Lercanidipine with enalapril (Zan-Extra) fixed-dose combination tablets PBS listed for hypertension Lercanidipine with enalapril (Zan-Extra) fixed-dose combination tablets PBS listed for hypertension

A fixed-dose combination preparation of lercanidipine with enalapril (Zan-Extra) was PBS listed on 1 May 2008 as a restricted benefit. It may be prescribed on the PBS for hypertension inadequately controlled by either lercanidipine or enalapril alone. Fixed-dose combinations can reduce out-of-pocket costs for patients, and people may find them more convenient to use. However, they are not suitable for all patients.

The National Heart Foundation hypertension guidelines recommend that patients are stabilised with two single-ingredient preparations before switching to an equivalent fixed-dose combination (see table below).¹ Stable response to a particular antihypertensive regimen takes at least 3–4 weeks.¹

Note that the fixed-dose combination of lercanidipine with enalapril is not available in the recommended starting dose of enalapril 5 mg daily; 2.5 mg daily for some patients, including elderly people and those with impaired renal function² and that the film-coated tablets cannot be split or divided.

Be aware that while the manufacturer states that patients whose blood pressure is not adequately controlled on enalapril 20 mg daily as monotherapy can change directly to the 10 mg / 20 mg fixed-dose tablet³, this does not allow titrating to a higher dose of either drug.

	Single-ingredient preparations		Fixed-dose combination preparation
Active ingredient	lercanidipine	enalapril	lercanidipine with enalapril
Brand names	Zanidip	various	Zan-Extra
Doses available		5 mg	not available
	10 mg	10 mg	10 mg / 10 mg
		20 mg	10 mg / 20 mg
	20 mg		not available

Ensure that patients stop taking their single-ingredient preparations of enalapril and/or lercanidipine when they switch — the brand name does not clearly indicate that this is a combination preparation.

References

1. National Heart Foundation of Australia. Guide to management of hypertension 2008. Quick reference guide for health professionals. 2008. http://www.heartfoundation.org.au/document/NHF/Hypertension_Management_QRG_2008_FINAL.pdf (accessed 30 June 2008).
2. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2008.
3. Solvay Pharmaceuticals. Zan-Extra product information. 31 January 2008.