Trandolapril And Verapamil Hydrochloride

Concurrent verapamil use increases ivabradine exposure and may exacerbate bradycardia and conduction disturbances. Avoid co-administration.

Hypotension, bradyarrhythmias, and lactic acidosis observed with concurrent clarithromycin use.

Verapamil reduces total body clearance and extrarenal clearance of digitoxin by 27% and 29%, respectively, risking toxicity.

Verapamil increases serum digoxin levels by 50-75% in first week, risking digoxin toxicity. Maintenance doses must be reduced and patient carefully monitored.

Increased lithium neurotoxicity and serum levels reported with verapamil component. ACE inhibitor component also increases toxicity risk. Frequent monitoring recommended.

Upon discontinuation of any verapamil-containing regime including trandolapril and verapamil hydrochloride extended-release tablets, the patient should be reassessed to avoid underdigitalization. No clinically significant pharmacokinetic interaction has been found between trandolapril (or its metabolites) and digoxin. Trandolapril and verapamil hydrochloride extended-release tablets and lithium should be coadministered with caution, and frequent monitoring of serum lithium levels is recommended.

CYP3A4 inhibitor causing elevation of verapamil plasma levels. Hypotension, bradyarrhythmias, and lactic acidosis reported with concurrent use.

Mammalian Target of Rapamycin (mTOR) Inhibitors Patients taking concomitant mTOR inhibitor (e.g., temsirolimus, sirolimus, everolimus) therapy may be at increased risk for angioedema (see WARNINGS - Angioedema ).

CYP3A4 inducer causing lowering of verapamil plasma levels. Patients should be monitored for drug interactions.

CYP3A4 inhibitor causing elevation of verapamil plasma levels. Patients should be monitored for drug interactions.

Lower starting and maintenance doses of other CYP3A4 substrates (e.g., atorvastatin) may be required as verapamil may increase the plasma concentration of these drugs.

Antiarrhythmic Agents Verapamil Component Disopyramide Phosphate Data on possible interactions between verapamil and disopyramide phosphate are not available. Therefore, disopyramide should not be administered within 48 hours before or 24 hours after verapamil administration.

No clinically significant pharmacokinetic interaction has been found between trandolapril (or its metabolites) and furosemide.

Limit the daily dose of lovastatin to 40 mg.

Drug interaction studies have indicated that the maximum concentrations of metoprolol and propanolol are increased after the administration of verapamil.

Tranquilizers/Anti-Depressants Due to metabolism via the CYP enzyme system, there have been reports that verapamil may increase the concentrations of buspirone, midazolam, almotriptan and imipramine.

Other (Trandolapril Component) No clinically significant pharmacokinetic interaction has been found between trandolapril (or its metabolites) and nifedipine.

There are reports that verapamil may result in higher concentrations of the alpha-agonists prazosin and terazosin.

Drug interaction studies have indicated that the maximum concentrations of metoprolol and propanolol are increased after the administration of verapamil.

Co-administration of multiple doses of 10 mg of verapamil with 80 mg simvastatin resulted in exposure to simvastatin 2.5-fold that following simvastatin alone. Limit the dose of simvastatin in patients on verapamil to 10 mg daily.

There have been reports that erythromycin and telithromycin may increase concentrations of verapamil.

There are reports that verapamil may result in higher concentrations of the alpha-agonists prazosin and terazosin.

Asymptomatic bradycardia (36 beats/min) with a wandering atrial pacemaker has been observed in a patient receiving concomitant timolol (a beta-adrenergic blocker) eyedrops and oral verapamil.