Lexxel for Hypertension
Although 14 million Americans are now being treated for hypertension, some estimates indicate that approximately 3 million remain poorly controlled. For some of these, the options for treatment have now expanded with the introduction of Lexxel, a combination antihypertensive agent that consists of an outer layer of enalapril maleate surrounding a core that consists of an extended-release formulation of felodipine.
How It Works
The two components of Lexxel perform complementary actions. Enalapril is a pro-drug that is activated to the angiotensin-converting enzyme (ACE) inhibitor, enalaprilat. This pro-drug inhibits the conversion of angiotensin I to angiotensin II and exerts an antihypertensive effect by suppressing the renin-angiotensin-aldosterone system. Felodipine is a calcium channel blocker that reduces blood pressure, primarily by affecting peripheral vascular resistance.
Lexxel: Clinical Tips
Lexxel is indicated for the treatment of hypertension; however, this fixed- drug combination is not indicated for the initial therapy of persons with high blood pressure. Patients who have been treated with either component of the drug as monotherapy and who may benefit from the combination are candidates for this new therapy. The tablet should not be chewed or broken and should be swallowed whole.
Lexxel is generally well tolerated; precautions that apply to other ACE inhibitors (ie, do not use during the 2nd or 3rd trimester of pregnancy; use of the drug may cause angioedema or agranulocytosis) also apply to this product. Because many of the side effects are dose dependent, they can be minimized by starting Lexxel therapy only after a patient has failed to achieve the desired effect with the use of one or the other component as monotherapy. The peak concentration of felodipine is nearly doubled when the drug is taken with food that is high in fat content; however, the AUC remains unaffected. The usual starting dose is one tablet taken daily; the recommended maximum is two tablets per day. Patients who do not respond to this dosage may benefit from the addition of a diuretic to the regimen.
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