====== Trandolapril ======

Trandolapril is a long-acting ACE inhibitor used in hypertension and post–myocardial infarction patients with left ventricular dysfunction.

It has strong outcome data in post-MI populations.

Class:
→ [[cardio:raas:acei|ACE Inhibitors]]

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===== Mechanism of Action =====

• Inhibits Angiotensin-Converting Enzyme (ACE)
• ↓ Angiotensin II
• ↓ Aldosterone
• ↑ Bradykinin

Net Effects:
• ↓ Systemic vascular resistance (afterload)
• Mild ↓ preload
• ↓ Ventricular remodeling
• ↓ Blood pressure

Mechanism identical to other ACE inhibitors.

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===== Unique Features =====

• Prodrug → converted to active trandolaprilat
• Long-acting (once-daily dosing)
• Strong evidence in post-MI LV dysfunction (TRACE trial)

Less commonly prescribed today but pharmacologically solid.

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===== Indications =====

==== Hypertension ====
• Effective once-daily ACE inhibitor

→ [[cardio:hypertension:start|Hypertension Module]]

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==== Post-Myocardial Infarction with LV Dysfunction ====
• Reduces mortality
• Prevents ventricular remodeling

TRACE trial demonstrated survival benefit in patients with reduced EF after MI.

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==== Heart Failure (HFrEF) ====
• Used similarly to other ACE inhibitors
• Mortality benefit expected as class effect

→ [[cardio:heart_failure:start|Heart Failure Module]]

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===== Dosing =====

Hypertension:
• Start: 1 mg once daily
• Typical range: 1–4 mg once daily
• Max: 4 mg daily

Post-MI:
• Start low
• Titrate as tolerated

Once-daily dosing.

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===== Pharmacokinetics =====

• Prodrug → activated in liver
• Renally cleared
• Long half-life of active metabolite (~16–24 hours)

Dose adjustment required in renal impairment.

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===== Adverse Effects =====

Class Effects:
• Dry cough
• Hyperkalemia
• Hypotension
• Angioedema (rare)
• Mild creatinine elevation

No major differences from other ACE inhibitors.

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===== Monitoring =====

Monitor:
• Serum creatinine
• Potassium

Check labs 1–2 weeks after initiation or dose changes.

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===== Contraindications =====

• Pregnancy
• History of ACE inhibitor–induced angioedema
• Bilateral renal artery stenosis

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===== Clinical Pearls =====

✔ Long-acting ACE inhibitor  
✔ Strong post-MI LV dysfunction data (TRACE)  
✔ Once-daily dosing  
✔ Less commonly prescribed today but evidence-based  
✔ Same monitoring as all ACE inhibitors  

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Related:

→ [[cardio:raas:acei|ACE Inhibitors]]
→ [[cardio:raas:ramipril|Ramipril]]
→ [[cardio:heart_failure:start|Heart Failure Module]]
→ [[cardio:start|Return to CV Modules]]