Trandolapril

Hypertension: initial 0.5 mg once daily - a 0.5 mg dose will only achieve a therapeutic response in a minority of patients. Dosage should be doubled incrementally at intervals of 2 to 4 weeks based on patient response, up to a maximum of 4 mg as a single daily dose. Recommended maintenance dose range 1 to 2 mg as a single daily dose. If response is still unsatisfactory at 4 mg, consider combination therapy with diuretics and calcium channel blockers. Left ventricular dysfunction after acute myocardial infarction: treatment can start as early as the third day once necessary treatment conditions have been attained (stable haemodynamics, management of any residual ischaemia); initial dose must be low - 0.5 mg per day (24 hours) - increased progressively to a maximum of 4 mg daily as a single dose. Start in hospital under strict surveillance, particularly of blood pressure; forced titration may be temporarily suspended, for example in the event of symptomatic hypotension. Prior diuretic treatment: either discontinue the diuretic at least 72 hours before starting trandolapril and/or start with 0.5 mg daily, then adjust to response; if the diuretic must continue, medical supervision is necessary. Renovascular hypertension: initial 0.5 mg daily, adjusted according to blood pressure response. Cardiac failure (hypertensive patients with congestive heart failure, with or without renal insufficiency): start 0.5 mg once daily under close medical supervision in hospital. Hepatic impairment: in severely impaired liver function initiate 0.5 mg once daily under close medical supervision and adjust to therapeutic response. Elderly: normally no dose reduction needed and no dose adjustment necessary in those over 65 with age-normal renal function, but as some elderly are especially sensitive to ACE inhibitors it is recommended to start with low doses and monitor blood pressure response and kidney function; caution with concurrent diuretic treatment, congestive heart failure, or renal or hepatic insufficiency. Paediatric population: the medicinal product should not be given to children, as experience with treatment of children is insufficient (US label: safety and effectiveness in paediatric patients have not been established). Method of administration: oral use; may be taken before, during or after a meal.