The Efficacy and Safety of Cilnidipine on Mild to Moderate Essential Hypertension: A Systematic Review and Meta-analysis of Randomized Controlled Trials in Chinese Patients

Xu, Guoliang; Wu, Haidi; Du, Bing; Qin, Ling

doi:10.2174/187152912801823165

Cited by 8 publications

(15 citation statements)

References 5 publications

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“…The mechanism by which amlodipine lowers the blood pressure includes, reduction in peripheral resistance thereby leading to vasodilation. Previous studies show that amlodipine is a racemic mixture of (R) and (S) isomers; S isomer has more pharmacologic effect than the R isomers [2]. Nausea, abdominal pain, headache, vomiting, constipation, dizziness, dry mouth, gingival hypertrophy, heartburn, photosensitivity, insomnia, light headedness, palpitation, ECG abnormalities, chest pain, hypersensitivity reaction, frequent urination and elevated liver enzyme are the most commonly occurring adverse effect with amlodipine [3].…”

Section: Discussionmentioning

confidence: 99%

Amlodipine Induced Severe Pedal Edema: A Case Report from a Tertiary Care Hospital

Sanghavi¹,

Someshwari²,

Ganesan³

et al. 2017

J Pharmacovigil

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Amlodipine is a fourth generation dihydropyridine derivative calcium channel blocker, mainly used in the treatment of hypertension, angina and certain other cardiac disorders. It is an L-type Ca2+ channel blocker, which leads to inhibitory action on the sympathetic N-type Ca2+ channels. The oral bioavailability of amlodipine is between 64% and 90%. The longer duration of action of amlodipine is due to a combination of high bioavailability, slow clearance and long half-life where by plasma concentration of the drug is above minimum effective concentration for a long time and show sustained efficacy. The most frequently occurring adverse effect with amlodipine therapy includes palpitation, flushing, ankle edema, hypotension, headache and nausea. PedaPl edema is a common adverse effect of calcium channel blocker (Amlodipine, Nifedipine, Diltiazem, Felodpine, Isradipine). We report a patient who developed pitting type pedal edema after treating with amlodipine for hypertension.Keywords: Amlodipine; Glimepride; Pedal edema Case DescriptionA 43 yrs old male patient was admitted to general medicine ward with complaints of swelling of the legs. On further interviewing, he was a known case of diabetes mellitus, under oral hypoglycemic agent of glimepride 2 mg and metformin 500 mg for past 1 yr. Before 3 months the patient was also diagnosed with hypertension and was under irregular medication.By examining the vital sign, blood pressure was found to be 160/90 mmHg, pulse rate 78 beats per minute and all other laboratory investigations such as complete blood count, liver function test urine analysis, chest X ray, electrocardiograph seems to be normal. The diabetic profile shows Random blood glucose -262 mg/dl, HbA1C-7%. From the subjective, laboratory examination and past history of the patient he was diagnosed with type II diabetes mellitus and hypertension. The patient was treated with glimepride 2 mg, metformin 500 mg and amlodipine 2.5 mg orally once daily. On the 4th day after initiation of amlodipine therapy, the patient was presented with pedal edema (pitting type). The physician interprets that the pedal edema was caused by amlodipine. On cessation of amlodipine the patient was recovered from edema and an alternative anti-hypertensive agent, telmisartan 40 mg and hydrochlorothiazide 12.5 mg once daily was prescribed.

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Section: Discussionmentioning

confidence: 99%

Amlodipine Induced Severe Pedal Edema: A Case Report from a Tertiary Care Hospital

Sanghavi¹,

Someshwari²,

Ganesan³

et al. 2017

J Pharmacovigil

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“…A recent meta-analysis on the efficacy and safety of cilnidipine has demonstrated good tolerability and an antihypertensive efficacy equivalent to amlodipine. [15] There is however, no available data on the tolerability of cilnidipine in patients with amlodipine-induced edema. This study was, therefore, planned to determine whether cilnidipine therapy can produce resolution of amlodipine-induced edema while maintaining adequate control of blood pressure.…”

Section: Introductionmentioning

confidence: 99%

Excellent tolerance to cilnidipine in hypertensives with amlodipine - induced edema

et al. 2013

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Background:Ankle edema is a common adverse effect of amlodipine, an L-type calcium channel blocker (CCB). Cilnidipine is a newer L/N-type CCB, approved for treatment of essential hypertension.Aim:This study was designed to determine whether cilnidipine can produce resolution of amlodipine-induced edema while maintaining adequate control of hypertension.Materials and Methods:A prospective study was performed on 27 patients with essential hypertension with amlodipine-induced edema. Concomitant nephropathy, cardiac failure, hepatic cirrhosis, or other causes of edema, and secondary hypertension were excluded by appropriate tests. Amlodipine therapy was substituted in all the cases with an efficacy-equivalent dose of cilnidipine. Clinical assessment of ankle edema and measurement of bilateral ankle circumference, body weight, blood pressure, and pulse rate were performed at onset of the study and after 4 weeks of cilnidipine therapy.Results:At completion of the study, edema had resolved in all the patients. There was a significant decrease in bilateral ankle circumference and body weight (P < 0.001). There was no significant change in mean arterial blood pressure and pulse rate.Conclusions:Therapy with cilnidipine resulted in complete resolution of amlodipine-induced edema in all the cases without significant worsening of hypertension or tachycardia. Cilnidipine is an acceptable alternative antihypertensive for patients with amlodipine-induced edema.

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“…There is an emerging trend to use dual N and L-type calcium channel blockers as it has been proposed that its use has a less possibility of the RAS. 5 Cilnidipine, a third-generation combined L/N-type CCB, is approved for the treatment of essential hypertension. 6 Moreover, it has also been proposed to provide with an action profile that goes beyond the antihypertensive effect like lowering the incidence of untoward side effects like ankle edema.…”

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confidence: 99%

A Comparative study to assess the effectiveness and safety of cilnidipine versus amlodipine in patients with newly diagnosed essential hypertension: insights from a single centre prospective observational study

Yethadka

Jayanthi

Raveendra

et al. 2017

Int J Basic Clin Pharmacol

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Background: Calcium channel blockers (CCBs) are proposed to play a pivotal role for the management and control of hypertension. Dihydropyridine-type calcium channel blockers (CCBs) like Amlodipine are frequently used because for their strong antihypertensive and minimal adverse side effects. However, it is commonly associated with the causation of pedal edema among the patients. Cilnidipine, which is a novel new generation calcium channel blocker, is presumed to cause lesser pedal edema with a satisfactory clinical control of hypertension along with negligible side effects. This study was carried out to compare clinical effectiveness and safety profile between Amlodipine and Cilnidipine.Methods: A prospective, randomized, open label study of 12 weeks’ duration was conducted amongst 60 patients with newly diagnosed essential hypertension. 30 patients of one group received Tab. Amlodipine 5 mg and 30 patients of same age groups received Tab. Cilnidipine 10mg.Results: There was a highly statistically significant decrease in the level of blood pressure in the Cilnidipine group compared to the Amlodipine group mainly at day 90 (P<0.001). Cilnidipine treated group had a fall in blood pressure of 23 ± 8 mmHg and the Amlodipine group had a decrease in the blood pressure of 12±7mmHg. Additionally, there was also significant reduction in pulse rate in the cilnidipine group. Only 4 patients in the Cilnidipine group developed ankle edema which completely disappeared at the end of 12 weeks of therapy compared to 9 patients in the Amlodipine group which persistently worsened at the completion of the study.Conclusions: Our study concluded that cilnidipine was a well-tolerated anti-hypertensive drug amongst patients with newly diagnosed essential hypertension and associated with minor adverse effects.

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The Efficacy and Safety of Cilnidipine on Mild to Moderate Essential Hypertension: A Systematic Review and Meta-analysis of Randomized Controlled Trials in Chinese Patients

Cited by 8 publications

References 5 publications

Amlodipine Induced Severe Pedal Edema: A Case Report from a Tertiary Care Hospital

Amlodipine Induced Severe Pedal Edema: A Case Report from a Tertiary Care Hospital

Excellent tolerance to cilnidipine in hypertensives with amlodipine - induced edema

A Comparative study to assess the effectiveness and safety of cilnidipine versus amlodipine in patients with newly diagnosed essential hypertension: insights from a single centre prospective observational study

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