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Pronunciation:

(tran DOE la pril & ver AP a mil)

U.S. Brand Names:

Tarka®

Synonyms:

Verapamil and Trandolapril

Generic Available:

Canadian Brand Names:

Tarka®

Use:

Combination drug for the treatment of hypertension, however, not indicated for initial treatment of hypertension; replacement therapy in patients receiving separate dosage forms (for patient convenience); when monotherapy with one component fails to achieve desired antihypertensive effect, or when dose-limiting adverse effects limit upward titration of monotherapy

Pregnancy Risk Factor:

C/D (2nd and 3rd trimesters)

Lactation:

Enters breast milk/contraindicated

Adverse Reactions:

See individual agents.

Drug Interactions:

Verapamil: Substrate of CYP1A2 (major), 2B6 (minor), 2C8/9 (minor), 2C19 (minor), 2E1 (minor), 3A4 (major); Inhibits CYP1A2 (weak), 2C8/9 (weak), 2D6 (weak), 3A4 (moderate)

Also see individual agents.

Pharmacodynamics/Kinetics:

See individual agents.

Dosage:

Dose is individualized

Patient Education:

See individual agents. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Do not breast-feed.

Cardiovascular Considerations:

Combination therapy for the treatment of hypertension should be individualized for each patient. Potential advantages for trandolapril and verapamil combination therapy may include improved compliance and synergistic reductions in blood pressure with an accompanied reduction in side effects. See Special Cardiovascular Considerations for individual agents.

Dental Health: Effects on Dental Treatment:

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Mental Health: Effects on Mental Status:

May cause dizziness, drowsiness, nervousness, or insomnia

Mental Health: Effects on Psychiatric Treatment:

May cause neutropenia; use caution with clozapine and carbamazepine; may decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels; concurrent use with low potency antipsychotics and TCAs may produce additive hypotensive effects; barbiturates may decrease verapamil serum concentrations; verapamil may increase carbamazepine serum concentrations

Dosage Forms:

Tablet, combination [trandolapril component is immediate release, verapamil component is sustained release]:

Trandolapril 1 mg and verapamil hydrochloride 240 mg

Trandolapril 2 mg and verapamil hydrochloride 180 mg

Trandolapril 2 mg and verapamil hydrochloride 240 mg

Trandolapril 4 mg and verapamil hydrochloride 240 mg

International Brand Names:

Tarka® (CA)

References

Chobanian AV, Bakris GL, Black HR, et al, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report,"JAMA, 2003, 289(19):2560-71.

"Consensus Recommendations for the Management of Chronic Heart Failure. On Behalf of the Membership of the Advisory Council to Improve Outcomes Nationwide in Heart Failure,"Am J Cardiol, 1999, 83(2A):1A-38A.

Kaplan NM and Sever PS, "Combination Therapy: A Key to Comprehensive Patient Care,"Am J Hypertens, 1997, 10(7 Pt 2):127S.

Moser M and Black HR, "The Role of Combination Therapy in the Treatment of Hypertension,"Am J Hypertens, 1998, 11(6 Pt 2):73S-8S, 95S-100S.

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