Cilnidipine + ARBs

Cilnidipine + ARBsHypertensionOverall prevalence of HT in india 29.8%One-tenth of rural and one-fifth of urban Indian hypertensive population have their BP under controlJournal of Hypertension 2014, 32:117011772Cilnidipine + ARBBrand NameATELEC (Cilnidipine 10 mg)ATEDIO (Clinidipine 10 mg + Valsartan 80 mg)Latest Development PhaseCilnidipine approved in Japan in 1995FDC approved in Japan in May 2014DCGI approvalCilnidipine approved in 2007FDC Not approvedIndications for the treatment of mild to moderate hypertension

ATEDIOClinidipine 10 mg + Valsartan 80 mgApproved for HT (Should not be used for the first-line treatment of hypertension)Cilnidipine + ARBDeveloperJointly developed byFuji Viscera Pharmaceutical Company, Japan andAjinomoto, JapanClinicaltrial.gov: 8 resultsCTRI: No resultsPubmed Hits: 207 hitsPatent in IndiaNo record foundCilnidipineDistinct 4th generation CCBAlso blocks N-type Ca+2 channels in addition to L-type Ca+2 channelsInhibition of sympathetic system activationPleotropic effectsImproves TG levels in diabeticsInhibits platelet activation

Cilnidipine advantages over CCBsAttenuates NE release from sympathetic nervous system less reflex tachycardia

Inhibit renal sympathetic nerve activity efferent arteriolar vasodilation protects the glomeruli through the attenuation of glomerular hypertension

Cilnidipine advantages over CCBsPedal edema less frequentShown to cause resolution of pedal edema in patients switching from amlodipine to cilnidipine

Cilnidipine advantages over CCBsAnti-proteinuric effect greater then amlodipineAs effective as ACE inhibitor for control of proteinuria

Urinary protein/creatinine ratio(mg/g) - Percentage change from baseline

Cilnidipine advantages over CCBsBetter 24-hr BP control with significant restoration of abnormal nocturnal dippingCilnidipine advantages over CCBsSwitching from L type CCB to clinidipine decreases proteinuria and improves renal function (Kyoto Cilnidipine Study) in patients with HT and CKD receiving RAS inhibitors

Cilnidipine CombinationNo studies found where cilnidipine is studied alone vs combination with ACE inhibitors

Among combination with ARBs; studies are available for valsartan combination [both efficacy studies and PK/PD interaction studies]

Available brandsCINOD-T (Ajanta)Cilnidipine 5/10/20 mg + Telmisartan 40 mgTRICINOD (Ajanta)Cilnidipine 5/10 mg + Telmisartan 40 mg + Chlorthalidone 6.25 mgCilnipar T (Wockhardt Ltd)Cilnidipine 10 mg + Telmisartan 40 mgCetanil T (Alembic)Cilnidipine 10 mg + Telmisartan 40 mg

Available brandsNexovas O McLoedscilnidipine 10 mg, olmesartan medoxomil 20 mgcilnidipine 10 mg, olmesartan medoxomil 40 mgTRINEXOVAS McLoedscilnidipine 10 mg, olmesartan 20 mg, chlortalidone 12.5 mgcilnidipine 10 mg, olmesartan 40 mg, chlortalidone 12.5 mgMedical recommendationYesCilnidipine 10 mg + Valsartan 80 mg

Medical recommendationYesCilnidipine 5/10/20 mg + Telmisartan 40 mg