Components:
Lercanidipin
Method of action:
Antihypertensive, Hypotensive
Available in countries
See all
close
Medically reviewed by Fedorchenko Olga Valeryevna, Pharmacy-Provisor Last updated on 2019.07.22

Name of the medicinal product

Pegfel

Qualitative and quantitative composition

Lercanidipin

Therapeutic indications

The information provided in Therapeutic indications of Pegfel is based on data of another medicine with exactly the same composition as the Pegfel of the medicine (Lercanidipin). Be careful and be sure to specify the information on the section Therapeutic indications in the instructions to the drug Pegfel directly from the package or from the pharmacist at the pharmacy.
more... close

Pegfel is indicated for the treatment of mild to moderate essential hypertension.

Dosage (Posology) and method of administration

The information provided in Dosage (Posology) and method of administration of Pegfel is based on data of another medicine with exactly the same composition as the Pegfel of the medicine (Lercanidipin). Be careful and be sure to specify the information on the section Dosage (Posology) and method of administration in the instructions to the drug Pegfel directly from the package or from the pharmacist at the pharmacy.
more... close

The recommended dosage is 10 mg orally once a day at least 15 minutes before meals; the dose may be increased to 20 mg depending on the individual patient's response.

Dose titration should be gradual, because it may take about 2 weeks before the maximal antihypertensive effect is apparent.

Some individuals, not adequately controlled on a single antihypertensive agent, may benefit from the addition of Pegfel to therapy with a beta-adrenoceptor blocking drug (atenolol), a diuretic (hydrochlorothiazide) or an angiotensin converting enzyme inhibitor (captopril or enalapril).

Since the dose-response curve is steep with a plateau at doses between 20-30 mg, it is unlikely that efficacy will be improved by higher doses; whereas side effects may increase.

Use in the elderly: although the pharmacokinetic data and clinical experience suggest that no adjustment of the daily dosage is required, special care should be exercised when initiating treatment in the elderly.

Use in children: since there is no clinical experience in patients under the age of 18 years, use in children is not currently recommended.

Use in renal or hepatic dysfunction: special care should be exercised when treatment is commenced in patients with mild to moderate renal or hepatic dysfunction. Although the usually recommended dose schedule may be tolerated by these subgroups, an increase in dose to 20 mg daily must be approached with caution. The antihypertensive effect may be enhanced in patients with hepatic impairment and consequently an adjustment of the dosage should be considered.

Pegfel is not recommended for use in patients with severe hepatic impairment or in patients with severe renal impairment (GFR < 30 ml/min).

Contraindications

The information provided in Contraindications of Pegfel is based on data of another medicine with exactly the same composition as the Pegfel of the medicine (Lercanidipin). Be careful and be sure to specify the information on the section Contraindications in the instructions to the drug Pegfel directly from the package or from the pharmacist at the pharmacy.
more... close

- Hypersensitivity to the active substance “lercanidipine“, to any dihydropyridine or to any of the excipients of the medicinal product.

- Pregnancy and lactation (see 4.6).

- Women of child-bearing potential unless effective contraception is used.

- Left ventricular outflow tract obstruction.

- Untreated congestive cardiac failure.

- Unstable angina pectoris.

- Severe renal or hepatic impairment.

- Within 1 month of a myocardial infarction.

- Co-administration with:

o strong inhibitors of CYP3A4 (see 4.5),

o cyclosporin (see 4.5),

o grapefruit juice (see 4.5).

Special warnings and precautions for use

The information provided in Special warnings and precautions for use of Pegfel is based on data of another medicine with exactly the same composition as the Pegfel of the medicine (Lercanidipin). Be careful and be sure to specify the information on the section Special warnings and precautions for use in the instructions to the drug Pegfel directly from the package or from the pharmacist at the pharmacy.
more... close

Special care should be exercised when Pegfel is used in patients with sick sinus syndrome (if a pacemaker is not in situ). Although hemodynamic controlled studies revealed no impairment of ventricular function, care is also required in patients with LV dysfunction. It has been suggested that some short-acting dihydropyridines may be associated with increased cardiovascular risk in patients with ischaemic heart disease. Although Pegfel is long-acting caution is required in such patients.

Some dihydropyridines may rarely lead to precordial pain or angina pectoris. Very rarely patients with pre-existing angina pectoris may experience increased frequency, duration or severity of these attacks. Isolated cases of myocardial infarction may be observed (see 4.8).

