This combination product contains two active ingredients: trandolapril and verapamil. Trandolapril belongs to the class of medications called ACE inhibitors. Trandolapril works by relaxing blood vessels and making it easier for the heart to pump blood. Verapamil belongs to the class of medications called calcium channel blockers. Verapamil works by relaxing blood vessels and normalizing heart rhythms.

This combination medication is used to treat mild-to-moderate high blood pressure (hypertension). This combination medication is prescribed when your doctor feels it is appropriate for you to be taking both medications and you have taken trandolapril and verapamil as separate medications without any problems. Trandolapril - verapamil combination should not be used for initial treatment. The blood-pressure-lowering effects are usually seen within a week of starting this medication but it may take longer to see the full effects of the medication.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

This combination medication is used to make dosing more convenient for people who are already taking both trandolapril and verapamil. The usual recommended dose of this medication is one tablet taken once or twice a day, with food. The dose is individualized and depends on your response to the medication. Your doctor will determine the best dose to control your symptoms. Swallow the medication whole. Do not crush or chew it.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones given here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not take this medication if you:

• are allergic to trandolapril, verapamil, or any ingredients of this medication
• are pregnant or breast-feeding
• have a very low heart rate
• have certain types of heart rhythm problems (such as second- or third-degree heart block, sick sinus syndrome, atrial flutter or atrial fibrillation and an accessory bypass tract [e.g., Wolff-Parkinson-White, Lown-Ganong-Levine syndromes])
• have hereditary angioedema (a serious allergic reaction which causes the area around the throat and tongue to swell) or have had angioedema after taking any other ACE inhibitors (e.g., captopril, ramipril)
• have had certain types of heart attack
• have severe congestive heart failure and/or severe left ventricular dysfunction unless it is due to a cause that is treatable by verapamil
• have severe low blood pressure or cardiogenic shock
• are taking aliskiren and have diabetes or decreased kidney function
• have severely reduced kidney function or significant renal artery stenosis
• have cirrhosis of the liver with ascites (an accumulation of fluid in the abdomen)
• are taking the medication ivabradine
• are taking the combination medication sacubitril/valsartan
• are being treated with dialysis
• have decreased kidney function caused by complications of diabetes and are taking a medication in the class of angiotensin receptor blockers (e.g., losartan, irbesartan, valsartan)
• are being treated with intravenous beta-blockers
• have galactose intolerance or glucose malabsorption (a rare hereditary disease)

Do not give this medication to children or adolescents less than 18 years of age.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal pain
• changed sense of taste
• constipation
• cough
• diarrhea
• drowsiness
• dry mouth
• fever and chills
• flushing
• hair loss
• headache
• heartburn
• itching
• joint or muscle aches
• mild dizziness
• nasal congestion
• nausea
• skin rash
• tingling or prickly feeling of the skin
• tiredness
• trouble sleeping
• weakness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• blurred vision
• decreased sexual desire or ability
• severe dizziness when rising from a sitting or lying position
• signs of a blockage in the stomach (e.g., abdominal pain, constipation, nausea, vomiting, excessive burping)
• signs of kidney problems (e.g., decreased urination, nausea, vomiting, swelling of the feet and ankles)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• signs of bleeding (e.g., nosebleeds, blood in urine, coughing blood, bleeding gums, unusual bruising or bleeding)
• signs of infections (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
• signs of low blood pressure (e.g., fainting, dizziness, weakness, changes in breathing)
• symptoms of too much potassium in the body (e.g., muscle fatigue, weakness, difficulty moving, abnormal heart rhythms, nausea)
• swelling of the legs and ankles

Stop taking the medication and seek immediate medical attention if any of the following side effects occur:

• irregular heartbeat
• seizures
• severe chest pain
• signs of an allergic reaction, including angioedema (shortness of breath or difficulty breathing; hives; swelling of the eyes, mouth, lips, or throat)
• sudden shortness of breath

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Angioedema: This medication may cause a serious allergic reaction called angioedema, which may be fatal if not treated promptly. If you have difficulty breathing or notice hives or swelling of the face, lips, tongue, or throat, stop taking this medication and get emergency medical help at once. Other ACE inhibitors should not be taken in the future. People who have had angioedema caused by other substances may be at increased risk of angioedema while receiving this medication.

Blood disorders: In rare cases, a low white blood cell count has been reported with people taking this medication. Your doctor may occasionally monitor your level of white blood cells by performing blood tests. Low white blood cell levels may increase your risk for infection. If you notice any signs of infection (e.g., fever, sore throat), contact your doctor as soon as possible.

Cough: A persistent, dry cough may occur when taking this medication. Be sure to tell your doctor of any cough which does not seem to be related to a usual cause.

Heart problems: This medication can cause changes to your heart rate. If you have heart failure or heart rhythm problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Kidney function: Trandolapril may affect the function of the kidneys, causing decreased kidney function, kidney failure, or possibly death. The use of diuretics (water pills), nonsteroidal anti-inflammatory drugs (NSAIDs), or aliskiren may further increase risk of kidney problems for people already at risk for this problem. Changes in kidney function have been seen in certain people who take this medication. Certain people may be more likely to experience changes in kidney function (e.g., people with narrowed blood vessels in their kidneys, or those with severe congestive heart failure). If you have kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver problems: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver damage is possible with this medication. If you experience any signs of liver problems such as yellowing of the skin or eyes, fever, generally feeling unwell, abdominal pain, nausea, vomiting, loss of appetite, itching, muscle pain, rash, or swollen glands, contact your doctor immediately. You will need to be closely monitored by your doctor while taking this medication if you have pre-existing liver problems.

