What is a reason to switch from amlodipine to lercanidipine in patients with hypertension?

Switching from Amlodipine to Lercanidipine in Hypertension Management

The primary reason to switch from amlodipine to lercanidipine is to reduce peripheral edema while maintaining antihypertensive efficacy, as lercanidipine causes significantly less edema than amlodipine while providing comparable blood pressure control.

Peripheral Edema with Dihydropyridine CCBs

Dihydropyridine calcium channel blockers (CCBs) are effective first-line agents for hypertension management, but they have important differences in their side effect profiles:

• Amlodipine is associated with dose-related peripheral edema that is often resistant to diuretic therapy 1
• This edema is more common in women than men due to the vasodilatory properties of dihydropyridine CCBs 1
• Peripheral edema is one of the most common reasons for discontinuation of amlodipine therapy

Advantages of Lercanidipine

Lercanidipine offers several benefits when replacing amlodipine:

1. Reduced peripheral edema: Clinical studies have demonstrated that lercanidipine has comparable antihypertensive efficacy to amlodipine but with significantly less peripheral edema 2, 3

2. Pharmacological properties:

   • High lipophilicity with slower onset and longer duration of action 4
   • Produces even and sustained blood pressure lowering with once-daily dosing 3
   • Less reflex tachycardia compared to other dihydropyridines 3, 5

3. Comparable efficacy: Lercanidipine 20 mg/day has been shown to be as effective as amlodipine 10 mg/day in controlling blood pressure 4

4. Better tolerability profile: While both medications can cause typical dihydropyridine side effects (headache, flushing, dizziness), the incidence of peripheral edema is notably lower with lercanidipine 3

Patient Selection for Switching

Consider switching from amlodipine to lercanidipine in:

• Patients experiencing peripheral edema with amlodipine
• Patients with poor adherence due to amlodipine side effects
• Elderly patients who may be more susceptible to edema
• Patients with mild to moderate hypertension where tolerability is a priority

Implementation of Switch

When switching from amlodipine to lercanidipine:

1. Start with lercanidipine 10 mg once daily
2. Titrate to 20 mg once daily if needed for blood pressure control
3. Monitor blood pressure within 2-4 weeks after medication change
4. Assess for resolution of edema after discontinuation of amlodipine

Important Considerations

• Maintain target blood pressure of <130/80 mmHg if tolerated 1
• Consider combination therapy with ACE inhibitors or ARBs if blood pressure control remains inadequate 1
• Avoid non-dihydropyridine CCBs (verapamil, diltiazem) in patients with heart failure with reduced ejection fraction 6
• Monitor for improvement in quality of life due to reduction in edema symptoms

Alternative Options if Lercanidipine is Not Suitable

If switching to lercanidipine is not appropriate or available:

• Consider chlorthalidone 12.5-25 mg daily as an alternative 1
• ACE inhibitors or ARBs are appropriate alternatives, especially in elderly patients 1
• Low-dose combination therapy with multiple agents may be more effective than maximum doses of a single agent 1

In real-world practice, switching from amlodipine to lercanidipine has been shown to be a valuable therapeutic option with improved tolerability while maintaining effective blood pressure control 7.