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(tran-DOE-lah-prill)
Mavik
Class: Antihypertensive/ACE inhibitor

 Action Reduces the formation of the vasopressor hormone angiotensin II by inhibiting angiotensin converting enzyme (ACE). Results in decreased BP, reduced sodium reabsorption and potassium retention.

 Indications Hypertension: Treatment of hypertension either alone or in combination with other antihypertensive drugs. Heart Failure Post-MI/Left-Ventricular Dysfunction Post-MI: For stable patients who have evidene of left-ventricular systolic dysfunction (dentified by wall motion abnormalities) or who are symptomatic from CHF within the first few days after sustaining acute MI.

 Contraindications Hypersensitivity or history of angioedema with any ACE inhibitor.

 Route/Dosage

Hypertension

ADULTS: PO 1–2 mg once daily initially with usual maintenance doses of 2–4 mg once daily.

Heart failure post-MI/Left-ventricular dysfunction post-MI

ADULTS: PO 1 mg/day. Following initial dose, titrate patients (as tolerated) toward a target dosage of 4 mg/day. RENAL/HEPATIC FUNCTION IMPAIRMENT: PO For patients with a creatinine clearance < 30 ml/min or with hepatic cirrhosis, starting dosage is 0.5 mg/day.

 Interactions

Allopurinol: Greater risk of hypersensitivity possible with coadministration. Diuretics: Possible hypotensive effect. Use lower starting doses. Potassium supplements or potassium-sparing drugs: May increase serum potassium levels. Lithium salts: Increased serum lithium levels and increased risk of lithium toxicity.

 Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Dizziness; headache; fatigue. GI: Diarrhea. META: Hyperkalemia. RESP: Cough (especially in females). OTHER: Angioedema; increased serum creatinine; BUN.

 Precautions

Pregnancy: Category D. (second and third trimester;) Category C. (First trimester) void use in nursing women if possible. Elderly: Reduce doses may be needed. Angioedema: Use with extreme caution in patients with hereditary angioedema. Lactation: Undetermined. Renal impairment: Reduce dosage. Decreases in renal function may occur if renal function is dependent on the renin-angiotensin system; patients with renal artery stenosis may experience acute renal failure. Hypotension/first-dose effect: Hypotension may occur during initiation of therapy, especially in patients with severe salt or volume depletion or those with CHF. Anaphylactoid teactions: Angioedema and anaphylactoid reactions are rarely reported but are potentially life-threatening. Hepatic failure: May occur. Discontinue drug if patient develops jaundice. Neutropenia or agranulocytosis: May occur; risk appears greater in patients with renal dysfunction, heart failure or immunosuppression. Periodically monitor WBC counts in these patients.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • May be taken without regard to meals.
  • Store at controlled room temperature in tightly closed container

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Monitor BP closely after initiation of therapy and during first 2 weeks. Observe for sudden hypotensive response and pulse throughout therapy.
  • Monitor for signs of hypersensitivity including angioedema involving swelling of the face, lips and tongue.
  • Monitor for hyperkalemia in patients with impaired renal function or diabetes mellitus and in patients receiving potassium supplements or potassium-sparing diuretics.
  • Keep side rails raised if hypotension or dizziness occur.
  • Monitor laboratory tests for increases in serum creatinine and BUN, hemoglobin, hematocrit and liver function tests.
  • Assist patients with position changes and ambulation during initial phase of therapy. Orthostatic hypotension is common.
OVERDOSAGE: SIGNS & SYMPTOMS
  Hypotension

 Patient/Family Education

  • Instruct patient to take medication as prescribed at same time each day.
  • Inform patient that trandolapril can control but does not cure hypertension.
  • Instruct patient to take dose as prescribed and not to stop taking medication even if feeling better. Instruct patient not to decrease or increase dosage.
  • Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
  • Instruct patient not to take otc medications without consulting physician.
  • Inform patient that if syncope occurs, stop taking drug until consulting physician.
  • Instruct patient to report these symptoms to physician: Decreased urinary output, discomfort during urination, weakness, fatigue, dizziness, lightheadedness, jaundice, swelling of face, extremities, eyes, lips, tongue, difficulty swallowing or breathing.
  • Caution patients that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting, resulting in reduced fluid volume, may lead to an excessive fall in blood pressure resulting in lightheadedness and possible fainting.
  • Tell patient not to use potassium supplements or salt substitutes containing potassium to prevent possible hyperkalemia.
  • Instruct patient to report any indications of an infection, such as sore throat, which could indicate neutropenia.
  • Caution patients to notify physician or dentist prior to surgery or treatment.
  • Caution female patients that should they become or plan to become pregnant, to notify their primary care provider so the medication can be discontinued immediately.
  • Advise patient to use caution while driving or performing tasks requiring mental alertness until response to medication is known.
  • Emphasize importance of follow-up visits and frequent assessment of BP while taking drug.
  • Advise patient and family that life-style changes (exercise, salt restriction, weight loss) will enhance effectiveness of medication and may facilitate lower medication dose.
  • Explain that chronic cough may occur. Instruct patient to avoid cough, cold, or allergy medications and to notify physician.

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