How does this medication work? What will it do for me?

Trandolapril belongs to the class of medications called angiotensin converting enzyme (ACE) inhibitors. It is used to treat high blood pressure. It works by relaxing blood vessels, allowing the heart to pump more efficiently. It is also used after heart attacks to reduce the risk of another heart attack and prevent the onset or worsening of congestive heart failure.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

0.5 mg
Each red opaque body and yellow opaque cap, No. 4 gelatin capsule, contains trandolapril 0.5 mg. Nonmedicinal ingredients: lactose, maize starch, povidone, and sodium stearyl fumarate; capsule cap and body: erythrosine, iron oxides and hydroxides, sodium lauryl sulfate, and titanium dioxide.

1 mg
Each red opaque body and orange opaque cap, No. 4 gelatin capsule, contains trandolapril 1 mg. Nonmedicinal ingredients: lactose, maize starch, povidone, and sodium stearyl fumarate; capsule cap and body: erythrosine, iron oxides and hydroxides, sodium lauryl sulfate, and titanium dioxide.

2 mg
Each red opaque body and red opaque cap, No. 4 gelatin capsule, contains trandolapril 2 mg. Nonmedicinal ingredients: lactose, maize starch, povidone, and sodium stearyl fumarate; capsule cap and body: erythrosine, iron oxides and hydroxides, sodium lauryl sulfate, and titanium dioxide.

4 mg
Each red opaque body and brown opaque cap, No. 4 gelatin capsule, contains trandolapril 4 mg. Nonmedicinal ingredients: lactose, maize starch, povidone, and sodium stearyl fumarate; capsule cap and body: erythrosine, iron oxides and hydroxides, sodium lauryl sulfate, and titanium dioxide.

How should I use this medication?

For treatment of high blood pressure, the recommended adult starting dose is 1 mg once daily with increases in dose every 2 to 4 weeks until blood pressure is controlled. The maximum recommended dose is 4 mg once daily.

After a heart attack, the recommended starting dose is 1 mg once daily starting no earlier than the third day after the heart attack has taken place. After 2 days, the recommended dose is increased to 2 mg once daily and after one month, the recommended dose is increased to 4 mg once daily if the medication is tolerated.

Trandolapril may be taken with or without food.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication  exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take trandolapril if you:

  • are allergic to trandolapril or any ingredients of the medication
  • are allergic to any other ACE inhibitors
  • are pregnant or plan to become pregnant
  • are breast-feeding
  • have been diagnosed with hereditary angioedema
  • have diabetes or kidney disease and are taking aliskiren
  • have any condition that makes you intolerant to lactose
  • have had angioedema (a serious allergic reaction which causes the area around the throat and tongue to swell) after taking any other ACE inhibitors (e.g., captopril, ramipril)

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal pain
  • cough (dry, persistent)
  • diarrhea
  • headache
  • loss of appetite
  • nausea
  • unusual tiredness
  • vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • blurred vision
  • confusion
  • dizziness, lightheadedness, or fainting (signs of low blood pressure)
  • flu-like symptoms (sudden lack of energy, fever, cough, sore throat)
  • numbness or tingling in hands, feet, or lips
  • signs of low blood pressure (e.g., dizziness, lightheadedness, fainting)
  • signs of bleeding (e.g., unusual nosebleeds, blood in urine, coughing blood, bruising easily, cuts that won't stop bleeding)
  • signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
  • signs of fluid and electrolyte imbalance (e.g., drowsiness, muscle pain or cramps, weakness, irregular heart beat)
  • signs of kidney problems (e.g., increased urination at night, decreased urine production, blood in the urine)
  • signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
  • signs of too much potassium in the body (e.g., confusion, irregular heartbeat; nervousness; numbness or tingling in hands, feet, or lips; shortness of breath or difficulty breathing; weakness or heaviness of legs)
  • skin rash, with or without itching, fever, or joint pain

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • abdominal pain, with or without nausea or vomiting
  • signs of angioedema (e.g., swollen mouth, lips, tongue, difficulty swallowing or breathing)
  • signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
  • signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Angioedema: Angioedema (a serious allergic reaction which causes the area around the throat and tongue to swell) may occur with trandolopril, although uncommonly. If swelling of the face, tongue, or glottis occurs, stop the medication at once and seek immediate medical attention. If you experience angioedema with trandolapril, you should not take any of the other ACE inhibitors, such as enalapril, lisinopril, or quinapril.