Use in renal or hepatic dysfunction: special care should be exercised when treatment is commenced in patients with mild to moderate renal or hepatic dysfunction. Although the usually recommended dose schedule may be tolerated by these subgroups, an increase in dose to 20 mg daily must be approached with caution. The antihypertensive effect may be enhanced in patients with hepatic impairment and consequently an adjustment of the dosage should be considered.

Pegfel is not recommended for use in patients with severe hepatic impairment or in patients with severe renal impairment (GFR < 30 ml/min) (see 4.2).

Alcohol should be avoided since it may potentiate the effect of vasodilating antihypertensive drugs (see 4.5).

Inducers of CYP3A4 like anticonvulsants (e.g. phenytoin, carbamazepine) and rifampicin may reduce lercanidipine's plasma levels and therefore the efficacy of lercanidipine may be less than expected (see 4.5).

1 tablet contains 30 mg lactose and therefore should not be administered to patients with Lapp lactase insufficiency, galactosaemia or glucose/galactose malabsorption syndrome.

Effects on ability to drive and use machines

The information provided in Effects on ability to drive and use machines of Pegfel is based on data of another medicine with exactly the same composition as the Pegfel of the medicine (Lercanidipin). Be careful and be sure to specify the information on the section Effects on ability to drive and use machines in the instructions to the drug Pegfel directly from the package or from the pharmacist at the pharmacy.
more... close

Clinical experience with lercanidipine indicates that it is unlikely to impair a patient's ability to drive or use machinery. However, caution should be exercised because dizziness, asthenia, fatigue and rarely somnolence may occur.

Undesirable effects

The information provided in Undesirable effects of Pegfel is based on data of another medicine with exactly the same composition as the Pegfel of the medicine (Lercanidipin). Be careful and be sure to specify the information on the section Undesirable effects in the instructions to the drug Pegfel directly from the package or from the pharmacist at the pharmacy.
more... close

About 1.8% of treated patients experienced adverse reactions.

The table below shows the incidence of adverse drug reactions, at least possibly causally related, grouped by MedDRA System Organ Class classification, and ranked by frequency (uncommon, rare).

As shown in the table, the most commonly occurring adverse drug reactions reported in controlled clinical trials are headache, dizziness, peripheral oedema, tachycardia, palpitations, flushing, each occurring in less than 1% of patients.

MedDRA System Organ Class

Frequency

Preferred Terms

Immune System Disorders

Very rare (<1/10,000)

hypersensitivity

Psychiatric Disorders

Rare (>1/10,000 <1/1000)

somnolence

Nervous System Disorders

Uncommon (>1/1000 <1/100)

headache; dizziness

Cardiac Disorders

Rare (>1/10,000 <1/1000)

Uncommon (>1/1000 <1/100)

angina pectoris

tachycardia; palpitations

Vascular Disorders

Uncommon (>1/1000 <1/100)

Very rare (<1/10,000)

flushing

syncope

Gastrointestinal Disorders

Rare (>1/10,000 <1/1000)

nausea; dyspepsia; diarrhoea; abdominal pain; vomiting

Skin and Subcutaneous Tissue Disorders

Rare (>1/10,000 <1/1000)

rash

Musculoskeletal, Connective Tissue and Bone Disorders

Rare (>1/10,000 <1/1000)

myalgia

Renal and Urinary Disorders

Rare (>1/10,000 <1/1000)

polyuria

General Disorders and Administration Site Conditions

Uncommon (>1/1000 <1/100)

Rare (>1/10,000 <1/1000)

oedema peripheral

asthenia; fatigue

In post-marketing experience, from spontaneous reports the following undesirable effects were reported very rarely (<1/10,000): gingival hypertrophy, reversible increases in serum levels of hepatic transaminases, hypotension, urinary frequency and chest pain.

Some dihydropyridines may rarely lead to precordial pain or angina pectoris. Very rarely patients with pre-existing angina pectoris may experience increased frequency, duration or severity of these attacks. Isolated cases of myocardial infarction may be observed.

Lercanidipine does not appear to influence adversely blood sugar or serum lipid levels.

