1. Introduction
Lercanidipine is a dihydropyridine calcium channel blocker (CCB) used to manage hypertension (high blood pressure). It works by inhibiting calcium ion entry into vascular smooth muscle and cardiac cells, leading to vasodilation and reduced blood pressure. Lercanidipine is characterised by its prolonged action and minimal reflex tachycardia.
2. Indications
- Approved Indications:
- Hypertension (mild to moderate).
- Off-Label Uses:
- Raynaud’s phenomenon (secondary to vasospasm).
3. Dosage
- Adults:
- Initial dose: 10 mg orally once daily.
- Maintenance dose: 10–20 mg once daily, adjusted based on response.
- Maximum dose: 20 mg once daily.
- Elderly:
- Start with 10 mg once daily; titrate cautiously.
- Paediatrics:
- Not recommended for use in children due to insufficient safety data.
4. Administration
- Take orally at least 15 minutes before a meal, preferably at the same time each day.
- Avoid grapefruit juice, as it can increase the plasma concentration of lercanidipine.
5. Forms Available
- Tablets: 10 mg, 20 mg.
6. Side Effects
6.1. Common Side Effects
- Headache.
- Flushing.
- Dizziness.
- Peripheral oedema.
6.2. Less Common Side Effects
- Palpitations.
- Nausea or dyspepsia.
- Fatigue.
6.3. Rare but Serious Side Effects
- Hypotension (severe).
- Angina pectoris (rare; may occur at the start of treatment or with dose increases).
- Allergic reactions (e.g., rash, itching, or swelling).
7. Warnings
- Severe Hepatic Impairment: Use with caution as lercanidipine metabolism may be affected, increasing its concentration.
- Aortic Stenosis: Avoid use in patients with severe aortic stenosis due to the risk of worsening heart function.
- Hypotension: May cause excessive lowering of blood pressure, especially in patients on other antihypertensive agents.
8. Precautions
- Avoid in patients with:
- Severe liver or kidney impairment.
- Unstable angina or recent myocardial infarction (within 1 month).
- Use cautiously in patients with mild to moderate hepatic or renal impairment.
9. Interactions
- Drug-Drug Interactions:
- CYP3A4 inhibitors (e.g., ketoconazole, erythromycin): Increased risk of lercanidipine toxicity.
- CYP3A4 inducers (e.g., rifampin, carbamazepine): Reduced efficacy of lercanidipine.
- Beta-blockers: Additive antihypertensive effects.
- Digoxin: Monitor for signs of toxicity when co-administered.
- Drug-Food Interactions:
- Grapefruit juice increases the risk of side effects by inhibiting lercanidipine metabolism.
10. Monitoring Parameters
- Blood pressure (regular monitoring to assess efficacy).
- Heart rate (to detect tachycardia or bradycardia).
- Signs of peripheral oedema or hypotension.
11. Use in Children
- Not recommended for use in individuals under 18 years due to insufficient safety and efficacy data.
12. Use in Pregnancy
- Category C: Avoid use during pregnancy unless absolutely necessary, as its safety has not been established.
13. Use in Elderly
- Safe with cautious dose titration, as elderly patients may be more sensitive to the antihypertensive effects of lercanidipine.
14. Use in Kidney Disease
- Avoid use in severe renal impairment (creatinine clearance <30 mL/min). In mild to moderate impairment, use with caution and monitor renal function regularly.
15. Use in Liver Disease
- Contraindicated in severe hepatic impairment. Use cautiously in mild to moderate liver disease, with close monitoring for side effects.
16. Patient Counselling Points
- Take lercanidipine 15 minutes before meals, as food can interfere with its absorption.
- Avoid grapefruit juice, as it may increase side effects.
- Do not stop taking lercanidipine suddenly without consulting your doctor.
- Report any symptoms of severe dizziness, swelling of the feet or ankles, or chest pain.
- Avoid alcohol, as it may enhance the blood-pressure-lowering effects and increase dizziness.
17. Table of Brand Names, Manufacturers, and Prices
Brand Name | Manufacturer | Price (USD) |
---|---|---|
Zanidip | Menarini | $25–50 (30 tablets, 10 mg) |
Lercadip | Torrent Pharmaceuticals | $20–40 (30 tablets, 10 mg) |
Generic Lercanidipine | Various manufacturers | $15–30 (30 tablets, 10 mg) |
18. FAQs (15 Questions)
- What is lercanidipine used for?
It is used to manage mild to moderate hypertension. - How does lercanidipine work?
It relaxes blood vessels by blocking calcium entry into smooth muscle cells, reducing blood pressure. - When should I take lercanidipine?
Take it 15 minutes before a meal, preferably at the same time each day. - What are common side effects of lercanidipine?
Headache, dizziness, flushing, and swelling of the ankles. - Can lercanidipine cause swelling?
Yes, peripheral oedema (swelling of the feet and ankles) is a common side effect. - Can I take lercanidipine with other blood pressure medications?
Yes, but consult your doctor to avoid excessive blood pressure reduction. - Is lercanidipine safe during pregnancy?
It is not recommended unless the benefits outweigh the risks. - Can I drink alcohol while taking lercanidipine?
Avoid alcohol, as it may enhance dizziness and lower blood pressure further. - Can lercanidipine cause low blood pressure?
Yes, it can cause hypotension, especially in combination with other antihypertensives. - Can I stop lercanidipine suddenly?
No, stopping abruptly may cause a sudden rise in blood pressure. Consult your doctor before discontinuing. - Can I take lercanidipine with food?
It should be taken on an empty stomach, 15 minutes before a meal. - Is lercanidipine safe for elderly patients?
Yes, but start with a lower dose and monitor for side effects. - Can lercanidipine interact with other drugs?
Yes, it interacts with CYP3A4 inhibitors and inducers, as well as digoxin and beta-blockers. - What should I do if I miss a dose of lercanidipine?
Take it as soon as you remember, unless it’s close to the next dose. Do not double the dose. - How should lercanidipine be stored?
Store at room temperature, away from moisture and direct sunlight.