Enalapril and Felodipine

Pronunciation

(e NAL a pril & fe LOE di peen)

U.S. Brand Names

Lexxel®

Synonyms

Felodipine and Enalapril

Generic Available

No

Canadian Brand Names

Lexxel®

Use

Treatment of hypertension, however, not indicated for initial treatment of hypertension; replacement therapy in patients receiving separate dosage forms (for patient convenience); when monotherapy with one component fails to achieve desired antihypertensive effect, or when dose-limiting adverse effects limit upward titration of monotherapy

Pregnancy Risk Factor

C/D (2nd and 3rd trimesters)

Pregnancy Implications

Refer to Enalapril monograph.

Lactation

Enters breast milk/use caution

Adverse Reactions

See individual agents.

Drug Interactions

Enalapril: Substrate of CYP3A4 (major)

Felodipine: Substrate of CYP3A4 (major); Inhibits CYP2C8/9 (weak), 2D6 (weak), 3A4 (weak)

Also see individual agents.

Mechanism of Action

See individual agents.

Pharmacodynamics/Kinetics

See individual agents.

Dosage

Adults: Oral: 1 tablet daily

Patient Education

See individual agents. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.

Cardiovascular Considerations

Combination therapy for the treatment of hypertension should be individualized for each patient. Potential advantages for enalapril and felodipine combination therapy may include improved compliance and synergistic reductions in blood pressure with an accompanied reduction in side effects. ACE inhibitors are standard therapy for left ventricular systolic dysfunction. Felodipine has neutral effects on mortality in this setting and therefore may be considered for the treatment of hypertension or angina in patients with heart failure.

Dental Health: Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Gingival hyperplasia (fewer reports with felodipine than with other CCBs); resolves upon discontinuation (consultation with physician is suggested).

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

May cause drowsiness and dizziness; rarely may cause nervousness, insomnia, confusion, or depression

Mental Health: Effects on Psychiatric Treatment

May rarely cause agranulocytosis; use caution with clozapine and carbamazepine; may decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels; carbamazepine may decrease felodipine effect

Dosage Forms

Tablet, extended release:

Enalapril maleate 5 mg and felodipine 2.5 mg

Enalapril maleate 5 mg and felodipine 5 mg

References

Chobanian AV, Bakris GL, Black HR, et al, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report,"JAMA, 2003, 289(19):2560-71.

"Consensus Recommendations for the Management of Chronic Heart Failure. On Behalf of the Membership of the Advisory Council to Improve Outcomes Nationwide in Heart Failure,"Am J Cardiol, 1999, 83(2A):1A-38A.

Kaplan NM and Sever PS, "Combination Therapy: A Key to Comprehensive Patient Care,"Am J Hypertens, 1997, 10(7 Pt 2):127S.

Moser M and Black HR, "The Role of Combination Therapy in the Treatment of Hypertension,"Am J Hypertens, 1998, 11(6 Pt 2):73S-8S, 95S-100S.

International Brand Names

Lexxel® (CA)