Lercamed
Calcium Channel Blocker for High Blood Pressure (Lercanidipine)
Quick Facts About Lercamed
Key Takeaways About Lercamed
- Effective blood pressure control: Lercanidipine is a third-generation dihydropyridine calcium channel blocker that provides smooth, 24-hour blood pressure reduction with once-daily dosing
- Take before breakfast: Lercamed should be taken at least 15 minutes before breakfast, as a high-fat meal significantly increases drug absorption and may cause unpredictable blood levels
- Lower incidence of ankle swelling: Compared to older calcium channel blockers like amlodipine, lercanidipine is associated with a lower rate of peripheral oedema due to its balanced effect on both arteries and veins
- Avoid grapefruit completely: Grapefruit juice is strictly contraindicated with Lercamed, as it significantly increases blood levels of lercanidipine through CYP3A4 enzyme inhibition
- Not for children: Lercamed is approved only for adults aged 18 years and over; safety and efficacy have not been established in children and adolescents
What Is Lercamed and What Is It Used For?
Lercamed contains lercanidipine hydrochloride, a calcium channel blocker belonging to the dihydropyridine group. It is prescribed to treat high blood pressure (hypertension) in adults aged 18 years and over. By relaxing the smooth muscle in blood vessel walls, Lercamed reduces peripheral vascular resistance and lowers blood pressure.
Lercanidipine is classified as a third-generation dihydropyridine calcium channel blocker. Like other drugs in this class, it works by blocking voltage-dependent L-type calcium channels in the smooth muscle cells of blood vessels. When calcium ions are prevented from entering these cells, the muscles relax, the blood vessels dilate, and blood flows more easily. This mechanism reduces the resistance that the heart must pump against, ultimately lowering blood pressure throughout the body.
What distinguishes lercanidipine from older calcium channel blockers such as amlodipine and nifedipine is its high lipophilicity (fat solubility). This property allows lercanidipine to accumulate in the lipid-rich cell membranes of vascular smooth muscle, producing a gradual onset of action and a prolonged duration of effect. The smooth, slow-onset mechanism reduces the likelihood of reflex tachycardia (a rapid increase in heart rate that can occur when blood pressure drops suddenly), which is a common drawback of some first-generation calcium channel blockers.
Lercanidipine also demonstrates a degree of vascular selectivity that is greater than that of many other dihydropyridines. This means it preferentially relaxes blood vessels rather than affecting the heart muscle itself. Clinical studies have shown that this selectivity translates into effective blood pressure lowering with a relatively favourable tolerability profile, particularly regarding peripheral oedema (ankle swelling), which is a well-known class effect of calcium channel blockers.
High blood pressure is a major risk factor for serious cardiovascular events, including heart attack, stroke, heart failure, and chronic kidney disease. The European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) in their 2023 guidelines recognise calcium channel blockers as one of the five main first-line classes of antihypertensive drugs, alongside ACE inhibitors, angiotensin receptor blockers (ARBs), thiazide diuretics, and beta-blockers. Effective and sustained blood pressure control with medications such as Lercamed is essential for reducing these long-term cardiovascular risks.
Lercanidipine is available under several brand names worldwide, including Zanidip, Lercanidipine Accord, Lercanidipine Orion, and Lercamed. It was first approved for medical use in Europe in the late 1990s and is widely used across the world for the management of hypertension. All these brands contain the same active ingredient and work in the same way.
What Should You Know Before Taking Lercamed?
Before starting Lercamed, inform your doctor about all your medical conditions, especially heart problems, liver or kidney disease, and all medications you are taking. Lercamed has several important contraindications, including untreated heart failure, severe liver or kidney disease, and concurrent use of strong CYP3A4 inhibitors or cyclosporine.
It is essential that your doctor has a complete picture of your health before prescribing Lercamed. Certain medical conditions and medications can interact dangerously with lercanidipine, and some patients should not take this medicine at all. The following sections outline the key information you need to be aware of before starting treatment.
