Lercaril (Enalapril Maleate, Lercanidipine Hydrochloride)

Lercaril is an antihypertensive medication that acts on the renin‑angiotensin system and vascular smooth‑muscle calcium channels.

• Essential hypertension: provides additive blood‑pressure reduction when monotherapy is insufficient.
• Hypertension requiring dual therapy: offers simultaneous ACE inhibition and calcium‑channel blockade in a single tablet.
• Uncontrolled blood pressure on single agents: improves control by targeting two complementary pathways.

• Enalapril maleate inhibits angiotensin‑converting enzyme, decreasing formation of angiotensin II and reducing vasoconstriction and aldosterone release. Lercanidipine hydrochloride blocks L‑type calcium channels in vascular smooth muscle, leading to arterial vasodilation. The combined actions lower systemic vascular resistance and cardiac afterload, producing an additive antihypertensive effect.

Lercaril may cause a range of adverse reactions, most of which are mild and reversible.

Common Side Effects

• Cough: dry, persistent throat irritation.
• Dizziness or light‑headedness, especially after standing.
• Headache: mild to moderate intensity.
• Peripheral edema: swelling of ankles or feet.
• Flushing: transient warmth and redness of the skin.
• Fatigue: generalized 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 enzymes or jaundice.
• Neutropenia or leukopenia: reduced white‑blood‑cell counts.
• Myocardial infarction: rare occurrence of heart attack.
• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.

Before prescribing Lercaril, clinicians should evaluate patient‑specific risk factors and monitor therapy.

• Renal function: assess creatinine clearance and adjust if impaired.
• Electrolytes: monitor potassium and sodium levels regularly.
• History of angioedema: avoid use in patients with prior episodes.
• Pregnancy: contraindicated due to ACE‑inhibitor teratogenicity; discontinue if pregnancy is detected.
• Elderly patients: start at lower dose and monitor for hypotension.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Lercaril can interact with several drug classes, requiring careful management.

Major Interactions (Avoid)

• Aliskiren: combined use may cause excessive hypotension and renal impairment.
• Potassium‑sparing diuretics or supplements: increase risk of hyperkalaemia.
• Lithium: may raise lithium concentrations, leading to toxicity.
• Dual ACE‑inhibitor/ARB therapy: heightened risk of renal dysfunction and hyperkalaemia.
• NSAIDs (high‑dose): can blunt antihypertensive effect and impair renal function.

Moderate Interactions (Monitor Closely)

• Thiazide diuretics: may enhance antihypertensive effect, watch for volume depletion.
• CYP3A4 inhibitors (e.g., erythromycin, clarithromycin): can increase lercanidipine levels.
• CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce lercanidipine exposure.
• Other antihypertensives: additive blood‑pressure lowering, monitor for hypotension.
• Grapefruit juice: may raise lercanidipine concentrations, advise avoidance.