Sacubitril Valsartan
Contraindicated
Textbook
Increased risk of angioedema.
Do not use in conjunction with ACEIs.
Source: G&G 14e · p602
Drug reference
Trandolapril
ACE Inhibitor · Antihypertensive
ACE InhibitorAntihypertensive
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
D
FDA category + note
Top interactionssee all 12 →
- Sacubitril ValsartanContraindicatedTextbookG&G 14e · p602
- AminoglycosidesSevereTextbookG&G 14e
- Angiotensin Receptor BlockersSevereTextbookHarrison 22e · p2396
- AzilsartanSevereTextbookG&G 14e
Mechanism
Trandolapril, an ACE inhibitor, works by inhibiting the conversion of angiotensin I to the active angiotensin II in the renin-angiotensin system. This inhibition leads to a reduction in angiotensin II levels, resulting in decreased blood pressure and enhanced natriuresis. Additionally, ACE inhibitors increase bradykinin levels, which stimulates prostaglandin production and may contribute to their vasodilatory effects.
Indications
Mild to moderate hypertensionProphylaxis after myocardial infarction in patients with left ventricular dysfunction (starting as early as 3 days after infarction)hypertensioncardiovascular diseaseheart failurediabetic nephropathyacute myocardial infarctionhigh risk of cardiovascular eventscoronary artery disease (without heart failure)Congestive heart failure (CHF)Myocardial infarction (MI)Prophylaxis in high cardiovascular risk subjectsNondiabetic nephropathyScleroderma crisis
Dosing
- Adult
- For mild to moderate hypertension, initially 500 micrograms once daily; increased to 1–2 mg once daily, dose to be increased at intervals of 2–4 weeks. For prophylaxis after myocardial infarction in patients with left ventricular dysfunction (starting as early as 3 days after infarction), initially 500 micrograms once daily, then increased to up to 4 mg once daily, with doses increased gradually.…
- Renal adjustment
- Max. 2 mg daily if eGFR less than 10 mL/minute/1.73 m2.
- Hepatic adjustment
- Manufacturer advises caution. Initiate under close supervision and adjust dose according to blood pressure response in severe impairment.
- Max dose
- 4 mg per day
Pharmacokinetics
Peak effect
Trandolaprilat in plasma are achieved in 4 to 10 h
Duration
Suitable for once daily dosing
Half-life
biphasic elimination kinetics, with an initial t1/2 of about 10 h...followed by a more prolonged t1/2
Bioavailability
trandolapril (10% bioavailability) and trandolaprilat (70% bioavailability)
Metabolism
Trandolapril is a prodrug.
Excretion
Predominantly by the kidneys (as an ACE inhibitor, not listed as an exception).
Contraindications
- Do not use in combination with ARB
- Contraindicated in pregnancy
Side effects
Common
hot flushincreased risk of infectioninsomnialibido decreasedmalaisemuscle spasmspainrhinorrhoeacoughhypotensionhyperkalemiaskin rashcough (5%-10%)increase in serum creatinine (<25% normal)Hyperkalemia in CKDAcute kidney failure in severe bilateral renal artery stenosisAngioedema
Serious
- Anaemia
- anxiety
- appetite abnormal
- azotaemia
- cerebrovascular insufficiency
- depression
- enzyme abnormality
- eye disorder
- eye inflammation
- gout
- haemorrhage
- hallucination
- hyperbilirubinaemia
- hyperglycaemia
- hypersensitivity
- hyperuricaemia
- migraine
- movement disorders
- myocardial ischaemia
- oedema
- osteoarthritis
- platelet disorder
- throat irritation
- urinary disorders
- vascular disorders
- visual impairment
- white blood cell disorder
- Atrioventricular block
- cardiac arrest
- jaundice
- proteinuria
- toxic epidermal necrolysis
- angioedema
- acute renal failure
- fetopathic syndrome
- neutropenia
- glycosuria
- anemia
- hepatotoxicity
- dysgeusia
- hepatic failure (rare)
- agranulocytosis (rare)
Pregnancy & lactation
Pregnancy
D
Lactation
Not recommended; alternative treatment options, with better established safety information during breast-feeding, are available.
Drug interactions
Aminoglycosides
Severe
Textbook
Increased risk and severity of renal impairment and nephrotoxicity.
Not explicitly stated, but implies careful monitoring of renal function and cautious co-administration.
Source: G&G 14e
Angiotensin Receptor Blockers
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Azilsartan
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Candesartan
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Dipeptidyl Peptidase Iv Inhibitor
Severe
Textbook
Increased risk of angioedema.
Avoid combination.
Source: G&G 14e · p600
Losartan + Hydrochlorothiazide
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Olmesartan + Amlodipine
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Olmesartan + Hydrochlorothiazide
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Olmesartan Medoxomil
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Sacubitril With Valsartan
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Telmisartan + Amlodipine + Hydrochlorothiazide
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Related guidelines
Other ACE Inhibitor drugs
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Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-13 · House clinical team