Contraindications
You should not take Lercamed if any of the following apply to you:
- Allergy to lercanidipine hydrochloride or any of the other ingredients in the tablet – symptoms of allergy may include skin rash, itching, swelling of the face or throat, or difficulty breathing
- Certain heart conditions, including:
- Obstruction of blood flow from the left ventricle (e.g. severe aortic stenosis)
- Untreated congestive heart failure
- Unstable angina pectoris (chest pain occurring at rest or progressively worsening)
- Within one month following a heart attack (myocardial infarction)
- Severe liver disease – lercanidipine is extensively metabolised by the liver, and severe hepatic impairment can lead to dangerously high drug levels
- Severe kidney disease or dialysis – patients with a glomerular filtration rate below 30 mL/min or those undergoing dialysis should not use lercanidipine
- Concurrent use of strong CYP3A4 inhibitors, including:
- Antifungal medicines such as ketoconazole or itraconazole
- Macrolide antibiotics such as erythromycin, troleandomycin, or clarithromycin
- Antiviral medicines such as ritonavir
- Concurrent use of cyclosporine – used after organ transplantation to prevent rejection; the combination with lercanidipine can lead to significantly increased blood levels of both drugs
- Grapefruit or grapefruit juice – this fruit inhibits CYP3A4 and can significantly increase lercanidipine levels, leading to excessive and unpredictable blood pressure lowering
Warnings and Precautions
Talk to your doctor or pharmacist before taking Lercamed if you have or have had any of the following:
- Heart problems – including mild to moderate heart failure, ischaemic heart disease, or arrhythmias. While lercanidipine is generally well tolerated, patients with pre-existing cardiac conditions require careful monitoring
- Mild to moderate liver or kidney impairment – your doctor may need to adjust your dose or monitor you more closely. Lercanidipine is extensively metabolised by the liver, and reduced liver function can increase drug exposure
- Sick sinus syndrome (without a pacemaker) – calcium channel blockers may affect the electrical conduction system of the heart in susceptible individuals
Patients with existing angina pectoris may, in rare cases, experience an increase in the frequency, duration, or severity of angina attacks when starting treatment with dihydropyridine calcium channel blockers. Isolated cases of myocardial infarction have been reported in the literature. If you experience worsening chest pain after starting Lercamed, contact your doctor immediately.
Pregnancy and Breastfeeding
Lercamed is not recommended during pregnancy. There is no clinical data on the use of lercanidipine in pregnant women, and the potential risks to the developing foetus are unknown. If you are pregnant, think you may be pregnant, or are planning to become pregnant, tell your doctor before taking Lercamed. Your doctor may recommend an alternative antihypertensive medication with a more established safety profile during pregnancy, such as labetalol, methyldopa, or nifedipine (extended-release formulations).
It is not known whether lercanidipine passes into breast milk. Therefore, Lercamed should not be used while breastfeeding. If you are breastfeeding or about to start breastfeeding, consult your doctor before taking this medication. Your doctor will help you weigh the benefits of blood pressure treatment against any potential risks to your baby.
If you are a woman of childbearing age who is not using contraception, discuss this with your doctor before starting Lercamed.
Driving and Operating Machinery
Lercamed can occasionally cause dizziness, weakness, or drowsiness, particularly when you first start taking it or after a dose increase. If you experience any of these symptoms, you should not drive or operate machinery until the symptoms have resolved. You are responsible for assessing whether you are fit to drive or perform tasks requiring alertness. Be aware that many medications can affect this ability through their effects and side effects. Discuss with your doctor or pharmacist if you are unsure.
Important Information About Excipients
Lercamed tablets contain lactose. If you have been told by your doctor that you have an intolerance to certain sugars, contact your doctor before taking this medicine. The tablets also contain a small amount of sodium (less than 1 mmol or 23 mg per tablet), meaning they are essentially sodium-free.
How Does Lercamed Interact with Other Drugs?
