Dihydropyridine calcium-channel blocker Pregnancy: There are no data from the use of lercanidipine in pregnant women. Not recommended during pregnancy and in women of childbearing potential not using contraception. Should not be used during breast-feeding — it is unknown whether lercanidipine/metabolites are excreted in human milk and a risk to the newborn/infant cannot be excluded.

Lercanidipine hydrochloride

Brand names: Zanidip

Lercanidipine is a dihydropyridine calcium-channel blocker used in the treatment of essential hypertension.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 10 mg orally once a day at least 15 minutes before meals; the dose may be increased to 20 mg depending on the individual patient's response

Route: Oral

Frequency: Once daily (preferably in the morning, at least 15 minutes before breakfast)

Max: 20 mg once daily (the SPC states the dose may be increased to 20 mg; the dose-response curve is steep with a plateau at doses between 20-30 mg, so it is unlikely that efficacy will be improved by higher doses whereas side effects may increase)

Dose titration should be gradual, because it may take about 2 weeks before the maximal antihypertensive effect is apparent. Some individuals not adequately controlled on a single antihypertensive agent may benefit from the addition of lercanidipine to a beta-adrenoceptor blocking drug (atenolol), a diuretic (hydrochlorothiazide) or an ACE inhibitor (captopril or enalapril). Elderly: although pharmacokinetic data and clinical experience suggest no adjustment of the daily dosage is required, special care should be exercised when initiating treatment in the elderly. Hepatic impairment: special care when commencing treatment in mild to moderate hepatic dysfunction; the antihypertensive effect may be enhanced so an adjustment of dosage should be considered; contraindicated in severe hepatic impairment. Must not be administered with grapefruit juice. Paediatric population: the safety and efficacy of lercanidipine in children aged up to 18 years have not been established — no data are available and no paediatric dose is stated in the SPC.

Dose adjustments

Renal

Special care should be exercised when treatment is commenced in patients with mild to moderate renal impairment; although the usual recommended dose of 10 mg daily may be tolerated, an increase to 20 mg daily should be approached with caution. Contraindicated in severe renal impairment (GFR < 30 ml/min), including patients undergoing haemodialysis. Associated with the development of cloudy peritoneal effluent in patients on peritoneal dialysis (due to increased triglyceride concentration), which tends to resolve soon after withdrawal.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Left ventricular outflow tract obstruction
Untreated congestive cardiac failure
Unstable angina pectoris or recent (within 1 month) myocardial infarction
Severe hepatic impairment
Severe renal impairment (GFR < 30 ml/min), including patients undergoing dialysis
Co-administration with strong inhibitors of CYP3A4, with ciclosporin, or with grapefruit or grapefruit juice

Side effects

Peripheral oedema
Headache; dizziness
Flushing
Tachycardia; palpitations
Dyspepsia, nausea
Rare/post-marketing: gingival hypertrophy, cloudy peritoneal effluent, raised serum transaminases, angioedema

Interactions

Strong inhibitors of CYP3A4 — co-administration contraindicated (section 4.3)
Ciclosporin — co-administration contraindicated (section 4.3)
Grapefruit or grapefruit juice — co-administration contraindicated (section 4.3)
Inducers of CYP3A4 such as anticonvulsants (e.g. phenytoin, carbamazepine) and rifampicin may reduce lercanidipine plasma levels, so efficacy may be less than expected (section 4.4)
Alcohol should be avoided since it may potentiate the effect of vasodilating antihypertensive drugs (section 4.4)
NOTE: the body of section 4.5 was truncated in the fetched source; the items above are the interactions named in sections 4.3/4.4 — review section 4.5 in full before publication

Clinical monograph

How it works

It selectively inhibits L-type calcium channels in vascular smooth muscle, producing arterial vasodilatation that lowers peripheral vascular resistance and blood pressure.

Prescribing in practice

Vasodilatory adverse effects such as ankle oedema, flushing and headache are common and may be dose-limiting.
It is contraindicated in significant hepatic or severe renal impairment, in unstable angina, in untreated heart failure and within a short period after myocardial infarction, and grapefruit juice should be avoided as it increases drug exposure.
It is best taken before food, as taking it with a high-fat meal can substantially increase absorption.

Monitoring

Monitor blood pressure for response and review the patient for ankle oedema and other vasodilatory effects.

Counselling the patient

Take the medicine before food and avoid grapefruit juice.
Ankle swelling, flushing or headache may occur, especially when starting treatment.
Keep taking it regularly, as it controls rather than cures high blood pressure.

Evidence & guidelines

Dihydropyridine calcium-channel blockers such as lercanidipine are recommended for hypertension in NICE guidance, with well-established efficacy in lowering blood pressure.

Reference: NICE NG136; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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