Lercaprel (Enalapril Maleate, Lercanidipine Hydrochloride)

Lercaprel is an antihypertensive medication that acts on the renin‑angiotensin system and vascular smooth‑muscle calcium channels to lower blood pressure.

• Essential hypertension: provides additive reduction of systolic and diastolic pressure.
• Isolated systolic hypertension: improves pulse pressure control.
• Mixed (systolic/diastolic) hypertension: achieves comprehensive blood‑pressure management.

• Enalapril maleate inhibits angiotensin‑converting enzyme, decreasing formation of angiotensin II and reducing aldosterone secretion, which leads to vasodilation and lowered blood volume. Lercanidipine hydrochloride blocks L‑type calcium channels in vascular smooth muscle, preventing calcium influx and causing arterial relaxation. The dual action produces an additive antihypertensive effect through both neurohormonal blockade and direct vascular dilation.

Lercaprel may cause a range of adverse reactions, most of which are mild and transient.

Common Side Effects

• Dizziness: sensation of light‑headedness, especially after standing.
• Headache: mild to moderate intensity.
• Cough: dry, non‑productive cough.
• Peripheral edema: swelling of ankles or feet.
• Flushing: transient warmth and redness of the skin.
• Fatigue: feeling unusually tired.

Serious or Rare Side Effects

• Angioedema: swelling of face, lips, tongue, or airway requiring emergency care.
• Severe hypotension: marked drop in blood pressure causing faintness.
• Liver dysfunction: abnormal liver enzymes or hepatitis.
• Acute renal failure: sudden loss of kidney function.
• Myocardial infarction: rare occurrence of heart attack.
• Severe allergic reactions: rash, itching, or anaphylaxis.

Before initiating therapy with Lercaprel, clinicians should assess patient‑specific risk factors and monitor relevant parameters.

• Blood pressure monitoring: check regularly to avoid excessive hypotension.
• Renal function assessment: evaluate serum creatinine and eGFR before and during treatment.
• Electrolyte balance: monitor potassium levels, especially if combined with potassium‑sparing agents.
• Hepatic impairment: use with caution in patients with liver disease.
• Hypersensitivity: discontinue if signs of angioedema or severe rash appear.
• Store at ambient temperature below 25°C: keep in the original packaging, protect from moisture and direct sunlight.

Lercaprel can interact with several drug classes, requiring attention to avoid reduced efficacy or increased toxicity.

Major Interactions (Avoid)

• Aliskiren in diabetic patients: combined use may increase risk of renal impairment.
• Potassium‑sparing diuretics: may cause hyperkalaemia.
• Strong CYP3A4 inhibitors (e.g., itraconazole, clarithromycin): raise lercanidipine plasma levels.
• NSAIDs: can blunt antihypertensive effect and affect renal function.
• Concurrent ACE inhibitors or ARBs: increase risk of angioedema.

Moderate Interactions (Monitor Closely)

• Thiazide diuretics: additive blood‑pressure lowering effect.
• Beta‑blockers: may enhance hypotensive response.
• Lithium: risk of lithium toxicity.
• CYP3A4 inducers (e.g., rifampicin, carbamazepine): reduce lercanidipine exposure.
• Glucocorticoids: may affect fluid balance and blood pressure.