Trandolapril with verapamil

Calcium channel blockers can be combined with ACE inhibitors. Such combinations include benazepril with amlodipine (Lotrel), enalapril with diltiazem (Teczem), enalapril with felodipine (Lexxel), and trandolapril with verapamil (Tarka). 

International Verapamil-Trandolapril Study Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria study intrinsic sympathomimetic activity intravenous... 

A 28-year-old man developed rhabdomyolysis and acute renal insufficiency 10 hours after taking four capsules containing verapamil 180 mg plus trandolapril 2 mg. He survived with gastric lavage and activated charcoal 70 g. By 4 hours after admission he was awake and complained of diffuse muscle cramps and myalgia. Creatinine and creatine kinase reached 565 pmol/l (6.7 mg/dl) and 10 700 U/1 respectively. After 6 days the laboratory tests were all within the reference ranges. 

The authors suggested that rhabdomyolysis should be considered in patients with myalgia and muscle cramps taking verapamil plus trandolapril, and that routine serum creatinine kinase should be checked (20). 

Pepine CJ, Handberg EM, Cooper-DeHoff RM, et al. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST) A randomized, controlled trial. JAMA 2003 290 2805-2816. 

Trandolapril is used in combination with calcium channel blockers (e.g., verapamil) as a second line antihypertensive therapy. The effects of the two drugs in combination are greater than that produced by either drug alone, indicating that the effects are synergistic in the lowering of blood pressure. 

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