Lercanidipine: clinical use

Prescribing considerations

• Licensed for adults; safety and efficacy have not been established in children.
• Food markedly increases systemic availability.
• Use caution in older people, mild to moderate renal or hepatic impairment, sick-sinus syndrome without a pacemaker, left-ventricular dysfunction and ischaemic heart disease.
• Review concurrent CYP3A4 inhibitors, inducers and other blood-pressure-lowering medicines.
• Lercanidipine-associated cloudy peritoneal dialysate may be mistaken for infective peritonitis.

Contraindications and cautions

• Hypersensitivity to lercanidipine or an excipient.
• Left-ventricular outflow obstruction.
• Untreated congestive heart failure.
• Unstable angina or myocardial infarction within the preceding month.
• Severe hepatic impairment.
• Severe renal impairment, including dialysis.
• Concurrent strong CYP3A4 inhibitors, ciclosporin, grapefruit or grapefruit juice.

Monitoring

• Blood pressure and symptoms of hypotension.
• Peripheral oedema, palpitations and new or worsening angina.
• Renal and hepatic status where impairment is present or suspected.
• Signs of digoxin toxicity during concurrent use.
• Blood-pressure response when a CYP3A4 inducer is present.

Clinical pharmacology

Lercanidipine is a vascular-selective dihydropyridine calcium antagonist. It lowers peripheral vascular resistance through arterial smooth-muscle relaxation, is highly protein-bound and is extensively metabolised by CYP3A4 to inactive metabolites.

Formulation and product differences

• The selected product is a yellow, round, film-coated tablet with a score line intended only to help swallowing, not to divide it equally.
• The selected formulation contains lactose and is essentially sodium-free.

Tablet

Route: Oral

Strengths: 10 mg, 20 mg