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Trandolapril is a medication designed to manage high blood pressure, but it is important to be aware of the associated safety precautions and risks. Please read the following warnings carefully and consult your healthcare provider if you have any concerns or if any of the conditions apply to you.

• Pregnancy Risks: Trandolapril can cause significant harm to an unborn baby, particularly during the second and third trimesters of pregnancy. Potential risks include birth defects such as a small skull, low blood pressure, and kidney failure. It is crucial to avoid pregnancy while on this medication. If you become pregnant or suspect you might be, discontinue the medication and inform your healthcare provider immediately to discuss alternative treatments.

• Angioedema: This is a serious condition characterized by swelling in various body parts, such as the face, throat, tongue, and intestines. Swelling in the throat or tongue can obstruct breathing and pose a life-threatening situation. Seek immediate medical attention if you experience facial swelling, abdominal pain, nausea, vomiting, or difficulty breathing. Those with a history of angioedema, Black individuals, and those on Entresto (sacubitril/valsartan) are at increased risk.

• Low Blood Pressure: Trandolapril can excessively lower blood pressure, leading to dizziness, fatigue, or lightheadedness, especially within the first two weeks of treatment or after dose increases. To mitigate this risk, maintain hydration and rise slowly from sitting or lying positions. Report persistent symptoms to your healthcare provider. Risks are higher in individuals with dehydration, low salt levels, those on long-term diuretics, or undergoing dialysis.

• Liver Concerns: There is a rare risk of liver issues, including blocked bile ducts, potentially leading to liver failure. If you experience abdominal pain, fatigue, or yellowing of the skin or eyes, notify your healthcare provider. Individuals with a history of liver problems should be particularly cautious.

• Kidney Function: While trandolapril can improve kidney circulation, it may worsen kidney problems in some cases, especially for those with blocked kidney arteries or severe heart failure. Regular lab tests may be necessary to monitor kidney health. Symptoms of kidney damage include reduced urination, fatigue, nausea, or chills.

• Increased Potassium Levels: Trandolapril may elevate potassium levels, which can be dangerous. Those with diabetes, kidney issues, or taking other potassium-raising medications are at a higher risk. Alert your healthcare provider if you experience nausea, muscle weakness, or irregular heartbeat.

• Dry Cough: A persistent dry cough may occur due to trandolapril's effect on a protein called bradykinin. This cough typically resolves upon discontinuation of the medication. Inform your healthcare provider if you experience this side effect.

Contraindications:

• A history of angioedema.
• Concurrent use with aliskiren (Tekturna) in patients with diabetes.
• Use within 36 hours of taking Entresto (sacubitril/valsartan).

Please ensure your healthcare provider is aware of your full medical history and current medications to safely manage your treatment with trandolapril.

Common side effects:

• dizziness
• lightheadedness
• tiredness
• persistent dry cough

Less common but important to monitor:

• indigestion
• fainting
• slow heart rate
• muscle pain
• increase in uric acid levels
• low blood pressure

Serious side effects:

• high potassium levels (muscle weakness, irregular heartbeat)
• significant kidney problems (changes in urination, swelling, unexplained weight gain)
• liver-related issues (persistent nausea, loss of appetite, abdominal pain, jaundice, dark urine)
• serious allergic reaction (rash, severe swelling, difficulty breathing)

Interactions with high risk of serious adverse effects and should be avoided:

• Aliskiren
• Sacubitril

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Everolimus
• Sirolimus
• Lithium
• ARBs (such as Losartan or Valsartan)
• Desensitization therapy for bee or wasp stings

Interactions with low risk that usually do not require a change in therapy:

• NSAIDs (such as Ibuprofen or Naproxen)
• Certain diuretics
• Potassium supplements