Drug
Trandolapril-Verapamil
Pronounced
"tran-DOLE-uh-prill w/ver-APP-uh-mill"
Drug Interactions
See also Precautions section.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Some products that may interact with this drug include: aliskiren, clonidine, disopyramide, dofetilide, fingolimod, gold injections, labetalol, lithium, sacubitril, certain drugs that weaken the immune system/increase the risk of infection (such as everolimus, sirolimus), drugs that may increase the level of potassium in the blood (such as ARBs including losartan/valsartan, birth control pills containing drospirenone).
Other medications can affect the removal of verapamil from your body, which may affect how this product works. Examples include erythromycin, rifamycins (such as rifampin), ritonavir, St. John's wort, among others.
Verapamil can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include colchicine, elacestrant, fezolinetant, flibanserin, ivabradine, lomitapide, midazolam, triazolam, among others.
Some products have ingredients that could raise your heart rate or blood pressure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).
A very serious reaction may occur if you are getting injections for bee/wasp sting allergy (desensitization) and are also taking trandolapril/verapamil. Make sure all your doctors know which medicines you are using.
Negative Interactions
2- Potential Negative Interaction
Trandolapril
Potassium
An uncommon yet potentially serious side effect of taking ACE inhibitors is increased blood potassium levels. This problem is more likely to occur in people with advanced kidney disease. Taking potassium supplements, potassium-containing salt substitutes (No Salt, Morton Salt Substitute, and others), or large amounts of high-potassium foods (such as bananas and other fruit) at the same time as taking ACE inhibitors could cause life-threatening problems. Therefore, people should consult their healthcare practitioner before supplementing additional potassium and should have their blood levels of potassium checked periodically while taking ACE inhibitors.
PotassiumTrandolapril- Good CB, McDermott L, McCloskey B. Diet and serum potassium in patients on ACE inhibitors. JAMA 1995;274:538.
- Rush JE, Merrill DD. The Safety and tolerability of lisinopril in clinical trials. J Cardiovasc Pharmacol 1987;9(Suppl 3):S99-107.
- Sifton DW, ed. Physicians' Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1965-8.
- Burnakis TG, Mioduch HJ. Combined therapy with captopril and potassium supplementation. A potential for hyperkalemia. Arch Intern Med 1984;144:2371-2.
- Burnakis TG. Captopril and increased serum potassium levels. JAMA 1984;252:1682-3 [letter].
- Ray K, Dorman S, Watson R. Severe hyperkalemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction. J Hum Hypertens 1999;13:717-20.
- Stoltz ML. Severe hyperkalemia during very-low-calorie diets and angiotensin converting enzyme use. JAMA 1990;264:2737-8 [letter].
- Potential Negative Interaction
Verapamil
Vitamin D
Vitamin D may interfere with the effectiveness of verapamil. People taking verapamil should ask their doctor before using vitamin D-containing supplements.
Vitamin DVerapamil- Threlkeld DS, ed. Diuretics and Cardiovasculars, Calcium Channel Blocking Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Nov 1992, 150-b.
Supportive Interactions
3- Replenish Depleted Nutrients
Trandolapril
Zinc
In a study of 34 people with hypertension, six months of captopril or enalapril (ACE inhibitors related to trandolapril) treatment led to decreased zinc levels in certain white blood cells, raising concerns about possible ACE inhibitor–induced zinc depletion.
While zinc depletion has not been reported with ramipril, until more is known, it makes sense for people taking trandolapril long term to consider, as a precaution, taking a zinc supplement or a multimineral tablet containing zinc. (Such multiminerals usually contain no more than 99 mg of potassium, probably not enough to trigger the above-mentioned interaction.) Supplements containing zinc should also contain copper, to protect against a zinc-induced copper deficiency.
ZincTrandolapril- Golik A, Zaidenstein R, Dishi V, et al. Effects of captopril and enalapril on zinc metabolism in hypertensive patients. J Am Coll Nutr 1998;17:75-8.
- Reduce Side Effects
Verapamil
Fiber
Constipation is a common side effect of verapamil treatment. Increasing fluid and fiber intake can ease constipation.
FiberVerapamil- Threlkeld DS, ed. Diuretics and Cardiovasculars, Calcium Channel Blocking Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Nov 1992, 150-b.
- Reduce Side Effects
Trandolapril
Iron
In a double-blind study of patients who had developed a cough attributed to an ACE inhibitor, supplementation with iron (in the form of 256 mg of ferrous sulfate per day) for four weeks reduced the severity of the cough by a statistically significant 45%, compared with a nonsignificant 8% improvement in the placebo group.
IronTrandolapril- Lee SC, Park SW, Kim DK, et al. Iron supplementation inhibits cough associated with ACE inhibitors. Hypertension 2001;38:166-70.
Explanation Required
3- Needs Explanation
Verapamil
Grapefruit
Grapefruit juice may increase verapamil blood levels. The importance of this interaction regarding verapamil effectiveness and side effects is unknown. Until more is known, it makes sense for people taking this drug to either avoid drinking grapefruit juice entirely or drink grapefruit juice only under the careful monitoring and supervision of the prescribing doctor. In theory, this last possibility might allow for a decrease in drug dose, but it could be dangerous in the absence of diligent monitoring. The same effects might be seen from eating grapefruit as from drinking its juice.
GrapefruitVerapamil- Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 274-5.
- Needs Explanation
Verapamil
Pleurisy Root
As pleurisy root and other plants in the Aesclepius genus contain cardiac glycosides, it is best to avoid use of pleurisy root with heart medications such as calcium channel blockers.
Pleurisy RootVerapamil- Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-Care Professionals. London: Pharmaceutical Press, 1996, 213-4.
- Needs Explanation
Verapamil
Pomegranate
Pomegranate juice has been shown to inhibit the same enzyme that is inhibited by grapefruit juice. The degree of inhibition is about the same for each of these juices. Therefore, it would be reasonable to expect that pomegranate juice might interact with verapamil in the same way that grapefruit juice does.
PomegranateVerapamil- Sorokin AV, Duncan B, Panetta R, Thompson PD. Rhabdomyolysis associated with pomegranate juice consumption. Am J Cardiol 2006;98:705-6.
- Summers KM. Potential drug-food interactions with pomegranate juice. Ann Pharmacother 2006;40:1472-3.