TRANDOLAPRIL /VERAPAMIL

Indications & Dose:

Treatment of hypertension

Contraindications:

Severe left ventricular dysfunction. Hypotension (systolic pressure less than 90 mmHg) or cardiogenic shock. Sick sinus syndrome (except in patients with a functioning artificial ventricular pacemaker.) Second or third degree AV block (except in patients with a functioning artificial ventricular pacemaker.) Patients with atrial flutter or atrial fibrillation and an accessory bypass tract (e.g. Wolff-ParkinsonWhitem Lown-Ganong-Levine syndromes) Patients with a history of angioedema related to previous treatment with angiotensin converting enzyme (ACE) inhibitor.
DOSAGE :
Children: not Recommended.
Adult: one tablet in the morning, if on diuretic, discontinue 1st and initiate therapy under close supervision.Pregnancy; Pregnancy Categories C (first trimester) and D (second and trimesters). Nursing Mothers: Should not be administered to nursing mothers. Geriatric Use: However, greater sensitivity of some older individual patients cannot be ruled out.
Pediatric Use: The safety and effectiveness in children below the age of 18 have not been established

Side Effects:

Cardiovascular: angina, AV block second degree, bundle branch block, edema, flushing, hypotension, myocardial infarction, palpitations, premature ventricular contractions, nonspecific ST-T changes, near syncope, tachycardia. Central Nervous System: drowsiness, hypesthesia, insomnia, loss of balance, paresthesia, vertigo. Dermatologic: pruritus, rash. Emotional. Mental, Sexual States: anxiety, impotence, abnormal mentation. Eye, Ear, Nose, Throat: epistaxis, tinnitus, upper respiratory tract infection, blurred vision. Gastrointestinal: diarrhea, dyspepsia, dry mouth, nausea. General Body Function: chest pain, malaise, weakness. Genitourinary: endometriois, hematuria, nocturia, polyuria, proteinuria. Hemopoietic: decreased leukocytes, decreased neutrophils. Musculoskeletal
System: arthralgias/myalgias, gout (increased uric acid). Pulmonary: dyspnea. Angioedema: Angioedema associated with laryngeal edema may be fetal. If angioedema of the face, extremities, lips, tongue, glottis, and/or larynx occurs, treatment with drug should be discontinued and appropriate therapy instituted immediately Hypotension: In hypertensive patients, hypotension occurred in 0.6% and near syncope occurred in 0.1%. Hypotension or syncope was a cause of discontinuation of therapy in 0.4% of hypertensive patients. Treatment of Acute Cardiovascular Adverse Reactions: The frequency of cardiovascular adverse reactions which require therapy is rare, hence, experience with their treatment is limited. Whenever severe hypotension or complete AV block occur following oral administration of drug (verapamil component), the appropriate emergency measures should be applied immediately, e.g. intravenously administered isoproterenol HCl, lavarterenol bitartrate, atropine, (all in the usual doses), or calcium gluconate (10% solution). In patients with hypertrophic cardiomyopathy (IHSS), alphaadrenergic agents (phenylephrine, metaraminol bitartrate or methoxamine) should be used to maintain blood pressure, and isoproterenol and levarterenol should be avoided. If further support is necessary, inotropic agents (dopamine or dobutamine) may be administered. Actual treatment and dosage should depend on the severity and the clinical situation and judgement and experience of the treating physician.

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