Cilacar (Cilnidipine) Dosing for Adults
The recommended starting dose of Cilacar (cilnidipine) for adults with essential hypertension is 10 mg once daily, which can be adjusted to a range of 5-20 mg/day based on blood pressure response and tolerability. 1, 2
Standard Dosing Regimen
- Initial dose: 10 mg once daily 1, 2
- Dose range: 5-20 mg/day 2
- Titration: Adjust dose after 3 weeks if blood pressure control is inadequate 2
- Maximum dose: 20 mg/day 2
Timing of Administration
Bedtime administration is particularly effective for controlling morning hypertension, which is a critical risk factor for cardiovascular events 1. When cilnidipine 10 mg was given at bedtime in patients with uncontrolled morning hypertension:
- Morning systolic BP decreased from 150.2 to 132.7 mmHg 1
- Morning diastolic BP decreased from 87.8 to 77.5 mmHg 1
- Morning-evening BP difference was significantly reduced 1
- Heart rate remained stable (no reflex tachycardia) 1
Clinical Advantages Over Other Calcium Channel Blockers
Cilnidipine offers distinct benefits compared to L-type-only calcium channel blockers like amlodipine:
- Heart rate reduction: Unlike amlodipine, cilnidipine significantly reduces heart rate due to N-type calcium channel blockade, which provides sympatholytic effects 2, 3
- Renal protection: Cilnidipine produces greater reduction in urinary albumin excretion compared to amlodipine at equivalent antihypertensive doses 3
- Arterial stiffness: Cilnidipine demonstrates superior improvement in brachial-ankle pulse wave velocity compared to amlodipine 3
- Uric acid metabolism: Cilnidipine significantly reduces serum uric acid levels, making it advantageous in hypertensive patients with hyperuricemia 2
Guideline-Based Context
While cilnidipine is not specifically mentioned in major international guidelines, dihydropyridine calcium channel blockers are recommended as first-line antihypertensive agents 4. The 2024 ESC guidelines recommend:
- Combination therapy as initial treatment for most patients with confirmed hypertension (BP ≥140/90 mmHg) 4
- Target systolic BP of 120-129 mmHg in most adults if well tolerated 4
- Single-pill combinations to improve adherence 4
Practical Considerations
- For morning hypertension: Administer 10 mg at bedtime 1
- For general hypertension: Administer 10 mg once daily in the morning, adjusting to 5-20 mg based on response 2
- In patients with hyperuricemia: Cilnidipine is preferable to other calcium channel blockers due to uric acid-lowering effects 2
- Monitoring: Assess BP response after 3 weeks before dose adjustment 2
Common Pitfalls to Avoid
- Do not assume cilnidipine will cause reflex tachycardia like other dihydropyridines; its N-type calcium channel blockade prevents this 1, 2
- Do not overlook the timing advantage for morning hypertension control—bedtime dosing is superior 1
- Do not use cilnidipine as monotherapy in patients requiring BP reduction >20/10 mmHg from baseline; combination therapy is more appropriate per current guidelines 4