Lercapril (Enalapril Maleate, Lercanidipine Hydrochloride)

• Lercapril is employed in the management of elevated arterial pressure, targeting both the renin‑angiotensin system and vascular smooth‑muscle tone to control hypertension.
• Hypertension (essential or secondary): provides combined ACE inhibition and calcium‑channel blockade, resulting in consistent reduction of systolic and diastolic blood pressure, decreased peripheral vascular resistance, and a favorable impact on long‑term cardiovascular risk.

• Lercapril combines enalapril, which blocks the angiotensin‑converting enzyme and prevents formation of vasoconstrictive angiotensin II, with lercanidipine, a dihydropyridine that inhibits L‑type calcium channels on vascular smooth muscle. The dual action produces vasodilation, reduced peripheral resistance, and lowered blood pressure.

Lercapril may cause a range of adverse reactions, some of which are relatively frequent while others are rare but serious.

Common Side Effects

• Cough
• Dizziness or light‑headedness
• Headache
• Peripheral edema
• Flushing
• Fatigue

Serious or Rare Side Effects

• Angioedema (swelling of face, lips, tongue)
• Severe hypotension
• Acute kidney injury or worsening renal function
• Hepatic dysfunction
• Myocardial infarction or unstable angina
• Life‑threatening arrhythmias

Before initiating Lercapril, clinicians should consider several safety aspects.

• Renal function monitoring: assess serum creatinine and eGFR regularly.
• Electrolyte balance: watch potassium levels, especially if combined with potassium‑sparing agents.
• History of angioedema: avoid use in patients with prior ACE‑inhibitor‑related swelling.
• Hepatic impairment: use with caution and adjust dose if needed.
• Concomitant potassium supplements or salt substitutes: monitor for hyperkalaemia.
• Store at ambient temperature: keep below 25°C in the original container, protect from moisture and direct sunlight.

Lercapril can interact with other medicines, requiring attention to avoid reduced efficacy or increased toxicity.

Major Interactions (Avoid)

• ARBs or direct renin inhibitors (e.g., aliskiren in diabetic patients): risk of additive renal impairment and hyperkalaemia.
• Potassium‑sparing diuretics or supplements: may cause dangerous hyperkalaemia.
• Lithium: increased lithium levels and potential toxicity.

Moderate Interactions (Monitor Closely)

• Non‑steroidal anti‑inflammatory drugs (NSAIDs): may blunt antihypertensive effect and affect renal function.
• CYP3A4 inhibitors (e.g., clarithromycin, itraconazole): can raise lercanidipine concentrations.
• Other antihypertensives (beta‑blockers, diuretics): may enhance blood‑pressure lowering, requiring dose adjustments.