Cilnidipine

Cilnidipine
Clinical data
Trade names	Atelec (アテレック), Cilaheart, Cilacar
AHFS/Drugs.com	International Drug Names
ATC code	C08CA14 (WHO) ;
Identifiers
	IUPAC name 3-(E)-3-Phenyl-2-propenyl 5-2-methoxyethyl 2,6-dimethyl-4-(m-nitrophenyl)-1,4-dihydropyridine-3,5-dicarboxylate;
CAS Number	132203-70-4;
PubChem CID	5282138;
IUPHAR/BPS	7767;
ChemSpider	4445338;
UNII	97T5AZ1JIP;
KEGG	D01173;
CompTox Dashboard (EPA)	DTXSID0046309 ;
ECHA InfoCard	100.162.338
Chemical and physical data
Formula	C27H28N2O7
Molar mass	492.528 g·mol−1
3D model (JSmol)	Interactive image;
	SMILES O=C(OCCOC)\C2=C(\N/C(=C(/C(=O)OC\C=C\c1ccccc1)C2c3cccc([N+]([O-])=O)c3)C)C;

Cilnidipine is a calcium channel blocker. Cilnidipine is approved for use in Japan, China, India, Nepal, and Korea for hypertension.

It is a calcium antagonist accompanied with L-type and N-type calcium channel blocking functions. Unlike other calcium antagonists, cilnidipine can act on the N-type calcium channel in addition to acting on the L-type calcium channel.

It was patented in 1984 and approved for medical use in 1995. Cilnidipine is currently being repurposed and developed for use in patients with Raynaud's Phenomenon and Systemic Sclerosis by Aisa Pharma, a US biopharma development company.^[1]

Medical uses

Cilnidipine decreases blood pressure and is used to treat hypertension and its comorbidities. Due to its blocking action at the N-type and L-type calcium channel, cilnidipine dilates both arterioles and venules, reducing the pressure in the capillary bed. Cilnidipine is vasoselective and has a weak direct dromotropic effect, a strong vasodepressor effect, and an arrhythmia-inhibiting effect. Blood pressure control with cilnidipine treatment in Japanese post-stroke hypertensive patients [The CA-ATTEND study] - the results of a large-scale prospective post-marketing surveillance study of post-stroke hypertensive patients (n = 2667, male 60.4%, 69.0 ± 10.9 years) treated with cilnidipine indicate that cilnidipine was effective in treating uncontrolled blood pressure and was well tolerated in post-stroke hypertensive patients.^[2] The Ambulatory Blood Pressure Control and Home Blood Pressure (Morning and Evening) Lowering By N-Channel Blocker Cilnidipine (ACHIEVE-ONE) trial is a large-scale (n=2319) clinical study on blood pressure (BP) and pulse rate (PR) in the real world with use of cilnidipine - this study revealed that Cilnidipine significantly reduced BP and PR in hypertensive patients at the clinic and at home, especially with higher BP and PR in the morning. Cilnidipine is currently being studied in the RECONNOITER study in Australia for its effect on Raynaud's and other manifestations of disease in patients with Systemic Sclerosis. ^[3]^[4]

Side effects

The side effects could be severe dizziness, fast heartbeat, and swelling of face, lips, tongue, eyelids, hands and feet. Lesser side effects include stomach pain, diarrhea and hypotension.

Peripheral edema, a common side effect from the use of amlodipine, was reduced when patients were shifted to cilnidipine.^[5]