Cilnidipine

Cilnidipine is a calcium channel blocker (dual l/n-type, antihypertensive) medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

• High blood pressure (hypertension) — alone or combined with other antihypertensives
• Patients who developed ankle swelling on amlodipine — a common reason doctors switch to cilnidipine
• Hypertension with protein in the urine or early kidney disease — its N-type channel action may help reduce proteinuria

Cilnidipine is generally well tolerated, with less ankle swelling than older calcium channel blockers. Possible side effects include:

• Headache, dizziness or light-headedness
• Flushing or warmth in the face
• Palpitations (less common than with amlodipine)
• Mild ankle or foot swelling (much less frequent than amlodipine)
• Nausea, abdominal discomfort, fatigue
• Uncommon but important: very low blood pressure with faintness, or fast irregular heartbeat — contact your doctor

• Check your blood pressure regularly and keep all follow-up appointments.
• Rise slowly from sitting or lying to avoid dizziness, especially in the first weeks.
• Tell your doctor if you have liver disease, kidney disease, heart failure or severe narrowing of a heart valve (aortic stenosis).
• Avoid grapefruit juice in large amounts — it can raise the level of this group of medicines.
• Avoid driving or operating machinery until you know how the medicine affects you.
• Limit alcohol, which can exaggerate the pressure-lowering effect.
• Continue lifestyle measures: less salt, regular walking, weight control and no smoking.

• Other blood pressure medicines and diuretics: additive effect — pressure may fall too low
• Beta-blockers (metoprolol, bisoprolol): often combined safely, but watch for excessive pressure drop or slow pulse
• Strong CYP3A4 inhibitors (ketoconazole, itraconazole, clarithromycin): can raise cilnidipine levels
• CYP3A4 inducers (rifampicin, carbamazepine, phenytoin): can reduce its effect
• Grapefruit juice: may increase drug levels
• NSAID painkillers: can blunt the blood-pressure-lowering effect
• Cimetidine: may raise calcium channel blocker levels

Tell your doctor about all medicines, supplements and herbal products you use.

• Allergy to cilnidipine or other dihydropyridine calcium channel blockers
• Cardiogenic shock or severe low blood pressure
• Severe aortic stenosis
• Unstable angina or within the first weeks after an acute heart attack, unless a specialist advises
• Pregnancy and breastfeeding (safety not established)

Pregnancy: Cilnidipine is not recommended during pregnancy, as adequate human safety data are not available. If you become pregnant or plan to conceive while taking it, tell your doctor immediately — better-studied blood pressure medicines are available for pregnancy.

Lactation: It is not known how much cilnidipine passes into breast milk, so it is generally avoided during breastfeeding. Your doctor can switch you to an alternative with an established safety record in nursing mothers.

Store below 30°C in a cool, dry place, protected from light and moisture. Keep the tablets in the original blister pack until use, and keep out of the reach of children. Do not use after the expiry date.