Monopin (Lacidipine)

Lacidipine is indicated for the management of hypertension, a condition characterized by chronically elevated arterial pressure.

• Hypertension: reduces systolic and diastolic blood pressure, helping achieve target levels.
• Essential hypertension: provides consistent blood pressure control in patients with primary hypertension.
• Isolated systolic hypertension: effectively lowers elevated systolic pressure, particularly in older adults.

• Lacidipine selectively blocks L‑type calcium channels in vascular smooth muscle cells. By inhibiting calcium influx, it prevents contraction of arterial smooth muscle, producing dose‑dependent vasodilation. The resulting decrease in peripheral vascular resistance lowers systemic blood pressure without significant effect on cardiac conduction or contractility. The drug exhibits a long half‑life, allowing once‑daily dosing, and its antihypertensive effect is additive when combined with other agents that act on different pathways, such as diuretics or ACE inhibitors.

Lacidipine may be associated with several adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Headache: mild to moderate pain often occurring early in therapy.
• Flushing: transient warmth and redness of the skin.
• Peripheral edema: swelling of the ankles or lower limbs.
• Dizziness: sensation of light‑headedness, especially when standing.

Serious or Rare Side Effects

• Severe hypotension: marked drop in blood pressure leading to fainting.
• Angioedema: rapid swelling of face, lips, tongue or airway.
• Hepatic dysfunction: abnormal liver enzymes or jaundice.

When prescribing lacidipine, clinicians should consider several precautionary measures to ensure safe use.

• Blood pressure monitoring: check readings regularly after initiation and dose adjustments.
• Liver function assessment: evaluate hepatic enzymes before starting therapy and periodically thereafter.
• Concomitant antihypertensives: adjust doses of other blood‑pressure drugs to avoid excessive hypotension.
• Elderly patients: start with the lowest effective dose and monitor for orthostatic effects.
• Abrupt discontinuation: taper the medication gradually to prevent rebound hypertension.
• Store at room temperature: keep tablets in the original container, protect from moisture and direct sunlight.

Lacidipine can interact with other medicines, influencing its efficacy or safety.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole): may increase lacidipine plasma levels, raising risk of hypotension.
• Grapefruit juice: can markedly elevate drug concentration and precipitate severe blood pressure drops.
• Concurrent use with other calcium‑channel blockers: may cause additive vasodilatory effects and profound hypotension.

Moderate Interactions (Monitor Closely)

• CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce lacidipine effectiveness.
• Beta‑blockers or ACE inhibitors: combined therapy may enhance antihypertensive response, requiring dose titration.
• Diuretics: may increase risk of electrolyte imbalance and orthostatic hypotension.
• NSAIDs: can attenuate antihypertensive effect of lacidipine.