Lercamed can interact with several medications, including antiepileptics, antifungals, macrolide antibiotics, HIV protease inhibitors, beta-blockers, immunosuppressants, and some cholesterol-lowering drugs. Always tell your doctor about all medications you are currently taking, including over-the-counter products and herbal supplements.
Lercanidipine is primarily metabolised by the liver enzyme CYP3A4. This means that any medication which strongly inhibits this enzyme can increase lercanidipine blood levels (potentially to dangerous levels), while drugs that induce CYP3A4 can decrease lercanidipine's effectiveness. Understanding these interactions is crucial for safe treatment. The following tables summarise the most clinically important drug interactions.
Contraindicated Combinations
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| Ketoconazole / Itraconazole | Antifungal | Strong CYP3A4 inhibitors that significantly increase lercanidipine blood levels | Contraindicated – do not use together |
| Erythromycin / Clarithromycin / Troleandomycin | Macrolide antibiotics | CYP3A4 inhibitors that increase lercanidipine levels | Contraindicated – do not use together |
| Ritonavir | HIV protease inhibitor | Potent CYP3A4 inhibitor that dramatically increases lercanidipine exposure | Contraindicated – do not use together |
| Cyclosporine | Immunosuppressant | Mutually increased blood levels of both drugs | Contraindicated – do not use together |
| Grapefruit juice | Food interaction | CYP3A4 inhibitor that unpredictably increases lercanidipine levels | Contraindicated – avoid completely |
Interactions Requiring Caution
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| Phenytoin / Phenobarbital / Carbamazepine | Antiepileptics | CYP3A4 inducers that may reduce lercanidipine levels and effectiveness | Monitor blood pressure closely; dose increase may be needed |
| Rifampicin | Antibiotic (tuberculosis treatment) | Strong CYP3A4 inducer that significantly reduces lercanidipine effectiveness | Monitor blood pressure; alternative antihypertensive may be needed |
| Metoprolol and other beta-blockers | Antihypertensives | Additive blood pressure and heart rate lowering; bioavailability of lercanidipine may be reduced by 50% | Use together with medical supervision; monitor blood pressure and heart rate |
| Digoxin | Heart medicine | Potential for increased digoxin levels; monitor for signs of digoxin toxicity | Monitor digoxin blood levels regularly |
| Simvastatin | Cholesterol-lowering (statin) | Lercanidipine may increase simvastatin exposure; risk of muscle damage | Take at different times of day; monitor for muscle pain |
| Cimetidine (above 800 mg) | Stomach acid reducer | Doses above 800 mg/day may increase lercanidipine blood levels | Use caution at high cimetidine doses; monitor blood pressure |
| Midazolam | Sedative / sleeping aid | Shared CYP3A4 metabolism; potential for interaction | Monitor for excessive sedation |
| Astemizole / Terfenadine | Antihistamines | Potential for QT prolongation and cardiac arrhythmias | Avoid combination; use alternative antihistamines |
| Amiodarone / Quinidine / Sotalol | Antiarrhythmics | Additive effects on cardiac conduction and rhythm | Use with caution under specialist supervision |
Food and Alcohol Interactions
A high-fat meal significantly increases the absorption of lercanidipine, leading to higher blood levels that may increase the risk of side effects. For this reason, Lercamed should always be taken at least 15 minutes before breakfast, not during or after a meal.
Alcohol can enhance the blood pressure-lowering effect of Lercamed, potentially causing excessive drops in blood pressure, dizziness, or fainting. You should avoid alcohol while being treated with Lercamed.
If you are taking other medications for high blood pressure, be aware that Lercamed can further lower your blood pressure. Your doctor will adjust your treatment regimen accordingly. Lercanidipine can be safely combined with many other antihypertensive medications, including ACE inhibitors and angiotensin receptor blockers (ARBs), but this should always be done under medical supervision.
What Is the Correct Dosage of Lercamed?
