchen sink, or in otherdamp places. Heat or moisture may cause the medicine to break down.
- Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
It isvery important that your doctor check your progress at regular visits. Thiswill allow your doctor to make sure the medicine is working properly, to checkfor unwanted effects, and to change the dosage if needed.
If you think that you may have become pregnant, checkwith your doctor immediately. Use of this medicine, especially duringthe second and third trimesters (after the first 3 months) of pregnancy, maycause serious injury or even death to the unborn child.
Do not take any other medicines, especially potassium supplements, or saltsubstitutes that contain potassium unless approved or prescribed by your doctor.
Dizziness, lightheadedness, or fainting may occur after the first dose,especially if you have been taking a diuretic (water pill). Make sure youknow how you react to the medicine before you drive, use machines, or do otherthings that could be dangerous if you experience these effects.
Check with your doctor if you notice any signs of fever, sore throat, orchills. These could be symptoms of an infection resulting from low white bloodcell counts.
Check with your doctor immediately if you notice difficult breathing orswelling of the face, arms, or legs. These could be symptoms of a seriousallergic reaction.
Check with your doctor if you become sick while taking this medicine, especiallywith severe or continuing vomiting or diarrhea. These conditions may causeyou to lose too much water, possibly resulting in low blood pressure.
Dizziness, lightheadedness, or fainting may also occur if you exerciseor if the weather is hot. Heavy sweating can cause loss of too much waterwhich can result in low blood pressure. Use extra care during exercise orhot weather.
Before having any kind of surgery (including dental surgery) or emergencytreatment, tell the medical doctor or dentist in charge that you are takingthis medicine.
Side Effects of This Medicine
Along with its needed effects, a medicine maycause some unwanted effects. Although not all of these side effects may occur,if they do occur they may need medical attention.
Check withyour doctor as soon as possible if any of the following side effects occur:
Rare
Chest pain; cough (with mucus); dark urine, yellow eyes or skin, or pain in right side; lightheadedness or fainting; fever,chills, or sore throat; general feeling of discomfortor illness; shortness of breath; slow heartbeat; wheezing
Signs and symptoms of too much potassium in the body
Confusion; irregular heartbeat; nervousness; numbness or tingling inhands, feet, or lips; weakness or heaviness of legs
Other side effects may occur that usually do not need medicalattention. These side effects may go away during treatment as your body adjuststo the medicine. However, check with your doctor if any of the following sideeffects continue or are bothersome:
Other side effectsnot listed above may also occur in some patients. If you notice any othereffects, check with your doctor.
Developed: 08/10/1998