Overdose

The information provided in Overdose of Pegfel is based on data of another medicine with exactly the same composition as the Pegfel of the medicine (Lercanidipin). Be careful and be sure to specify the information on the section Overdose in the instructions to the drug Pegfel directly from the package or from the pharmacist at the pharmacy.
more... close

In the post-marketing experience, three cases of overdose were reported (150 mg, 280 mg and 800 mg of lercanidipine, respectively, ingested in an attempt to commit suicide).

Dose level

Signs/Symptoms

Management

Outcome

150 mg

+

undefined amount of alcohol

Sleepiness

Gastric lavage

Active charcoal

Recovered

280 mg

+

5.6 mg moxonidine

Cardiogenic shock

Severe myocardial ischaemia

Mild renal failure

High-dose catecholamines

Furosemide

Digitalis

Parenteral plasma expanders

Recovered

800 mg

Emesis

Hypotention

Active charcoal

Cathartics

Dopamine i.v.

Recovered

As with other dihydropyridines, overdosage might be expected to cause excessive peripheral vasodilatation with marked hypotension and reflex tachycardia. In case of severe hypotension, bradycardia and unconsciousness, cardiovascular support could be helpful, with intravenous atropine for bradycardia.

In view of the prolonged pharmacological effect of lercanidipine, it is essential that the cardiovascular status of patients who take an overdose is monitored for 24 hours at least. There is no information on the value of dialysis. Since the drug is highly lipophilic, it is most probable that plasma levels are no guide to the duration of the period of risk and dialysis may not be effective.

Pharmacodynamic properties

The information provided in Pharmacodynamic properties of Pegfel is based on data of another medicine with exactly the same composition as the Pegfel of the medicine (Lercanidipin). Be careful and be sure to specify the information on the section Pharmacodynamic properties in the instructions to the drug Pegfel directly from the package or from the pharmacist at the pharmacy.
more... close

Pharmacotherapeutic group:

Selective calcium channel blockers with mainly vascular effects

ATC code: C08CA13

Lercanidipine is a calcium antagonist of the dihydropyridine group and inhibits the transmembrane influx of calcium into cardiac and smooth muscle. The mechanism of its antihypertensive action is due to a direct relaxant effect on vascular smooth muscle thus lowering total peripheral resistance. Despite its short pharmacokinetic plasma half-life, lercanidipine is endowed with a prolonged antihypertensive activity because of its high membrane partition coefficient, and is devoid of negative inotropic effects due to its high vascular selectivity.

Since the vasodilatation induced by Pegfel is gradual in onset, acute hypotension with reflex tachycardia has rarely been observed in hypertensive patients.

As for other asymmetric 1,4-dihydropyridines, the antihypertensive activity of lercanidipine is mainly due to its (S)-enantiomer.

In addition to the clinical studies conducted to support the therapeutic indications, a further small uncontrolled but randomised study of patients with severe hypertension (mean + SD diastolic blood pressure of 114.5 + 3.7 mmHg) showed that blood pressure was normalised in 40% of the 25 patients on 20 mg once daily dose and in 56% of 25 patients on 10 mg twice daily doses of Pegfel. In a double-blind, randomized, controlled study versus placebo in patients with isolated systolic hypertension Pegfel was efficacious in lowering systolic blood pressure from mean initial values of 172.6 + 5.6 mmHg to 140.2 + 8.7 mmHg.

Pharmacokinetic properties

The information provided in Pharmacokinetic properties of Pegfel is based on data of another medicine with exactly the same composition as the Pegfel of the medicine (Lercanidipin). Be careful and be sure to specify the information on the section Pharmacokinetic properties in the instructions to the drug Pegfel directly from the package or from the pharmacist at the pharmacy.
more... close

Pegfel is completely absorbed after 10-20 mg oral administration and peak plasma levels, 3.30 ng/ml + 2.09 s.d. and 7.66 ng/ml + 5.90 s.d. respectively, occur about 1.5-3 hours after dosing.

The two enantiomers of lercanidipine show a similar plasma level profile: the time to peak plasma concentration is the same, the peak plasma concentration and AUC are, on average, 1.2-fold higher for the (S) enantiomer and the elimination half-lives of the two enantiomers are essentially the same. No "in vivo" interconversion of enantiomers is observed.

Due to the high first pass metabolism, the absolute bioavailability of Pegfel orally administered to patients under fed conditions is around 10%, although it is reduced to 1/3 when administered to healthy volunteers under fasting conditions.