The recommended starting dose for adults is 10 mg once daily, taken in the morning at least 15 minutes before breakfast. If needed, your doctor may increase the dose to 20 mg once daily. Take the tablet at the same time each day with a little water.
Always take Lercamed exactly as your doctor has instructed. Do not change your dose without first consulting your doctor. The timing of your dose is important – take it in the morning before breakfast to avoid the increased absorption that occurs when the drug is taken with food.
Adults
Hypertension (High Blood Pressure)
Starting dose: 10 mg once daily in the morning
Maximum dose: 20 mg once daily
Your doctor may increase the dose from 10 mg to 20 mg if your blood pressure is not adequately controlled after an appropriate period. The full antihypertensive effect may take 2 to 4 weeks to develop. The tablet should be swallowed whole with a little water at least 15 minutes before breakfast.
Lercamed tablets have a score line (breakable groove), but this is only intended to make the tablet easier to swallow by breaking it into smaller pieces. The score line should not be used to split the tablet into two equal doses.
Children and Adolescents
Not Recommended
The safety and efficacy of Lercamed in children and adolescents under 18 years of age have not been established. This medication should not be given to patients younger than 18 years. Your doctor will recommend an alternative antihypertensive medication if treatment is needed in a younger patient.
Elderly Patients
No specific dose adjustment is required for elderly patients. However, particular caution should be exercised when initiating treatment in this age group, as elderly patients may be more sensitive to the blood pressure-lowering effects of calcium channel blockers. Your doctor will start with the standard 10 mg dose and monitor your response carefully before considering a dose increase.
Patients with Liver or Kidney Impairment
Patients with mild to moderate liver or kidney impairment should exercise special caution when starting Lercamed. The standard starting dose of 10 mg should be used, and any increase to 20 mg should be done gradually and with close medical monitoring. Patients with severe liver or kidney disease (including those on dialysis) must not use Lercamed (see Contraindications section above).
Missed Dose
If you forget to take a dose, simply skip the missed dose and take your next dose at the usual time the following morning. Do not take a double dose to compensate for a forgotten dose. If you frequently forget to take your tablets, consider setting a daily alarm on your phone or linking your dose to a fixed part of your morning routine. Consistent daily dosing is important for maintaining effective blood pressure control throughout the day.
Overdose
Taking more Lercamed than prescribed can cause excessively low blood pressure (hypotension) and an irregular or rapid heartbeat. Symptoms may include severe dizziness, lightheadedness, fainting, weakness, and a pounding or racing heart. Seek immediate medical attention if you suspect an overdose. Contact your local emergency services or poison control centre without delay. Take the medication packaging with you to hospital so that medical staff can identify the drug involved.
Stopping Lercamed
Do not stop taking Lercamed without first consulting your doctor. If you stop taking the medication suddenly, your blood pressure may rise again, which can increase your risk of cardiovascular complications. Your doctor will advise you on how to stop treatment safely, which may involve gradually reducing the dose or switching to an alternative medication.
What Are the Side Effects of Lercamed?
Like all medicines, Lercamed can cause side effects, although not everyone experiences them. The most common side effects include headache, faster heartbeat, palpitations, flushing, and ankle swelling. Most side effects are mild and often improve as your body adjusts to the medication.
The side effects listed below are categorised by how frequently they occur. If you experience any side effects that concern you, or if they are severe or persistent, consult your doctor or pharmacist. This includes any side effects not listed below.
