Cilnidipine Dosing for Hypertension
For an adult hypertensive patient without diabetes or impaired renal function, start cilnidipine at 10 mg once daily in the morning, with dose adjustments ranging from 5-20 mg/day based on blood pressure response.
Starting Dose and Titration
The recommended starting dose is 10 mg once daily, administered in the morning 1, 2, 3.
The dose can be adjusted within a range of 5-20 mg/day depending on blood pressure control 2, 3.
Once-daily administration provides sufficient 24-hour blood pressure reduction without causing reflex tachycardia 2.
Blood Pressure Targets
For patients without comorbidities, target blood pressure should be <140/90 mmHg 4.
For patients with cardiovascular disease or diabetes, a more stringent target of <130/80 mmHg is recommended 5, 4.
If blood pressure is ≥160/100 mmHg at baseline, consider initiating combination therapy with two antihypertensive agents rather than monotherapy 5, 6.
Clinical Advantages of Cilnidipine
Cilnidipine offers specific benefits compared to other calcium channel blockers:
Dual L- and N-type calcium channel blockade provides sympatholytic action, preventing the reflex tachycardia commonly seen with dihydropyridines 1, 2.
Superior renal protection through balanced dilation of both afferent and efferent glomerular arterioles, resulting in greater reduction of albuminuria compared to amlodipine 1, 7.
Improved insulin sensitivity without adverse metabolic effects, making it suitable for patients at risk of diabetes 8.
Reduction in serum uric acid levels, which may benefit patients with concurrent hyperuricemia 3.
Dosing Considerations
The antihypertensive effect is dose-dependent and correlates with baseline blood pressure levels—patients with higher baseline pressures show greater reductions 2.
Cilnidipine at 10 mg provides comparable blood pressure reduction to amlodipine 2.5-5 mg, but with additional renal and metabolic benefits 1, 7.
No dose adjustment is needed for elderly patients initially, though monitoring for excessive blood pressure reduction is prudent 2.
Common Pitfalls to Avoid
Underdosing is common in clinical practice—ensure adequate titration to 20 mg if blood pressure remains uncontrolled on 10 mg 6.
Do not combine with other calcium channel blockers or use in patients with advanced aortic stenosis 5.
Monitor for the typical dihydropyridine side effects (peripheral edema, flushing), though cilnidipine may cause less reflex tachycardia than other agents 2, 8.