Does Lercanidipine (Lercanidipine) cause fluid retention?

From the Guidelines

Lercanidipine is not directly implicated in causing significant fluid retention based on the provided evidence. The primary concern with fluid retention is often associated with diuretic use and management in patients with hypertension and heart failure, as discussed in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.

When considering the management of hypertension and potential side effects like fluid retention, it's crucial to understand that diuretics play a key role in controlling fluid retention in heart failure patients. The use of diuretics is recommended for patients with hypertension and HFpEF who have evidence of fluid retention, highlighting the importance of appropriate diuretic use in managing fluid balance 1.

Key points to consider in the context of lercanidipine and fluid retention include:

• The mechanism of action of lercanidipine as a calcium channel blocker, which primarily affects vascular smooth muscle, leading to vasodilation.
• The potential for vasodilation to contribute to fluid retention, although this is not a primary concern highlighted in the guidelines for managing hypertension or heart failure.
• The importance of monitoring and managing fluid retention through appropriate means, such as diuretic therapy, in patients with heart failure.

Given the information provided and the focus on diuretic use in managing fluid retention, the primary approach to managing fluid retention should involve the appropriate use of diuretics, as outlined in the guidelines, rather than a significant concern over lercanidipine's potential to cause fluid retention 1.

From the Research

Lercanidipine and Fluid Retention

• Lercanidipine is a vasoselective dihydropyridine calcium antagonist that causes systemic vasodilation by blocking the influx of calcium ions through L-type calcium channels in cell membranes 2.
• The drug is well tolerated, with most treatment-related adverse events typical of dihydropyridine calcium antagonists, namely headache, flushing, dizziness, and ankle oedema 2.
• Vasodilatory edema, a common adverse effect of antihypertensive therapy with vasodilators, is related to several mechanisms, including arteriolar dilatation, stimulation of the renin-angiotensin-aldosterone system, and fluid volume retention 3.
• Not all dihydropyridine calcium antagonists are created equal with regard to vasodilatory edema, and lercanidipine is associated with less vasodilatory edema than amlodipine and nifedipine 3.
• The incidence of vasodilatory oedema was significantly lower in patients receiving lercanidipine than in those receiving some other calcium channel antagonists 4.
• Lercanidipine is well-tolerated, with a very low rate of drop-out (1-2%) because of adverse events, and a low occurrence of peripheral oedema 5.
• One of the main clinical side effects of the first and second generation CCBs including amlodipine is the development of peripheral edema, but lercanidipine has significantly less peripheral edema compared to amlodipine 6.

Comparison with Other Calcium Channel Blockers

• Lercanidipine 10-20 mg/day was as effective as nifedipine slow release (SR) 20-40 mg twice daily, amlodipine 10 mg/day, felodipine 10-20 mg/day, nifedipine gastrointestinal therapeutic system (GITS) 30-60 mg once daily or verapamil SR 240 mg/day at reducing SBP and DBP in patients with mild-to-moderate hypertension 4.
• Lercanidipine 5-30 mg/day effectively decreased BP in elderly patients (aged >60 years) with mild-to-moderate hypertension or isolated systolic hypertension to the same extent as amlodipine 5-10 mg/day, nifedipine GITS 30-60 mg/day or lacidipine 2-4 mg/day 4.
• Lercanidipine is an effective alternative in patients who are insufficiently controlled with another therapy, or in patients not tolerating other calcium channel blockers 5.