- Angina pectoris (chest pressure or pain due to reduced blood flow to the heart)
- Allergic reactions, including severe skin rash, hives, itching, or swelling of the face, lips, tongue, or throat (angioedema) which may cause difficulty breathing or swallowing
- Fainting (syncope)
- Signs of a heart attack: severe chest pain radiating to the arm or jaw, shortness of breath, cold sweats
Common
May affect up to 1 in 10 people
- Headache
- Faster heartbeat (tachycardia)
- Palpitations (awareness of heartbeat, pounding or racing sensation)
- Flushing (sudden redness of the face, neck, or upper chest)
- Ankle swelling (peripheral oedema)
Uncommon
May affect up to 1 in 100 people
- Dizziness
- Low blood pressure (hypotension)
- Heartburn
- Nausea
- Abdominal pain
- Skin rash
- Itching (pruritus)
- Muscle pain (myalgia)
- Increased urine output (polyuria)
- Weakness or fatigue (asthenia)
Rare
May affect up to 1 in 1,000 people
- Drowsiness (somnolence)
- Vomiting
- Diarrhoea
- Hives (urticaria)
- Increased frequency of urination (pollakiuria)
- Chest pain
- Angina pectoris (chest pain from reduced heart blood flow)
- Allergic reactions (rash, itching, hives)
- Fainting (syncope)
Not Known
Frequency cannot be estimated from available data
- Gingival hyperplasia (enlarged or swollen gums)
- Changes in liver function (detected by blood tests)
- Cloudy peritoneal dialysis fluid (in patients undergoing peritoneal dialysis)
- Angioedema (swelling of the face, lips, tongue, or throat that may cause difficulty breathing or swallowing)
Patients who already have angina pectoris may experience an increase in the frequency, duration, or severity of attacks when treated with dihydropyridine calcium channel blockers such as lercanidipine. In isolated cases, myocardial infarction (heart attack) has been observed. If you notice any worsening of chest pain, contact your doctor immediately.
If you experience any side effects, talk to your doctor or pharmacist. You can also report side effects directly to your national medicines regulatory agency. By reporting side effects, you help provide valuable information about the safety of medicines.
How Should You Store Lercamed?
Store Lercamed in its original packaging, protected from moisture, at a temperature not exceeding 30°C. Keep the medicine out of the sight and reach of children. Do not use Lercamed after the expiry date printed on the packaging.
Proper storage of your medication ensures that it remains effective and safe to use throughout its shelf life. Follow these storage guidelines:
- Temperature: Store at or below 30°C (86°F). Do not refrigerate or freeze
- Moisture protection: Keep the tablets in the original blister packaging to protect them from moisture
- Light: Store in the original carton
- Keep out of reach of children: Store the medicine where children cannot see or reach it
- Expiry date: Do not use Lercamed after the expiry date (EXP) shown on the blister and carton. The expiry date refers to the last day of the stated month
Do not dispose of medicines by flushing them down the toilet or throwing them in household waste. Ask your pharmacist how to dispose of medicines you no longer use. These measures help protect the environment.
What Does Lercamed Contain?
The active ingredient in Lercamed is lercanidipine hydrochloride. A 10 mg tablet contains 10 mg of lercanidipine hydrochloride (equivalent to 9.4 mg lercanidipine). A 20 mg tablet contains 20 mg of lercanidipine hydrochloride (equivalent to 18.8 mg lercanidipine).
Active Ingredient
Lercanidipine hydrochloride is the active pharmaceutical ingredient in Lercamed. It is a dihydropyridine calcium channel blocker. Each 10 mg film-coated tablet contains 10 mg of lercanidipine hydrochloride, which corresponds to 9.4 mg of lercanidipine (free base). Each 20 mg film-coated tablet contains 20 mg of lercanidipine hydrochloride, corresponding to 18.8 mg of lercanidipine (free base).
Inactive Ingredients (Excipients)
The other ingredients in Lercamed are:
- Tablet core: Magnesium stearate (E572), povidone (E1201), sodium starch glycolate (type A), lactose monohydrate, microcrystalline cellulose (E460)
- Film coating (10 mg tablets): Macrogol, polyvinyl alcohol (partially hydrolysed), talc, titanium dioxide (E171), yellow iron oxide (E172)
- Film coating (20 mg tablets): Macrogol, polyvinyl alcohol (partially hydrolysed), talc, titanium dioxide (E171), yellow iron oxide (E172), red iron oxide (E172)
Appearance and Pack Sizes
10 mg tablets: Yellow, round, biconvex, film-coated tablets with a score line on one side and marked with “L” on the other side. Diameter: 6.5 mm.
