A rational, synergistic, and potent fixed-dose combination (FDC) antihypertensive therapy. It combines a unique dual L/N-type calcium channel blocker (Cilnidipine) with a long-acting, highly selective angiotensin II receptor blocker (Telmisartan). This combination provides superior 24-hour blood pressure control, reduces peripheral edema associated with dihydropyridines, and offers potential metabolic benefits, including PPAR-γ modulation. It is a first-line therapy for essential hypertension, especially in patients with high cardiovascular risk, diabetes, or metabolic syndrome.
Adult: One tablet (Cilnidipine 10mg + Telmisartan 40mg) once daily, preferably in the morning. Dose may be titrated to a maximum of Cilnidipine 20mg + Telmisartan 80mg per day based on response, typically as two tablets of the 10/40 strength or a higher strength formulation.
Note: Swallow the tablet whole with a glass of water, with or without food. Consistency in timing (preferably morning) is advised. Do not crush or chew. It may be taken with food to improve tolerability and enhance Telmisartan absorption.
The combination exerts a complementary and synergistic blockade of two major pressor systems: the Renin-Angiotensin-Aldosterone System (RAAS) and voltage-gated calcium channels. Cilnidipine blocks L-type channels on vascular smooth muscle causing vasodilation, and N-type channels on sympathetic nerve terminals, inhibiting norepinephrine release and reducing sympathetic drive. Telmisartan selectively and insurmountably blocks the AT1 receptor, preventing the vasoconstrictor, aldosterone-secreting, and proliferative effects of angiotensin II. This dual action leads to potent arterial vasodilation, reduced peripheral resistance, and decreased cardiac afterload.
Pregnancy: CONTRANDICATED in second and third trimester (Pregnancy Category D). Drug exposure during these trimesters can cause injury and death to the developing fetus (oligohydramnios, renal failure, hypoplastic skull, hypotension). Discontinue as soon as pregnancy is detected. First trimester use should be avoided unless no alternative exists.
Driving: May cause dizziness, lightheadedness, or fatigue, especially during initiation of therapy. Patients should be cautioned about operating machinery or driving until they know how the medication affects them.
| Other Antihypertensives (Diuretics, Beta-blockers, ACEIs) | Additive hypotensive effect; risk of severe hypotension. | Major |
| Potassium-sparing diuretics (Spironolactone, Amiloride), Potassium supplements | Increased risk of hyperkalemia. | Major |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | May reduce antihypertensive effect and increase risk of renal impairment and hyperkalemia. | Major |
| Lithium | Increased serum lithium levels and toxicity. | Major |
| Digoxin | Cilnidipine may increase digoxin plasma concentration; monitor levels. | Moderate |
| Strong CYP3A4 Inhibitors (Ketoconazole, Itraconazole, Clarithromycin, Ritonavir) | May increase Cilnidipine plasma levels, increasing risk of adverse effects. | Moderate |
| Strong CYP3A4 Inducers (Rifampicin, Phenytoin, Carbamazepine) | May decrease Cilnidipine plasma levels, reducing efficacy. | Moderate |
| Aliskiren | Increased risk of hyperkalemia, hypotension, and renal impairment; contraindicated in diabetes/renal impairment. | Major |
Same composition (Cilnidipine (10mg) + Telmisartan (40mg)), different brands: