Lercanidipine can simultaneously be used with β-adrenoblockers, diuretics, angiotensin-converting enzyme (ACE inhibitors) inhibitors.
When used simultaneously with metoprolol, the bioavailability of lercanidipine is reduced by 50%. This effect can occur and with simultaneous use with other β-blockers, so dose adjustment may be required lercanidipine to achieve a therapeutic effect with this combination. Lercanidipine metabolized with the participation of isoenzyme CYP3A4, so the inhibitors and inducers of this isoenzyme, with simultaneous application, can influence the metabolism and excretion of lercanidipine. The simultaneous use of lercanidipine with inhibitors is not recommended CYP3A4 (ketoconazole, itraconazole, ritonavir, erythromycin, troleandomycin) (see section "Contraindications").
It is not recommended simultaneous use of cyclosporine and lercanidipine, as there is an increase in the concentration of both substances in the blood plasma (see section "Contraindications").
Care should be taken when lercanidipine is used together with other substrates CYP3A4 (terfenadine, astemizole, antiarrhythmic drugs of the III class, for example, amiodarone, quinidine).
With the simultaneous use of lercanidipine at a dose of 20 mg with midazolam, the bioavailability of lercanidipine in elderly patients may increase by approximately 40%. Lercanidipine should be administered with caution at the same time as inductors CYP3A4, for example, anticonvulsants (phenytoin, carbamazepine) and rifampicinbecause it is possible to reduce the antihypertensive action of the drug. Regular monitoring of blood pressure is necessary.
With the simultaneous use of lercanidipine in a dose of 20 mg in patients who constantly take beta-methyl-digoxin, no pharmacokinetic interaction was observed, while as in healthy volunteers who were treated digoxin, an increase in the value of FROMmax (maximum concentration in blood plasma) for digoxin on average by 33% after taking 20 mg of lercanidipine on an empty stomach, while AUC (the area under the curve is "concentration-time") and renal clearance changed insignificantly. It is necessary to monitor the presence of signs of intoxication with digoxin in patients taking both digoxin and lercanidipine.
Simultaneous use of lercanidipine with cimetidine (up to 800 mg) does not cause significant changes in the concentration of lercanidipine in blood plasma. At high doses of cimetidine, the bioavailability and antihypertensive effects of lercanidipine may increase.
With the simultaneous use of lercanidipine (20 mg) and simvastatin (40 mg), the value AUC for simvastatin increased by 56%, and the same value for its active metabolite - β-hydroxy acid by 28%. When taking drugs at different times of the day (lercanidipine - In the morning, simvastatin - in the evening) you can avoid unwanted interaction.
With the simultaneous use of 20 mg lercanidipine and warfarin in healthy volunteers, there was no change in the pharmacokinetics of warfarin. Simultaneous use with fluoxetine (inhibitor CYP2D6 and CYP3A4) in elderly patients did not have clinically significant changes in the pharmacokinetics of lercanidipine.
It is possible to intensify antihypertensive action while simultaneously taking the juice of grapefruit and lercanidipine (see section "Contraindications"). Ethanol can potentiate the antihypertensive effect of lercanidipine.