Oral availability of lercanidipine increases 4-fold when Pegfel is ingested up to 2 hours after a high fat meal. Accordingly, Pegfel should be taken before meals.

Distribution from plasma to tissues and organs is rapid and extensive.

The degree of serum protein binding of lercanidipine exceeds 98%. Since plasma protein levels are reduced in patients with severe renal or hepatic dysfunction, the free fraction of the drug may be increased.

Pegfel is extensively metabolised by CYP3A4; no parent drug is found in the urine or the faeces. It is predominantly converted to inactive metabolites and about 50% of the dose is excreted in the urine.

“In vitro” experiments with human liver microsomes have demonstrated that lercanidipine shows some degree of inhibition of CYP3A4 and CYP2D6, at concentrations 160- and 40-fold, respectively, higher than those reached at peak in the plasma after the dose of 20 mg.

Moreover, interaction studies in humans have shown that lercanidipine did not modify the plasma levels of midazolam, a typical substrate of CYP3A4, or of metoprolol, a typical substrate of CYP2D6. Therefore, inhibition of biotransformation of drugs metabolised by CYP3A4 and CYP2D6 by Pegfel is not expected at therapeutic doses.

Elimination occurs essentially by biotransformation.

A mean terminal elimination half life of 8-10 hours was calculated and the therapeutical activity lasts for 24 hours because of its high binding to lipid membrane. No accumulation was seen upon repeated administration.

Oral administration of Pegfel leads to plasma levels of lercanidipine not directly proportional to dosage (non-linear kinetics). After 10, 20 or 40 mg, peak plasma concentrations observed were in the ratio 1:3:8 and areas under plasma concentration-time curves in the ratio 1:4:18, suggesting a progressive saturation of first pass metabolism. Accordingly, availability increases with dosage elevation.

In elderly patients and in patients with mild to moderate renal dysfunction or mild to moderate hepatic impairment the pharmacokinetic behaviour of lercanidipine was shown to be similar to that observed in the general patient population; patients with severe renal dysfunction or dialysis-dependent patients showed higher levels (about 70%) of the drug. In patients with moderate to severe hepatic impairment, the systemic bioavailability of lercanidipine is likely to be increased since the drug is normally metabolised extensively in the liver.

Preclinical safety data

The information provided in Preclinical safety data of Pegfel is based on data of another medicine with exactly the same composition as the Pegfel of the medicine (Lercanidipin). Be careful and be sure to specify the information on the section Preclinical safety data in the instructions to the drug Pegfel directly from the package or from the pharmacist at the pharmacy.
more... close

Safety pharmacological studies in animals have shown no effects on the autonomic nervous system, the central nervous system or on gastrointestinal function at antihypertensive doses.

The relevant effects which have been observed in long-term studies in rats and dogs were related, directly or indirectly, to the known effects of high doses of Ca-antagonists, predominantly reflecting exaggerated pharmacodynamic activity.

Lercanidipine was not genotoxic and showed no evidence of carcinogenic hazard.

Fertility and general reproductive performance in rats were unaffected by treatment with lercanidipine.

There was no evidence of any teratogenic effect in rats and rabbits; however, in rats, lercanidipine at high dose levels induced pre- and post- implantation losses and delay in foetal development.

Lercanidipine hydrochloride, when administered at high dose (12 mg/kg/day) during labour, induced dystocia.

The distribution of lercanidipine and/or its metabolites in pregnant animals and their excretion in breast milk have not been investigated.

Metabolites have not been evaluated separately in toxicity studies.

Incompatibilities

The information provided in Incompatibilities of Pegfel is based on data of another medicine with exactly the same composition as the Pegfel of the medicine (Lercanidipin). Be careful and be sure to specify the information on the section Incompatibilities in the instructions to the drug Pegfel directly from the package or from the pharmacist at the pharmacy.
more... close

Not applicable.

Special precautions for disposal and other handling

The information provided in Special precautions for disposal and other handling of Pegfel is based on data of another medicine with exactly the same composition as the Pegfel of the medicine (Lercanidipin). Be careful and be sure to specify the information on the section Special precautions for disposal and other handling in the instructions to the drug Pegfel directly from the package or from the pharmacist at the pharmacy.
more... close

No special requirements.