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.
Source: FDA drug label - trandolapril and verapamil hydrochloride
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 ).
Source: FDA drug label - trandolapril and verapamil hydrochloride
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.
Source: FDA drug label - trandolapril and verapamil hydrochloride
Clarithromycin Hypotension, bradyarrhythmias, and lactic acidosis have been observed in patients receiving concurrent clarithromycin.
Source: FDA drug label - trandolapril and verapamil hydrochloride
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.
Source: FDA drug label - trandolapril and verapamil hydrochloride
erythromycin, ritonavir) causing elevation of plasma levels of verapamil while inducers of CYP3A4 (e.g. Erythromycin Hypotension, bradyarrhythmias, and lactic acidosis have been observed in patients receiving concurrent erythromycin ethylsuccinate. There have been reports that erythromycin and telithromycin may increase concentrations of verapamil.
Source: FDA drug label - trandolapril and verapamil hydrochloride
No clinically significant pharmacokinetic interaction has been found between trandolapril (or its metabolites) and furosemide.
Source: FDA drug label - trandolapril and verapamil hydrochloride
Limit the daily dose of lovastatin to 40 mg.
Source: FDA drug label - trandolapril and verapamil hydrochloride
Drug interaction studies have indicated that the maximum concentrations of metoprolol and propanolol are increased after the administration of verapamil.
Source: FDA drug label - trandolapril and verapamil hydrochloride
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.
Source: FDA drug label - trandolapril and verapamil hydrochloride
Other (Trandolapril Component) No clinically significant pharmacokinetic interaction has been found between trandolapril (or its metabolites) and nifedipine.
Source: FDA drug label - trandolapril and verapamil hydrochloride
There are reports that verapamil may result in higher concentrations of the alpha-agonists prazosin and terazosin.
Source: FDA drug label - trandolapril and verapamil hydrochloride
Drug interaction studies have indicated that the maximum concentrations of metoprolol and propanolol are increased after the administration of verapamil.
Source: FDA drug label - trandolapril and verapamil hydrochloride
erythromycin, ritonavir) causing elevation of plasma levels of verapamil while inducers of CYP3A4 (e.g. Other Concentrations of verapamil may be increased by the concomitant administration of protease inhibitors such as ritonavir, and reduced by the concomitant administration of sulfinpyrazone, or St John’s Wort.
Source: FDA drug label - trandolapril and verapamil hydrochloride
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.
Source: FDA drug label - trandolapril and verapamil hydrochloride
There have been reports that erythromycin and telithromycin may increase concentrations of verapamil.
Source: FDA drug label - trandolapril and verapamil hydrochloride
There are reports that verapamil may result in higher concentrations of the alpha-agonists prazosin and terazosin.
Source: FDA drug label - trandolapril and verapamil hydrochloride
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.
Source: FDA drug label - trandolapril and verapamil hydrochloride