Lercaprel (Enalapril Maleate, Lercanidipine Hydrochloride)

• Lercaprel combines an ACE inhibitor and a calcium‑channel blocker to manage high blood pressure.
• Essential hypertension: provides additive blood‑pressure reduction, helping patients achieve target blood‑pressure goals.

• Enalapril maleate blocks the angiotensin‑converting enzyme, decreasing formation of angiotensin II and reducing aldosterone secretion, which leads to vasodilation. Lercanidipine hydrochloride inhibits L‑type calcium channels in vascular smooth muscle, causing arterial relaxation. The dual action produces an additive effect on lowering systemic vascular resistance and arterial pressure.

Lercaprel may cause a range of adverse reactions, some of which are more frequent than others.

Common Side Effects

• Cough: dry, persistent throat irritation.
• Dizziness or light‑headedness, especially after standing.
• Headache: mild to moderate intensity.
• Peripheral edema: swelling of the ankles or feet.
• Flushing: transient warmth and redness of the skin.
• Fatigue: general feeling of tiredness.

Serious or Rare Side Effects

• Angioedema: rapid swelling of face, lips, tongue or airway.
• Severe hypotension: marked drop in blood pressure causing fainting.
• Hepatic dysfunction: abnormal liver enzyme elevations.
• Myocardial infarction: rare occurrence of heart attack.
• Arrhythmias: irregular heart rhythms.
• Neutropenia: significant reduction in white blood cells.

Before initiating Lercaprel, several safety considerations should be observed.

• Renal function monitoring: assess serum creatinine and eGFR periodically.
• Electrolyte balance: check potassium and sodium levels, especially if using diuretics.
• History of angioedema: avoid in patients with prior ACE‑inhibitor‑related swelling.
• Pregnancy: use only if potential benefit justifies risk; data are limited.
• Concomitant potassium‑sparing agents: evaluate risk of hyperkalaemia.
• Store at ambient temperature: keep in the original container, protect from moisture and direct sunlight.

Lercaprel can interact with several medicines; the significance varies.

Major Interactions (Avoid)

• Aliskiren in diabetic patients: combined renin‑angiotensin blockade may increase renal risk.
• Concurrent use of another ACE inhibitor or ARB: may cause excessive hypotension and renal impairment.
• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): increase lercanidipine plasma levels.
• Potassium supplements or potassium‑sparing diuretics: risk of hyperkalaemia.
• Neprilysin inhibitors (e.g., sacubitril): may amplify angioedema risk.

Moderate Interactions (Monitor Closely)

• NSAIDs: may blunt antihypertensive effect and affect renal function.
• Thiazide or loop diuretics: may enhance hypotensive response.
• Other antihypertensives: dose adjustments may be needed to avoid excessive blood‑pressure drop.
• Grapefruit juice: can modestly raise lercanidipine concentrations.
• CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce lercanidipine efficacy.