Lercanidipine: uses, side effects and cautions

Lercanidipine is used to manage high blood pressure, which lowers the risk of stroke and heart failure. As a calcium channel blocker it relaxes and widens blood vessels, making it easier for blood to circulate. UK product information describes it as treatment of mild to moderate essential hypertension in adults. The NHS names the brand Zanidip.

The NHS says you will usually take lercanidipine once a day, at the same time each day, and at least 15 minutes before a meal, ideally before the first meal of the day. Fatty meals change how much of the drug is absorbed, which is why the timing matters.

The manufacturer information gives a standard dose of 10 mg once daily, which may be increased to 20 mg depending on response. The full effect takes about two weeks, so increases are gradual, and doses beyond 20 to 30 mg are unlikely to improve control and may add side effects. Your prescriber sets your dose.

If you miss a dose, skip it and take the next as usual; never take two. Taking an extra dose can be dangerous, so call NHS 111 if you exceed your dose.

Lercanidipine is unsuitable if you have had an allergic reaction to it, have heart failure, have recently had a heart attack, or have severe liver or kidney problems. Product information also lists untreated heart failure, unstable angina, left ventricular outflow obstruction, and use with strong CYP3A4 inhibitors, ciclosporin or grapefruit juice as contraindications. It advises caution in sick sinus syndrome and ischaemic heart disease, and notes that some people with angina may find it more frequent or severe.

Common effects are headaches, palpitations, flushing of the face or neck, swollen ankles, tummy pain and nausea, tiredness, dizziness and rash. If you feel dizzy or sleepy, do not drive, ride a bike or use machinery until it passes.

Serious effects are fainting, chest pain or angina, and anaphylaxis with throat swelling and difficulty breathing. Seek urgent medical help for those.

Product information says older people do not usually need a different dose, though starting with care is advisable. For mild to moderate liver or kidney problems, closer monitoring is needed, and increasing to the higher dose calls for caution. In liver impairment the blood-pressure-lowering effect may be stronger, so the dose may need adjusting.

Because of this, tell the prescriber about any kidney or liver condition and mention it again if your health changes. Routine blood pressure checks show whether the dose is right for you.

Do not eat grapefruit or drink grapefruit juice. Product information says lercanidipine is sensitive to inhibition of its metabolism, which increases the blood-pressure-lowering effect. Alcohol can add to the vasodilating effect.

Named medicines are erythromycin and clarithromycin, beta blockers, simvastatin, other blood pressure medicines, digoxin, sotalol, antifungals and carbamazepine. Ciclosporin can raise lercanidipine levels about threefold and must not be combined with it.

The NHS says your doctor will usually recommend a different blood pressure medicine while you are pregnant or breastfeeding. Product information says it is not recommended in either situation and that a risk to breastfed infants cannot be excluded. Report suspected side effects via the Yellow Card scheme.