Low blood pressure and heart rate: Low blood pressure symptoms of tiredness and weakness with faintness have been reported following the first or second dose, or when the dose is increased. Less often, it may also occur after several months of treatment with this medication. It is more likely to happen to those who take aliskiren, water pills, have a salt-restricted diet, are on dialysis, are suffering from diarrhea or vomiting, or have been sweating excessively and not taking in enough fluids. Some people may require a reduced dose.

To reduce the risk of dizziness, get up slowly from a lying or sitting position. If low blood pressure causes you to faint or feel lightheaded, contact a doctor. Excessive sweating and lack of fluid intake may lead to an excessive fall in blood pressure because of reduced fluid in your blood vessels. Vomiting or diarrhea may also lead to a fall in blood pressure.

This medication can also cause very low heart rate for some people. If you notice that your heart rate has become abnormally low (less than 50 beats per minute), contact your doctor.

Potassium levels: Increases in blood levels of potassium occur for a small percentage of people taking this medication. This rarely causes problems, but potassium levels should be monitored by your doctor.

Pregnancy: ACE inhibitors such as trandolapril may cause severe harm or death to the developing baby if taken by the mother during pregnancy. This medication should not be used during pregnancy. If you become pregnant while taking this medication, stop taking it immediately and contact your doctor.

Breast-feeding: It is not known if trandolapril passes into breast milk. Verapamil passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. This medication is not recommended for breast-feeding women. Talk to your doctor.

Children: The safety and effectiveness of using this medication have not been established for children. Its use by this age group is not recommended.

Seniors: Seniors may have an increased risk of developing side effects to this medication, as a result of decreased kidney, liver and heart function.

There may be an interaction between trandolapril - verapamil and any of the following:

• acetylsalicylic acid (ASA)
• alcohol
• aldesleukin
• aliskiren
• allopurinol
• alpha blockers (e.g., alfuzosin, doxazosin, silodosin, tamsulosin)
• alpha agonists (e.g., clonidine, methyldopa)
• amiodarone
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• angiotensin converting enzyme inhibitors (ACEIs; captopril, enalapril, ramipril)
• angiotensin receptor blockers (ARBs; e.g., candasartan, irbesartan, losartan)
• antacids
• anti-cancer medications (e.g., cabazitaxel, docetaxel; doxorubicin; etoposide, ifosfamide, irinotecan, vincristine)
• antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• apixaban
• aprepitant
• asunaprevir
• azathioprine
• "azole" antifungals (e.g., ketoconazole, fluconazole)
• barbiturates (e.g., butalbital, pentobarbital phenobarbital)
• benzodiazepines (e.g., diazepam, lorazepam)
• beta-blockers (e.g., propranolol, metoprolol, nadolol)
• bosentan
• brimonidine
• bromocriptine
• budesonide
• buspirone
• calcitriol
• calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
• calcium salts (e.g., calcium carbonate, calcium citrate)
• canagliflozin
• cannabis
• carbamazepine
• cimetidine
• ciprofloxacin
• chloroquine
• clopidogrel
• cobicistat
• colchicine
• conivaptan
• cyclosporine
• dabigatran
• dantrolene
• darifenacin
• deferasirox
• dexamethasone
• digoxin
• disopyramide
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
• dofetilide
• domperidone
• donepezil
• dronedarone
• drospirenone
• edoxaban
• enzalutamide
• eplerenone
• estrogens (e.g., conjugated estrogen, estradiol, ethinyl estradiol)
• everolimus
• fingolimod
• flecainide
• galantamine
• "gliptin" diabetes medications (e.g., linagliptin, saxagliptin, sitagliptin)
• gold salts
• grapefruit juice
• grass pollen allergen extract
• guanfacine
• heparin
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• hydralazine
• hydrocortisone
• ivabradine
• levodopa
• lidocaine
• lithium
• lomitapide
• loperamide
• lumacaftor
• low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• magnesium salts (e.g., magnesium hydroxide, magnesium sulfate)
• maraviroc
• mefloquine
• metformin
• methadone
• methylphenidate
• mifepristone
• mirtazapine
• modafinil
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
• montelukast
• narcotic pain relievers (e.g., fentanyl, hydrocodone, methadone, oxycodone)
• nefazodone
• nitrates (e.g., isosorbide dinitrate, isosorbide mononitrate)
• nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., diclofenac, ibuprofen, indomethacin, ketorolac)
• octreotide
• ondansetron
• pasireotide
• pentoxifylline
• phenytoin
• phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
• pimecrolimus
• pimozide
• pregabalin
• primidone
• primaquine
• prucalopride
• quinidine
• quinine
• ranitidine
• rifabutin
• rifampin
• rituximab
• rivaroxaban
• rivastigmine
• romidepsin
• St. John's wort
• sacubitril
• salmeterol
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
• silodosin
• simeprevir
• sirolimus
• sodium phosphates
• solifenacin
• "statin" anti-cholesterol medications (e.g., atorvastatin, lovastatin, simvastatin)
• substances that increase potassium levels (e.g., potassium chloride, salt substitutes containing potassium)
• tacrolimus
• tamoxifen
• theophylline
• ticagrelor
• ticlopidine
• tizanidine
• tocilizumab
• tofacitinib
• tolterodine
• tolvaptan
• trazodone
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
• trimethoprim
• tyrosine kinase inhibitors (e.g., bosutinib, dasatinib, imatinib, nilotinib)
• ulipristal
• warfarin
• zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.