Amlodipine has been the gold standard among calcium channel blockers for many years.“Clinidipine and azelnidipine are the recent fourth generation calcium blockers which have been found to reduce heart rate effectively,” says Dr. JPS Sawhney in an interview with Dr. Rishi Jain “The added advantage of cilnidipine over amlodipine is that by blocking the N type of channels it prevents the action of norepinephrine not only in the blood vessels, but also in the cardiac tissues and renal vasculature. Side effect like headache and pedal edema commonly observed in amlodipine are also absent.” “Azelnidipine is being used in Japan, but it is still under trials and is expected to arrive in the market soon.”“Due to lack of data on these new agents, it is difficult to match amlodipine’s proven rate of reduction in cardiovascular events. But once extensive trials are conducted, they can become the drug of choice in future.”

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Complete Transcript:

Dr. Rishi Jain Sir you have a very interesting talk in this meeting. It is on a newer calcium channel blocker. Amlodipine has been the gold standard in the calcium channel and has been there for X number of years. So what is exciting happening in this phase which are the new molecules which are coming now.
Dr. JPS Sawhney Yes you are right, the amlodipine has been gold standard and now we are having fourth generation calcium blocker available. One is cilnidipine which is already available to us in the clinical practice and another molecule is azelnidipine which is going to come to our country soon.The clinical trials have been going on at the moment and it is developed in Japan and it is used in Japan also.
Dr. Rishi Jain Sir what are the extra advantages or benefits which cilnidipine offers to the patients?
Dr. JPS Sawhney The amlodipine acts only on the L type of calcium channel, it blocks the L type of calcium channels, so it mainly effects on the cardiac tissue as well as the blood vessels there by it causes vascular dilation and reduction in blood pressure. Where as the cilnidipine has an added advantage, it is not only the L type of calcium channel blocker it has got additional action on the N type of calcium channels which are present in the periphery of the neurons which they stimulate to release the norepinephrines, so by blocking the N type of channels it prevents the action of norepinephrine not only in the blood vessels, but the cardiac issues and also in the renal vasculature,so that is the added advantage of this drug.So because of this, it reduces the glomerular pressures and reduces the proteinuria. Since it is acting on the norepinephrine release functions, there is a reduction in heart rate also in these patients.
Dr. Rishi Jain What about azelnidipine sir, how does it differ from amlodipine?
Dr. JPS Sawhney Azelnidipine is the trials which are going on at the moment and also being used in Japan. The small number of studies like aorta and aorta II study has confirmed that this drug is as effective rather slightly more effective than amlodipine, but at the same it has a distant advantage that it prevents the reflex tachycardia. The heart rate reduction has been seen in this group. But we do not have any at the moment hard cardiovascular endpoint data available with this new molecule.
Dr. Rishi Jain Sir are you excited about these new molecules, will it help you in your practice?
Dr. JPS Sawhney Yes, I am quite exited, because particularly with the uses and we are using now the cilnidipine for almost a couple of years. We found that this drug has added advantage that it is as effective as amlodipine, but at the same time it reduces the heart rate and also it reduces proteinuria. It is more renoprotective. Thirdly, it has a distant advantage it is little more safe. The side effect profile is better than that of amlodipine.It reduces the pedal edema and headache as the side effect which is commonly observed with amlodipine.So there is definitely a role of this new group of drug particularly in patients those who are having hypertension with CKD or those patients those who are on amlodipine and having side effects of headache and pedal edema where we can replace them with cilnidipine which is as effect.Only problem is at the moment that we do not have any large clinical trial supporting the reduction in cardiovascular events which is there with amlodipine in large number of patients. More than 50,000 patients have been studied with amlodipine and shown reduction in cardiovascular events.
Dr. Rishi Jain Lately, do you foresee that they will ever replace amlodipine?
Dr. JPS Sawhney Well, at the moment, it is very difficult to answer this question. It is good question, but what we see the efficacy part, the safety part has been seemed to be certainly proven that is as effective at the same time more safer and more renoprotective than amlodipine. So I can see if you have a large number of data because there is some data available with cilnidipine in the Kato study and Kyoto study where they have found it is more renoprotective. Large cardiovascular endpoint data is not yet available, but in future the trials are going on and if we found that the drug is equally effective, more safer and also reduces the cardiovascular events then probably this fourth generation of calcium channel blockers may be a drug of choice in future.
Dr. Rishi Jain Thanks a lot sir, thanks for joining us and it looks exciting, so let us wait for them to show more results in clinical practice.
Dr. JPS Sawhney Thank you very much.

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