Felodipine (Plendil) is a calcium channel blocker like amlodipine and nicardipine that primarily acts on the vascular smooth muscles. It is used in the treatment of patients with hypertension.

Felodipine Uses:

• Hypertension:

  • Management of hypertension

• Off Label Use of Felodipine in Adults:

  • Chronic stable angina
  • Management of angina

Felodipine (Plendil) Dose in Adults

Felodipine (Plendil) Dose as an alternative agent in the treatment of chronic stable angina (off-label):

Note: A beta-blocker is the preferred therapy; a calcium channel blocker (typically a dihydropyridine [eg, felodipine]) may be added if symptoms are uncontrolled on beta-blockers or as an alternative therapy if there are contraindications or side effects with beta-blockers.

• Oral: Initial: 5 to 10 mg once daily;
• if started at 5 mg, increase the dose to 10 mg once daily according to tolerance, after 2 to 4 weeks.

Felodipine (Plendil) Dose in the treatment of Hypertension:

Note: For initial treatment in patients with blood pressure ≥20/10 mm Hg above goal, use in combination (eg, ACE inhibitor, ARB, or thiazide diuretic).

• Oral: Initial: 2.5 to 5 mg once daily;
• Titrate the dose every 1 to 2 weeks as required based on patient response;
• The usual dose range: 2.5 to 10 mg once daily.

Felodipine (Plendil) Dose in Childrens

Felodipine (Plendil) Dose in the treatment of Hypertension:

• Children ≥6 years and Adolescents:

  • Oral: Initial: 2.5 mg once daily;
  • The dose may be increased as needed at 2-week intervals to a maximum daily dose:
    • 10 mg/day as tolerated after 2 to 4 weeks.

Pregnancy Risk Factor "C"

• It is possible for adverse events to occur in the mother, infant and fetus. It is not recommended during pregnancy.
• You can also use other agents during pregnancy.

Felodipine use during breastfeeding:

• Potential harm to the infant
• Before starting therapy during lactation, assess the risks and benefits.

Dose in Kidney Disease:

No dose adjustment needed

Dose in Liver disease:

Initial: 2.5 mg once daily; monitor blood pressure closely during titration.

Common Side Effects of Felodipine (Plendil):

• Cardiovascular:

  • Peripheral edema

• Central nervous system:

  • Headache

Less Common Side Effects of Felodipine (Plendil):

• Cardiovascular:

  • Flushing
  • Tachycardia

• Other Side effects:

  • Gingival hyperplasia
  • Rash
  • Upper respiratory tract infection

Contraindications to Felodipine (Plendil):

• Hypersensitivity to felodipine and any component of the formulation
• Women with reproductive potential
• Pregnancy
• Breastfeeding

Warnings and precautions

• Angina/MI

  • Reflex tachycardia can occur, which may cause angina or MI in patients with obstructive heart disease.

• Hypotension/syncope

  • Rarely, symptoms of hypotension can develop with or without syncope.

• Peripheral edema

• Peripheral edema is the most common side effect (dose-dependent).

• Aortic stenosis

  • It reduces coronary perfusion, which can lead to ischemia.

• Heart failure:

  • Do not use calcium channel blockers to treat heart disease according to ACC/AHA guidelines.

• Hepatic impairment

  • Hepatic dysfunction: Dose adjustment required.

• Hypertrophic cardiomyopathy with outflow tract obstruction (HCM)

  • Patients with HCM or outflow tract obstruction may experience a decrease in afterload, which can worsen their symptoms.

Felodipine: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• Blood pressure,
• heart rate

Hypertension:

• The 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults:

Confirmed hypertension and known CVD or 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥10%:

• Target blood pressure <130/80 mm Hg

Confirmed hypertension without markers of increased ASCVD risk:

• Target blood pressure <130/80 mm Hg may be reasonable.

Diabetes and hypertension: The American Diabetes Association (ADA) guidelines:

• Patients 18 to 65 years of age, without ASCVD, and 10-year ASCVD risk <15%:
  • Target blood pressure <140/90 mm Hg is recommended.
• Patients 18 to 65 years of age and known ASCVD or 10-year ASCVD risk >15%:
  • Target blood pressure <130/80 mm Hg if it can be safely achieved.
• Patients >65 years of age (healthy or complex/intermediate health):
  • Target blood pressure <140/90 mm Hg is advised.
• Patients >65 years of age (very complex/poor health):
  • Target blood pressure <150/90 mm Hg is advised.

How to administer Felodipine (Plendil)?

• Oral: Swallow tablet whole do not chew or cut.
• Take an empty stomach or with a low-fat low carb meal.

Mechanism of action of Felodipine (Plendil):

• Felodipine blocks the influx extracellular Ca ions across myocardial and vascular smooth muscles cell membranes.
• This prevents cardiac & vasospastic patients from contracting their smooth muscle.

The onset of action:

• Antihypertensive: 2 to 5 hours
• Duration of antihypertensive effect: 24 hours

Absorption:

• 100%;
• Absolute: 20% due to the first-pass effect

Protein binding:

• >99%

Metabolism:

• Hepatic; CYP3A4 substrate (major); extensive first-pass effect

Half-life elimination:

• Immediate-release: 11 to 16 hours

Time to peak:

• 2.5 to 5 hours

Excretion:

• Urine (70% as metabolites);
• feces 10%

International Brand Names of Felodipine:

• APO-Felodipine
• Plendil
• SANDOZ Felodipine
• AGON SR
• Dilahex
• Dilofen ER
• Dilopin
• Fedil
• Fedil SR
• Felo ER
• Feloblock
• Felocor
• Felocor Retardtab
• Felodil ER
• Felodil XR
• Felodip
• Felodur ER
• Felogamma Retard
• Felogard
• Felogard-ER
• Felopine 5
• Felopine-SR
• Felostad 5 Retard
• Feloten
• Felpin
• Felpin E.R.
• Feltor
• Flodil LP
• Hidipine
• Hydac
• Keliping
• Keydipin ER
• Lodil
• Lodipin ER
• Lodistad MR
• Mibeplen
• Modip
• Munobal
• Munobal Retard
• Nirmadil
• Penedil
• Perfudal
• Phenodical
• Plendil
• Plendil Depottab
• Plendil ER
• Plendil PR
• Plendil Retard
• Plentopine
• Polo
• Presid
• Preslow
• Renedil
• Splendil
• Splendil ER
• Stapin ER
• Topidil
• Vascalpha
• Vaspine ER
• Versant XR

Felodipine Brand Names in Pakistan: