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|
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.
- National Heart Foundation of Australia. Guide to management of hypertension 2008. Quick reference guide for health professionals. 2008. http://www.heartfoundation.org.au/document
- Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd, 2008.
- Solvay Pharmaceuticals. Zan-Extra product information. 31 January 2008.