Can I increase the lercanidipine (calcium channel blocker) dose to 20mg at night?

Lercanidipine Dose Increase to 20mg at Night

Yes, you can increase lercanidipine to 20mg at night as this is an appropriate dose escalation for patients requiring better blood pressure control. 1, 2

Dosing Guidelines for Lercanidipine

• The standard starting dose for lercanidipine is 10mg once daily, with the option to increase to 20mg once daily for patients who do not achieve adequate blood pressure control 2
• Clinical trials have demonstrated that increasing the dose from 10mg to 20mg daily can improve response rates from 50-66% (at 10mg) to up to 86% (at 20mg) 1
• The 20mg dose maintains the once-daily dosing schedule, which helps with medication adherence 3

Efficacy of 20mg Dosing

• Lercanidipine at 20mg daily has been shown to be as effective as amlodipine 10mg daily in comparative studies 1, 2
• The 20mg dose is appropriate for patients with inadequate response to the 10mg dose after an adequate trial period (typically 4 weeks) 4
• The higher dose maintains the 24-hour antihypertensive effect without significant increases in heart rate 3

Safety Considerations

• Lercanidipine is generally well-tolerated even at the 20mg dose 2
• Common side effects include headache, flushing, dizziness, and ankle edema, but these are typically mild and transient 1
• The incidence of vasodilatory edema is significantly lower with lercanidipine compared to some other calcium channel blockers 2
• No dose adjustment is required for elderly patients or those with moderate renal or hepatic impairment when increasing to 20mg 5

Administration Considerations

• The increased dose can be administered at night as requested, which may help reduce any potential side effects that occur during waking hours 3
• Lercanidipine's high lipophilicity contributes to its gradual onset of action and long duration of effect, making it suitable for once-daily dosing at either 10mg or 20mg 3, 5
• The trough/peak ratio of >0.8 for both 10mg and 20mg dosages ensures effective 24-hour blood pressure control 1

When to Consider Dose Increase

• Consider increasing to 20mg if blood pressure remains above target despite adherence to 10mg dose for at least 4 weeks 4
• The dose increase is particularly appropriate for patients with resistant hypertension or severe hypertension requiring more intensive therapy 1, 2
• Monitoring blood pressure 2-4 weeks after dose increase is recommended to assess efficacy 4