Lacidipine (
Caldine,
Lacimen,
Lacipil, Midotens,
Motens) is a once-daily, orally-administered, lipophilic
dihydropyridine calcium antagonist with an intrinsically slow onset of activity, resulting in a lack of reflex
tachycardia. It has a long duration of action and a high degree of vascular selectivity. In addition to
calcium channel-modulated vasodilation,
lacidipine displays
antioxidant activity greater than that of other
dihydropyridine calcium antagonists. In randomised, well-controlled trials,
lacidipine 2-6 mg orally once daily had
antihypertensive efficacy similar to that of other long-acting
dihydropyridine calcium antagonists,
thiazide diuretics,
atenolol (a beta-blocker) and
enalapril (an
ACE inhibitor).
Lacidipine was effective in elderly patients (including those with
isolated systolic hypertension), African Nigerian patients and patients with concurrent
type 2 diabetes mellitus. During long-term treatment for 4 or 5 years in patients with
isolated systolic hypertension or
essential hypertension, the incidence of cardiovascular events and mortality with
lacidipine was similar to that with
chlorthalidone or
atenolol. The European
Lacidipine Study on
Atherosclerosis (ELSA), in which 2334 patients with
hypertension were randomised to 4 years of
therapy with
lacidipine 4-6 mg/day or the beta-blocker
atenolol 50-100 mg/day, demonstrated significantly lower atherosclerotic progression and plaque formation with
lacidipine compared with
atenolol in patients completing the full 4 years of the study. Between-group differences in favour of
lacidipine for the primary efficacy variable (mean change in carotid artery intima-media thickness) did not reach statistical significance in the intent-to-treat population. The tolerability profile of
lacidipine (
headache,
flushing, pedal oedema,
dizziness and palpitations) is similar to that of other
dihydropyridine calcium antagonists, but with a lower incidence of peripheral oedema. Data from the ELSA study suggest that the incidence of serious adverse events during long-term
lacidipine therapy is similar to that with
atenolol.
CONCLUSION:
Lacidipine is an effective, well tolerated, once-daily, oral
antihypertensive agent that can be used in a wide variety of patients. As with other members of its class,
lacidipine has shown potentially beneficial antiatherosclerotic effects, although definitive data with respect to possible superiority over other
drug classes are still required. Therefore,
lacidipine is an attractive
therapy for the long-term management of
essential hypertension.