20 mg tablets: Pink, round, biconvex, film-coated tablets with a score line on one side and marked with “L” on the other side. Diameter: 8.5 mm.
Available in packs of 100 tablets.
Frequently Asked Questions About Lercamed
Lercamed (lercanidipine) is used to treat high blood pressure (hypertension) in adults aged 18 years and over. It belongs to the calcium channel blocker class and works by relaxing blood vessels to allow blood to flow more easily, thereby lowering blood pressure. By controlling hypertension, Lercamed helps reduce the long-term risk of heart attack, stroke, and kidney disease.
The most common side effects of Lercamed include headache, rapid heartbeat (tachycardia), palpitations, flushing (redness of the face, neck, or upper chest), and ankle swelling (peripheral oedema). These side effects affect up to 1 in 10 people and are generally mild and temporary. Contact your doctor if side effects are persistent or troublesome.
Grapefruit and grapefruit juice inhibit the CYP3A4 enzyme that metabolises lercanidipine. This can significantly increase the amount of lercanidipine in your blood, leading to an excessive and unpredictable drop in blood pressure, which may cause dizziness, flushing, or fainting. This interaction is so significant that it is classified as a contraindication – you should completely avoid grapefruit products while taking Lercamed.
Take Lercamed once daily in the morning, at least 15 minutes before breakfast. This timing is important because a high-fat meal can significantly increase the absorption of lercanidipine, leading to unpredictably higher blood levels and an increased risk of side effects. Swallow the tablet whole with a little water. Take it at the same time each day for consistent blood pressure control.
Lercamed is not recommended during pregnancy. There is insufficient clinical data on the use of lercanidipine in pregnant women, and potential risks to the unborn child cannot be excluded. It is also not known whether lercanidipine passes into breast milk, so breastfeeding while taking Lercamed is not recommended. If you are pregnant, planning to become pregnant, or breastfeeding, tell your doctor. They may recommend an alternative blood pressure medication with a better-established safety profile, such as labetalol or methyldopa.
Both lercanidipine (Lercamed) and amlodipine are dihydropyridine calcium channel blockers used to treat hypertension. They have similar blood pressure-lowering effectiveness. However, lercanidipine is often associated with a lower incidence of ankle swelling (peripheral oedema) compared to amlodipine, which is a major advantage for patients who are susceptible to this side effect. Lercanidipine has a shorter plasma half-life but a longer effective duration due to its high lipophilicity and membrane binding. An important practical difference is that Lercamed must be taken before breakfast, while amlodipine can be taken at any time.
References
- European Medicines Agency (EMA). Lercanidipine – Summary of Product Characteristics. EMA Product Information. Available from: www.ema.europa.eu
- Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension. Journal of Hypertension. 2023;41(12):1874–2071. doi:10.1097/HJH.0000000000003480
- Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Journal of the American College of Cardiology. 2018;71(19):e127–e248.
- Borghi C, Prandin MG, Dormi A, Ambrosioni E, on behalf of the Study Group. Improved tolerability of the dihydropyridine calcium-channel antagonist lercanidipine: the lercanidipine challenge trial. Blood Pressure. 2003;12(sup1):14–21. doi:10.1080/08038020310000087
- Barrios V, Escobar C, Navarro Á, et al. Lercanidipine is an effective and well tolerated antihypertensive drug regardless the cardiovascular risk profile: The LAURA Study. International Journal of Clinical Practice. 2006;60(11):1364–1370.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List (2023). Geneva: World Health Organization; 2023.
- National Institute for Health and Care Excellence (NICE). Hypertension in adults: diagnosis and management. NICE guideline [NG136]. Updated 2022. Available from: www.nice.org.uk/guidance/ng136
- British National Formulary (BNF). Lercanidipine hydrochloride. BNF Drug Monograph. Available from: bnf.nice.org.uk
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