People who have had angioedema caused by other substances may be at increased risk of angioedema while taking an ACE inhibitor such as trandolapril.

Blood disorders: In rare cases, a low white blood cell count has been reported by people taking this medication. Your doctor may occasionally monitor your level of white blood cells by performing blood tests. Low white blood cell levels may increase your risk for infection. If you notice any signs of infection (e.g., fever, sore throat), contact your doctor as soon as possible.

Cough: People taking trandolapril may develop a dry, persistent cough that usually disappears only after stopping or lowering the trandolapril dose. Be sure to tell your doctor of any cough which does not seem to be related to a usual cause.

Fluid and electrolyte balance: Increases in blood levels of potassium may occur as a result of taking perindopril. This rarely causes problems, but your doctor will probably want to monitor your potassium levels regularly with blood tests. If you experience unexplained nausea, fatigue, muscle weakness, or tingling sensations, contact your doctor.

Kidney function: Changes in kidney function have been seen in certain people who take this medication. The use of diuretics (water pills) or aliskiren may further increase risk of kidney problems for those at risk for this problem. If you have kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

This medication may also cause a decrease in liver function. If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Low blood pressure: Occasionally, blood pressure drops too low after taking trandolapril. This usually happens after the first or second dose or when the dose is increased. It is more likely to occur for those who take aliskiren, water pills, have a salt restricted diet, are on dialysis, or are experiencing diarrhea or vomiting. These individuals should be monitored closely by their doctor for the first weeks of treatment and whenever the dose of the medication is increased. To reduce the risk of dizziness, get up slowly from a lying down or sitting position. If low blood pressure causes you to faint or feel lightheaded, contact your doctor.

Excessive sweating and lack of fluid intake may lead to an excessive fall in blood pressure because of reduced fluid in your blood vessels. Vomiting or diarrhea may also lead to a fall in blood pressure. Consult your doctor if you feel your blood pressure is too low.

Pregnancy: ACE inhibitors such as trandolapril may cause severe harm or death to a developing baby if taken by the mother during pregnancy. This medication should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if trandolapril passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

Seniors: Seniors have an increased risk of experiencing side effects when taking trandolapril due to reduced kidney function. Lower doses may be necessary to minimize side effects.

What other drugs could interact with this medication?

There may be an interaction between trandolapril and any of the following:

  • acetazolamide
  • aliskiren
  • allopurinol
  • alpha blockers (e.g., alfuzosin, doxazosin, tamsulosin)
  • alpha agonists (e.g., clonidine, methyldopa)
  • amifostine
  • amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
  • angiotensin converting enzyme inhibitors (ACEIs; captopril, enalapril, ramipril)
  • angiotensin receptor blockers (ARBs; e.g., candasartan, irbesartan, losartan)
  • antacids (e.g., calcium carbonate, magnesium hydroxide)
  • azathioprine
  • barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
  • beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
  • brimonidine
  • calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
  • ciprofloxacin
  • cyclosporine
  • diabetes medications (e.g., chlorpropamide, glipizide, glyburide, insulin, metformin, nateglinide, rosiglitazone)
  • dipyridamole
  • diuretics (water pills; e.g., furosemide, amiloride, spironolactone, triamterene)
  • duloxetine
  • everolimus
  • iron dextran
  • iron gluconate
  • grass pollen allergen extract
  • guanfacine
  • heparin
  • levodopa
  • lithium
  • low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
  • medications that increase blood levels of potassium (e.g., potassium chloride, salt substitutes containing potassium)
  • medications that lower blood pressure
  • methylphenidate
  • monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
  • nitrates (e.g., isosorbide dinitrate,  isosorbide mononitrate)
  • nonsteroidal anti-inflammatory medications (NSAIDs; e.g., indomethacin)
  • obinutuzumab
  • pentoxifylline
  • phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
  • risperidone
  • rituximab
  • sirolimus
  • sodium phosphates
  • temsirolimus
  • tetracycline
  • tizanidine
  • tolvaptan
  • trimethoprim
  • yohimbine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.