Blood Pressure

[Ghoul]

Better decrease in BP compared to when you added the BB probably.

I'd also say if BP is not very high using those two meds, I'd start cautiously and only add 5mg of Cilnipidine (the minimum), and give it a couple of weeks to see how low it pushes you before increasing to the standard 10mg dose.

The additive effects of blocking epinephrine receptors with a Beta Blocker, while also lowering the release of epinephrine with the N channel calcium blocking of Cildipidine may be a potent combination that drops pressure a lot more than you'd expect from a small dose.

 

[aljowa]

One drug from each class, ACE/ARB are the same class, then there's CCBs, Beta Blockers, and Diuretics.

Ah, I gotcha. Thank you for the explanation.

 

[BamaCrazy]

Did you add the Cilnidipine later?

I am just curious what the effect of adding that one 10mg dose of Cilnidipine on top of the others was.

I am on an ARB and BB already. I am curious what to expect from adding the CCB.

I was only on 20mg Telmisartan. When I started this cycle my BP creeped up some and I cannot increase Telmisartan due to potassium issues. So I added 5mg Amlodipine. The edema was barely noticeable but I increased to 10mg and my hands swole up really bad. I dropped the Amlodipine and ordered Cilnidipine. While I waited I started taking 10mg Nebivolol in the mornings. Then I added 10mg Cilnidipine at night with my Telmisartan and after 2-3 weeks my BP is around 117/75. No side effects from any of them. Well, except the Nebivolol needs to be taken after I go to the gym in the morning. My HR was staying too low at the gym and I felt a little tired.

 

[Sampei]

I was only on 20mg Telmisartan. When I started this cycle my BP creeped up some and I cannot increase Telmisartan due to potassium issues. So I added 5mg Amlodipine. The edema was barely noticeable but I increased to 10mg and my hands swole up really bad. I dropped the Amlodipine and ordered Cilnidipine. While I waited I started taking 10mg Nebivolol in the mornings. Then I added 10mg Cilnidipine at night with my Telmisartan and after 2-3 weeks my BP is around 117/75. No side effects from any of them. Well, except the Nebivolol needs to be taken after I go to the gym in the morning. My HR was staying too low at the gym and I felt a little tired.

Decrease the nebivolol to 5mg. Past that it's not worth it and it starts becoming less cardio selective

 

[Ghoul]

In the category of good news/bad news (a little), Cildipidine, uniquely among CCBs, can also significantly lower insulin resistance. While problems of hypoglycemia are extremely rare, for those using GLPs, insulin, metformin etc it's something to be on the lookout for.

On the other hand, it seems increased insulin sensitivity has mostly positive effects for the metabolic health of the vast majority.

But here's worst case scenario from a hyper-responder in an unusual circumstance.

https://sciforschenonline.org/journals/clinical-case-studies/article-data/JCCS-3-178/JCCS-3-178.pdf

 

[malfeasance]

I was only on 20mg Telmisartan. . . . While I waited I started taking 10mg Nebivolol in the mornings. Then I added 10mg Cilnidipine at night with my Telmisartan and after 2-3 weeks my BP is around 117/75.

Did you take your blood pressure on telmisartan and nebivolol prior to adding the Cilnidipine?

I was trying to figure out the additive effect of this one drug to the other two.

 

[malfeasance]

Although Cilnipidine doesn't have nearly the same amount of research behind it (it still has hundreds of studies, just not thousands like Amlodipine), that largely comes down to its use being limited to Japan and South Korea.

It's been around for 30 years though, and there's not been a hint of any serious issues in that amount of time. Japan and South Korea have robust 1st world medical systems, so they would've caught any indication of major problems.

At least that's how I view it from a risk tolerance perspective. It's not a "new" drug, is really my point, we have data from decades of use.

Everything I have read online says not hundreds, less than 200 studies, and most of those are on animals.

I hear what you are saying about it being prescribed in some countries, but that is another thing mentioned online, that the number of patients is relatively small.

What I could not find is whether some drug company has even tried to get it approved in the US.

 

[Sampei]

Everything I have read online says not hundreds, less than 200 studies, and most of those are on animals.

I hear what you are saying about it being prescribed in some countries, but that is another thing mentioned online, that the number of patients is relatively small.

What I could not find is whether some drug company has even tried to get it approved in the US.

They never tried because patent is expired so no money to be made

 

[BamaCrazy]

Did you take your blood pressure on telmisartan and nebivolol prior to adding the Cilnidipine?

I was trying to figure out the additive effect of this one drug to the other two.

On Telmisartan and Nebivolol it was averaging around 123/80 to 127/82. On all 3 I’m now around 117/75 most days.

 

[Ghoul]

They never tried because patent is expired so no money to be made

Correct.

