Cilnidipine Dosing Frequency
Cilnidipine is administered once daily (OD) for hypertension, not twice daily. Multiple clinical studies consistently demonstrate that a single daily dose of cilnidipine (5-20 mg) provides effective 24-hour blood pressure control without requiring split dosing 1, 2, 3.
Evidence for Once-Daily Dosing
The pharmacodynamic profile of cilnidipine supports once-daily administration:
24-hour efficacy: Once-daily cilnidipine (5-20 mg) significantly reduces average blood pressure over the entire 24-hour period, during both daytime and nighttime, without reflex tachycardia 1.
Timing flexibility: The drug can be administered either in the morning or at bedtime with equivalent antihypertensive efficacy, allowing dosing at the most convenient time to improve adherence 1.
Sustained blood pressure reduction: Studies using ambulatory blood pressure monitoring confirm that single daily doses maintain therapeutic effect throughout the dosing interval, with significant reductions in both systolic and diastolic blood pressure across all time segments (morning, afternoon, nighttime, and sleeping periods) 2, 3.
Dosing Algorithm
Start with 10 mg once daily as the standard initial dose for most patients with essential hypertension 4, 5:
If blood pressure remains uncontrolled after 1-3 weeks, titrate up to 20 mg once daily 3, 5.
For patients requiring lower initial doses (elderly, hepatic impairment, or those on multiple antihypertensives), begin with 5 mg once daily and titrate as needed 1, 2.
Administer at a consistent time each day—either morning or bedtime—based on patient preference to maximize adherence 1.
Unique Advantages of Once-Daily Dosing
Cilnidipine's dual L-type and N-type calcium channel blocking action provides several benefits that support once-daily use:
No reflex tachycardia: Unlike other dihydropyridine calcium channel blockers that may require twice-daily dosing to minimize heart rate increases, cilnidipine does not significantly increase heart rate even with once-daily administration 1, 2, 3.
Morning blood pressure control: Single daily dosing effectively suppresses the early morning blood pressure surge and reduces morning hypertension, a critical period for cardiovascular events 1, 5.
Sympathetic nervous system modulation: The N-type calcium channel blocking action provides sympatholytic effects that persist throughout the 24-hour dosing interval 1, 4.
Common Pitfall to Avoid
Do not split the dose to twice daily unless there is documented inadequate trough blood pressure control on once-daily dosing. The evidence base consistently supports once-daily administration, and splitting doses unnecessarily complicates the regimen and may reduce adherence without improving efficacy 1, 2, 3.