Lotensyl

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What Is Lotensyl?

Lotensyl is 10 / 20 mg cilnidipine tablets from Lupin, supplied in 30-90 tablets. Cilnidipine was introduced in Japan in 1995 (FujiRebio as Atelec) and gained FDA-equivalent approval in many Asian markets. It is a fourth-generation dihydropyridine with a distinctive dual L/N-type calcium-channel blocking profile.

How Cilnidipine Works

Most DHP CCBs (amlodipine, nifedipine, felodipine, nicardipine) block L-type calcium channels on arterial smooth muscle, producing vasodilation and BP fall. Cilnidipine uniquely adds N-type channel blockade at sympathetic-nerve terminals:

• L-type blockade (arterial smooth muscle) — standard vasodilation; afterload reduction; BP falls 10-15 mmHg
• N-type blockade (pre-synaptic sympathetic terminals) — reduced noradrenaline release; suppresses the reflex tachycardia that normally follows arterial vasodilation
• Lower ankle oedema rate — L-type blockade dilates pre-capillary arterioles; the N-type blockade’s effect on post-capillary tone is more balanced, producing less capillary hydrostatic pressure spike and less peripheral oedema than pure-L-type CCBs
• Proteinuria reduction — reduced renal sympathetic tone dilates efferent as well as afferent arterioles, reducing glomerular hyperfiltration; trials in proteinuric CKD have shown greater proteinuria reduction vs amlodipine at equivalent BP
• Long half-life — 6-8 hours (once-daily dosing at steady state)

Evidence for Cilnidipine

• CARTER (2007) — cilnidipine vs amlodipine in proteinuric hypertensive CKD: cilnidipine produced greater proteinuria reduction at equivalent BP control; creatinine trajectory similar.
• Direct head-to-head comparisons with amlodipine show comparable BP efficacy but approximately 50% lower ankle oedema rates on cilnidipine.
• ACTION-HKD (2014) — extended renoprotection data in CKD patients.
• Indian real-world data — widely used as amlodipine alternative where ankle oedema or reflex tachycardia limits amlodipine.

Cilnidipine is not included in Western guideline first-line recommendations for hypertension — partly because amlodipine has a much larger outcome-trial dataset (ASCOT, ACCOMPLISH, VALUE), partly because cilnidipine has not been marketed in the US or most of Europe.

Dosage

Hypertension: start 5-10 mg once daily; titrate to 10-20 mg once daily at 2-4 weeks.

Administration: with or without food; same time each day; swallow whole.

Övervakning: BP at 2 and 4 weeks; then every 3-6 months. LFTs at baseline and periodically (cilnidipine is hepatically cleared). Check for ankle oedema on review.

Side Effects

Common:

• Headache, flushing
• Dizziness
• Ankle oedema (lower than amlodipine — roughly half the rate in head-to-head trials)
• Constipation
• Mild transaminase elevation
• Palpitations (much less than short-acting DHPs)

Uncommon:

• Severe hypotension
• Gingival hyperplasia (rare DHP class effect)
• Photosensitivity
• Rash

Contraindications

• Cardiogenic shock
• Acute myocardial infarction with hypotension
• Severe aortic stenosis
• Svår leversvikt (Child-Pugh C)
• Known hypersensitivity to dihydropyridines
• Pregnancy (limited data; amlodipine or nifedipine are preferred DHPs if a CCB is required in pregnancy)

Läkemedelsinteraktioner

• Strong CYP3A4 inhibitors (clarithromycin, itraconazole, ritonavir) — raise cilnidipine levels; increased hypotension risk.
• Grapefruktjuice — minor to moderate interaction; regular daily consumption is discouraged.
• Other antihypertensives — additive BP lowering; intentional in combination therapy.
• CYP3A4 inducers (rifampicin, phenytoin, St John’s Wort) — may reduce cilnidipine effect.
• Digoxin — modest digoxin level rise; monitor.
• Alkohol — additive orthostatic hypotension.

Storage

Store Lotensyl below 25°C. Keep out of reach of children.

Vanliga frågor

How is cilnidipine different from amlodipine?

Cilnidipine blocks both L-type (same as amlodipine) AND N-type calcium channels. N-type blockade at sympathetic nerve terminals reduces noradrenaline release, giving cilnidipine two practical advantages: (1) lower ankle-oedema rates (roughly half of amlodipine’s in head-to-head trials); (2) no reflex tachycardia. Amlodipine, however, has vastly more cardiovascular outcome evidence (ASCOT, ACCOMPLISH, VALUE) and is the preferred DHP where outcome data are paramount.

When is Lotensyl a better choice than amlodipine?

Two common clinical situations: (1) troublesome ankle oedema on amlodipine that has not responded to adding an ACEi/ARB; (2) proteinuric CKD where the N-type mechanism may give additional renoprotection (CARTER trial).

Will Lotensyl cause ankle swelling?

Less than amlodipine, but not never. Roughly half the rate in head-to-head trials. Adding an ACE inhibitor or ARB reduces residual oedema further by venous dilation that rebalances the capillary pressure.

Can I take Lotensyl in pregnancy?

Avoid — pregnancy data are limited. If a CCB is required in pregnancy, nifedipine is the preferred DHP (largest safety database).

Where can I buy Lotensyl online?

You can buy Lotensyl (cilnidipine 10 / 20 mg, 30-90 tablets) from MedsBase with discreet packaging and worldwide shipping.

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