Trandolapril

How it works

Its active metabolite trandolaprilat inhibits ACE, reducing angiotensin II and aldosterone, thereby lowering vascular resistance and blood pressure.

Prescribing in practice

• Contraindicated in pregnancy and in patients with a history of ACE inhibitor-associated angioedema.
• Risk of hyperkalaemia and renal impairment, particularly with potassium-sparing agents, potassium supplements, NSAIDs or renal artery stenosis.
• Initiate cautiously in volume-depleted patients because of the risk of symptomatic first-dose hypotension.

Monitoring

Check renal function and serum potassium before and after starting or changing the dose, along with blood pressure.

Counselling the patient

• Report swelling of the face, lips, tongue or throat urgently.
• A dry cough can develop; let your clinician know if it troubles you.
• Avoid potassium-containing salt substitutes and tell your clinician if you may be pregnant.

Evidence & guidelines

ACE inhibitors improve survival after myocardial infarction with left ventricular dysfunction, as shown in the TRACE trial with trandolapril.