Plendil (felodipine) is a calcium channel blocker medication specifically designed for the management of hypertension and certain forms of chronic stable angina. As a second-generation dihydropyridine, it offers a favorable hemodynamic profile, selectively targeting vascular smooth muscle with minimal effect on cardiac contractility. Its extended-release formulation ensures 24-hour therapeutic coverage, supporting consistent blood pressure reduction and improved cardiovascular outcomes. Clinicians value Plendil for its well-established efficacy, tolerability, and role within comprehensive antihypertensive regimens.

Features

• Active ingredient: Felodipine (5 mg or 10 mg extended-release tablets)
• Pharmacological class: Dihydropyridine calcium channel blocker
• Mechanism: Selective inhibition of calcium influx into vascular smooth muscle
• Formulation: Extended-release (ER) gastro-resistant tablets
• Half-life: Approximately 24 hours in plasma
• Bioavailability: ~15% (increased with high-fat meals)
• Metabolism: Hepatic, via CYP3A4 isoenzyme
• Excretion: Primarily renal (70%) and fecal (10%)

Benefits

• Provides smooth, sustained 24-hour blood pressure control with once-daily dosing
• Reduces peripheral vascular resistance without significantly affecting cardiac output
• Demonstrates proven efficacy in lowering both systolic and diastolic blood pressure
• May be used as monotherapy or in combination with other antihypertensive agents
• Shows minimal negative inotropic effects compared to non-dihydropyridine calcium channel blockers
• Supports long-term cardiovascular risk reduction when used as part of a treatment plan

Common use

Plendil is primarily indicated for the management of essential hypertension in adults. It may be used as initial monotherapy or as part of combination therapy when additional blood pressure control is required. Additionally, Plendil is approved for the management of chronic stable angina pectoris in patients who remain symptomatic despite adequate doses of beta-blockers and/or organic nitrates, or who cannot tolerate these agents. Clinical studies have demonstrated its effectiveness across various patient demographics, including elderly populations, though dose adjustments may be necessary based on individual response and tolerability.

Dosage and direction

The recommended initial dosage for hypertension is 5 mg once daily, which may be increased to 10 mg once daily based on therapeutic response and tolerability. For angina, the starting dose is typically 5 mg once daily, with titration to 10 mg once daily if needed. Dosage adjustments should generally occur at intervals of not less than 2 weeks. Tablets should be swallowed whole with a glass of water, without crushing, chewing, or dividing. Administration with a light meal is recommended to minimize the potential for variable absorption, though consistent timing relative to meals is advised once a pattern is established. Elderly patients or those with hepatic impairment may require lower starting doses (2.5 mg daily) with careful titration.

Precautions

Patients should be monitored for peripheral edema, which is dose-related and more common in elderly patients. Blood pressure and heart rate should be regularly assessed, particularly during dose titration. Use with caution in patients with heart failure or significantly impaired cardiac function due to potential negative inotropic effects, though these are less pronounced with dihydropyridines. Hepatic impairment requires dosage adjustment and careful monitoring as felodipine is extensively metabolized by the liver. Patients should avoid grapefruit juice as it may significantly increase felodipine bioavailability. Abrupt withdrawal should be avoided as it may lead to rebound hypertension or angina exacerbation.

Contraindications

Plendil is contraindicated in patients with known hypersensitivity to felodipine or any component of the formulation. It should not be used in patients with severe hypotension (systolic pressure <90 mmHg) or cardiogenic shock. The medication is contraindicated in patients with unstable angina or acute myocardial infarction, particularly when used as the sole therapeutic agent. Concomitant use with strong CYP3A4 inhibitors such as ketoconazole, itraconazole, ritonavir, or clarithromycin is contraindicated due to the risk of significantly increased felodipine concentrations.

Possible side effect

Common adverse reactions (≥2%) include peripheral edema (dose-dependent), headache, flushing, dizziness, and fatigue. Less frequently reported effects include palpitations, nausea, dyspepsia, constipation, muscle cramps, and gingival hyperplasia (typically with prolonged use). Serious but rare side effects include symptomatic hypotension, syncope, myocardial infarction, arrhythmias, and significant allergic reactions including angioedema. Most side effects are dose-dependent and tend to diminish with continued therapy. Peripheral edema, while common, is typically localized and not associated with fluid retention or weight gain.

Drug interaction

Plendil interacts significantly with CYP3A4 inhibitors (macrolide antibiotics, antifungal agents, HIV protease inhibitors, nefazodone) which may increase felodipine concentrations. Concurrent use with beta-blockers may potentiate hypotension and requires careful monitoring. Additive hypotensive effects may occur with other antihypertensive agents, nitrates, phosphodiesterase-5 inhibitors, and alcohol. Felodipine may increase serum levels of carbamazepine, theophylline, and cyclosporine. Grapefruit juice should be avoided as it may increase felodipine bioavailability by up to 200%. CYP3A4 inducers (rifampin, phenobarbital, phenytoin, St. John’s wort) may decrease felodipine efficacy.

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. If it is near the time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed one. Consistent daily administration at approximately the same time is recommended to maintain stable plasma concentrations. Setting reminders or using pill organizers may help improve adherence, particularly given the extended-release nature of the formulation.

Overdose

Felodipine overdose may manifest as pronounced hypotension, reflex tachycardia, bradycardia (in some cases), and shock. Other potential effects include confusion, drowsiness, nausea, and reduced urinary output. Management should include cardiovascular monitoring, elevation of lower extremities, and administration of intravenous fluids. Calcium gluconate (10%) intravenous administration may be considered to counteract calcium channel blockade. Vasopressors such as dopamine or norepinephrine may be required for refractory hypotension. Given the extended-release formulation, gastric lavage may be considered if presentation is early, though activated charcoal may be more effective. Hemodialysis is not effective due to high protein binding.

Storage

Store at controlled room temperature (20-25°C or 68-77°F) with excursions permitted between 15-30°C (59-86°F). Protect from light and moisture. Keep in the original container with the lid tightly closed. Do not transfer tablets to other containers. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Proper disposal of unused medication should follow local regulations, typically through medication take-back programs or by mixing with undesirable substance before disposal in household trash.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Individual patient responses to Plendil may vary based on numerous factors including age, renal/hepatic function, concomitant medications, and underlying medical conditions. Healthcare providers should exercise clinical judgment when prescribing, considering individual patient characteristics and current treatment guidelines. Patients should not initiate, discontinue, or modify therapy without consulting their healthcare provider. Full prescribing information including boxed warnings should be reviewed before administration.

Reviews

Clinical trials have consistently demonstrated Plendil’s efficacy in blood pressure reduction, with mean reductions of 10-15 mmHg systolic and 8-10 mmHg diastolic at the 10 mg dose. The medication generally receives positive evaluations from clinicians for its predictable pharmacokinetics and favorable side effect profile compared to earlier calcium channel blockers. Patient satisfaction surveys indicate good tolerability, though peripheral edema remains a notable concern requiring management in some cases. Long-term outcome studies show consistent antihypertensive effects maintained over treatment periods exceeding one year. Real-world evidence supports its position as a valuable option within treatment algorithms for hypertension management.