Calcium channel blockers, dihydropyridine
Brand names: Manidipino Cinfa, Manyper
Updated · Methodology
First line
Stage 1–2 hypertension. Starting dose 10 mg once daily in the morning; up-titrate to 20 mg after 2–4 weeks. More effective in combination with an ACE inhibitor or ARB – Spanish SEH-LELHA 2022 recommends combination therapy from the start for BP >=160/100 or high-risk patients. Not validated for post-MI protection or heart failure (unlike ACE inhibitors).
Sources
ICD-10: I10 · ICD-11: BA00
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Manidipine is a dihydropyridine calcium channel blocker. It is prescribed for hypertension (AEMPS Ficha Técnica, SEH-LELHA). In anti-aging regimens, manidipine is marketed as a mild long-acting CCB for healthy normotensives with promises of vessel protection from aging. In people with normal blood pressure, no clinical studies of prophylactic use exist. The drug can cause ankle edema, dizziness, tachycardia, and flushing. Manidipine is not approved by the . If manidipine was prescribed to a person with normal blood pressure, consider seeking a second opinion.
A dihydropyridine L-type calcium channel blocker with high arteriolar selectivity. 24-hour duration via long half-life (4–9 hours) and slow receptor dissociation. Compared with amlodipine, manidipine causes fewer peripheral edema – a known advantage in Spanish practice where manidipine (Chiesi's Artedil) is widely used in amlodipine-edema-intolerant patients. Metabolized by hepatic CYP3A4.
AEMPS summary of product characteristics (section 4.6): there is no clinical experience and there are no clinical data on manidipine use in pregnant women, and animal studies of embryo-fetal development are insufficient. Other dihydropyridines have been teratogenic in animals and the potential risk in humans is unknown, so for safety reasons manidipine should not be given during pregnancy.
No milk excretion data. Not recommended during lactation – prefer nifedipine or verapamil.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Grapefruit juice slows the metabolism of dihydropyridines, so manidipine becomes more bioavailable and lowers blood pressure more. The Artedil SmPC says manidipine should not be taken together with grapefruit juice. Excess shows as dizziness on standing, palpitations, flushing and ankle swelling.
Source: AEMPS: Ficha técnica de Artedil 10 mg comprimidos (manidipino) (2024)
Verbatim lines from the interaction sections, in the language of the label
«Como sucede con otras dihidropiridinas bloqueadoras del canal del calcio, es probable que el metabolismo de manidipino sea catalizado por el citocromo P450 3A4. No se poseen estudios de interacción…»AEMPS, section 4.5 · Open on CIMA
«Como sucede con otras dihidropiridinas bloqueadoras del canal del calcio, es probable que el metabolismo de manidipino sea catalizado por el citocromo P450 3A4. No se poseen estudios de interacción…»AEMPS, section 4.5 · Open on CIMA
«Como sucede con otras dihidropiridinas bloqueadoras del canal del calcio, es probable que el metabolismo de manidipino sea catalizado por el citocromo P450 3A4. No se poseen estudios de interacción…»AEMPS, section 4.5 · Open on CIMA
«Como sucede con otras dihidropiridinas bloqueadoras del canal del calcio, es probable que el metabolismo de manidipino sea catalizado por el citocromo P450 3A4. No se poseen estudios de interacción…»AEMPS, section 4.5 · Open on CIMA
«Como sucede con otras dihidropiridinas bloqueadoras del canal del calcio, es probable que el metabolismo de manidipino sea catalizado por el citocromo P450 3A4. No se poseen estudios de interacción…»AEMPS, section 4.5 · Open on CIMA
«Como sucede con otras dihidropiridinas bloqueadoras del canal del calcio, es probable que el metabolismo de manidipino sea catalizado por el citocromo P450 3A4. No se poseen estudios de interacción…»AEMPS, section 4.5 · Open on CIMA
«Como sucede con otras dihidropiridinas bloqueadoras del canal del calcio, es probable que el metabolismo de manidipino sea catalizado por el citocromo P450 3A4. No se poseen estudios de interacción…»AEMPS, section 4.5 · Open on CIMA
«Como sucede con otras dihidropiridinas bloqueadoras del canal del calcio, es probable que el metabolismo de manidipino sea catalizado por el citocromo P450 3A4. No se poseen estudios de interacción…»AEMPS, section 4.5 · Open on CIMA
«Como sucede con otras dihidropiridinas bloqueadoras del canal del calcio, es probable que el metabolismo de manidipino sea catalizado por el citocromo P450 3A4. No se poseen estudios de interacción…»AEMPS, section 4.5 · Open on CIMA
«Como sucede con otras dihidropiridinas bloqueadoras del canal del calcio, es probable que el metabolismo de manidipino sea catalizado por el citocromo P450 3A4. No se poseen estudios de interacción…»AEMPS, section 4.5 · Open on CIMA
«Como sucede con otras dihidropiridinas bloqueadoras del canal del calcio, es probable que el metabolismo de manidipino sea catalizado por el citocromo P450 3A4. No se poseen estudios de interacción…»AEMPS, section 4.5 · Open on CIMA
«Como sucede con otras dihidropiridinas bloqueadoras del canal del calcio, es probable que el metabolismo de manidipino sea catalizado por el citocromo P450 3A4. No se poseen estudios de interacción…»AEMPS, section 4.5 · Open on CIMA
«El efecto antihipertensivo de manidipino puede potenciarse al ser administrado conjuntamente con diuréticos, beta-bloqueantes y, en general, con otros fármacos antihipertensivos.»AEMPS, section 4.5 · Open on CIMA
«El efecto antihipertensivo de manidipino puede potenciarse al ser administrado conjuntamente con diuréticos, beta-bloqueantes y, en general, con otros fármacos antihipertensivos.»AEMPS, section 4.5 · Open on CIMA
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Manidipine is evaluated for the following indications with varying evidence strength: Hypertension (evidence tier A), Anti-aging and longevity (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Manidipine (≥ 1 in 100): Headache, Flushing, Palpitations, Peripheral edema (less than amlodipine), Fatigue. See the Safety section for uncommon and serious reactions.
AEMPS summary of product characteristics (section 4.6): there is no clinical experience and there are no clinical data on manidipine use in pregnant women, and animal studies of embryo-fetal development are insufficient. Other dihydropyridines have been teratogenic in animals and the potential risk in humans is unknown, so for safety reasons manidipine should not be given during pregnancy.
No milk excretion data. Not recommended during lactation – prefer nifedipine or verapamil.
Manidipine is contraindicated in: Manidipine or DHP hypersensitivity; Cardiogenic shock; Unstable angina; Severe heart failure NYHA III-IV; Severe hepatic impairment. Full list in the Safety section.
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