Lercanidipine and Enalapril

ACE Inhibitor · ACE inhibitor/Calcium antagonist

Indications

Mild to moderate hypertension.

Dosage

Adults: 1 tab daily. Children: Not recommended.

Adverse Effects

Lercanidipine: Worsening angina, MI. Enalapril: Hypotension, renal failure angioedema, rash, headache, fatigue, dizziness, GI upset, cough. Very rarely anaphylactoid reactions during desensitization and LDL apheresis.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Contraindicated or not recommended. Contraindications: LERCANIDIPINE: Ensure contraception in women. Left ventricular outflow obstruction, untreated CHF, unstable angina, recent MI, severe hepatic or renal impairment. ENALAPRIL: Aortic stenosis, outflow obstruction. Precautions: LERCANIDIPINE: Sick sinus syndrome, LVD, ischaemic heart disease, mild to moderate renal or hepatic impairment. Elderly. ENALAPRIL: Haemodialysis (avoid in patients dialysed with high-flux membranes). Renal impairment, renovascular hypertension, severe congestive heart failure; monitor renal function before and during therapy. Anaesthesia. Desensitization, apheresis; withdraw ACE inhibitor before procedure.

Interactions

LERCANIDIPINE: CYP3A4 inhibitors including cyclosporin, azole antifungals, erythromycin, ritonavir. CYP3A4 inducers including phenytoin, carbamazepine. CYP3A4 substrates including digoxin, cimetidine, class III antiarrhythmics, beta-blockers. Grapefruit juice, alcohol. ENALAPRIL: K+ supplement, K+ -sparing diuretics, NSAIDs, antidiabetic agents, lithium, neuroleptics, narcotic drugs, antihypertensives, antacids, sympathomimetics, cyclosporin, immunosuppressants, cytostatic agents, corticosteroids, procainamide, allopurinol, alcohol.

Advice to Patient

Take tablets atleast 15 minutes before a meal. Swallow whole with a glass of water. Contact prescriber immediately if there is allergic reaction (rash, hives, swelling on face/lips/tongue, difficulty in breathing), chest pain, disturbed taste, chest tightness, abdominal pain, diarrhoea, abnormal heart rhythm, redness/warmth on skin. Avoid alcohol during therapy. Avoid grapefruit and grapefruit juice during therapy.

Pharmacokinetics

LERCANIDIPINE: Duration: 24 hrs. Absorption: Oral: Completely absorbed from the GI tract. Metabolism: Undergoes extensive saturable first-pass metabolism. Hepatic (extensive). Bioavailability: Low; increased in the presence of food. Half-life elimination: Terminal: 2-5 hrs. Some studies have reported 8-10 hrs. Time to peak, plasma: Oral: 1.5-3 hrs. Excretion: Oral: Urine (50%). ENALAPRIL MALEATE: Onset of action: Approx. 1 hr. Peak effect: 4-6 hrs. Duration: 12-24 hrs. Absorption: 55%-75%. Metabolism: Prodrug, undergoes hepatic biotransformation to enalaprilat. Half-life elimination: Enalapril: CHF: Neonates (PNA=10-19 days): 10.3 hrs. CHF: Infants and Children =6.5 yrs: 2.7 hrs. Adults: Healthy: 2 hrs; CHF: 3.4-5.8 hrs. Enalaprilat: CHF: Neonates (PNA=10-19 days): 11.9 hrs. CHF: Infants and Children =6.5 yrs: 11.1 hrs. Infants 6 wks-8 mth: 6-10 hrs. Adults: Approx. 35 hrs. Time to…

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.