But since it's been found to be effective in treating Raynaud's (20% of adults have this, pain/numbness in fingers or toes, especially when exposed to cold), the company that developed it got special protection. from the FDA guaranteeing 7 years of exclusivity once it's fully approved.

Good news for the US and EU.

FDA grants orphan drug designation to calcium channel blocker for systemic sclerosis

The FDA has granted orphan drug designation to AISA-021, a fourth-generation calcium channel blocker, for the treatment of systemic sclerosis, according to a press release from Aisa Pharma.The drug is a form of cilnidipine, a dihydropyridine calcium channel blocker approved and used for the...

www.healio.com

Currently conducting clinical trials in phase 2 in Australia for Cildipidine combined with tadalafil also for treatment of Raynaud's. Moving on to US trials after this.

RECONNOITER Study Program – Aisa Pharma, Inc.

About the RECONNOITER Study Program (Randomized Evaluation of the benefit of Cilnidipine ON the Nature, Observational Indices, Temperature changes and overall Effect in scleroderma and Raynaud’s Disease) The RECONNOITER Study is a 76 patient prospective, double-blind, randomized Phase 2A trial...

aisapharma.com

The statement "long standing drug with a good safety profile" is commonly found in reference to Cildipidine.

There's a ton of data out there on humans, much of it from real world use via retrospective medical record reviews because this is a well established medicine that some patients have been using for decades.

 

[Ghoul]

On Telmisartan and Nebivolol it was averaging around 123/80 to 127/82. On all 3 I’m now around 117/75 most days.

Man those are excellent numbers. If you can tolerate that combo, statistically you've reduced your risk of many cardiovascular problems tremendously.

 

[BamaCrazy]

Man those are excellent numbers. If you can tolerate that combo, statistically you've reduced your risk of many cardiovascular problems tremendously.

That’s what I’m thinking. I am in a good place and the fact neither of the 3 give me any negative side effects is a huge bonus.

 

[Sampei]

Correct.

But since it's been found to be effective in treating Raynaud's (20% of adults have this, pain/numbness in fingers or toes, especially when exposed to cold), the company that developed it got special protection. from the FDA guaranteeing 7 years of exclusivity once it's fully approved.

Good news for the US and EU.

FDA grants orphan drug designation to calcium channel blocker for systemic sclerosis

The FDA has granted orphan drug designation to AISA-021, a fourth-generation calcium channel blocker, for the treatment of systemic sclerosis, according to a press release from Aisa Pharma.The drug is a form of cilnidipine, a dihydropyridine calcium channel blocker approved and used for the...

www.healio.com

Currently conducting clinical trials in phase 2 in Australia for Cildipidine combined with tadalafil also for treatment of Raynaud's. Moving on to US trials after this.

RECONNOITER Study Program – Aisa Pharma, Inc.

About the RECONNOITER Study Program (Randomized Evaluation of the benefit of Cilnidipine ON the Nature, Observational Indices, Temperature changes and overall Effect in scleroderma and Raynaud’s Disease) The RECONNOITER Study is a 76 patient prospective, double-blind, randomized Phase 2A trial...

aisapharma.com

The statement "long standing drug with a good safety profile" is commonly found in reference to Cildipidine.

There's a ton of data out there on humans, much of it from real world use via retrospective medical record reviews because this is a well established medicine that some patients have been using for decades.

With the luck I have they approve it only in USA and not EU

 

[Ghoul]

PCT24 offering Telm/Cild 40/10 combo now. ($1.30/10)

In aluminum/aluminum blister packs, shelf life is at least 3 years for those who are figuring out how much they can keep on hand,

 

[Ghoul]

With the luck I have they approve it only in USA and not EU

They keep traveling to Milan to announce updates so maybe you have hope. Or maybe they just like going there with company money

 

[BigNewb]

Timely info as this cycle, despite all the usual risk factor reduction (don't smoke, don't drink, clean diet, limited sodium , plenty of fish, etc, no rec drugs, run + z2/3 cardio several times per week) has my BP abit higher than preferred.
Presently with pharma 40mg Telemarstin I sit around 137/79 to 132/85 with 10mg pharma tadalafil ED as well.
I'd like a bit lower but probably need to go UGL or alternate route as my GP has the Telemarstin as acute but don't want to get too much on insurance or diagnosis. I also don't think going to 80mg tel would be best route.
Would love some specific feedback on what or where to go next. My other sources don't carry anything mentioned here.

 

[Ghoul]

Timely info as this cycle, despite all the usual risk factor reduction (don't smoke, don't drink, clean diet, limited sodium , plenty of fish, etc, no rec drugs, run + z2/3 cardio several times per week) has my BP abit higher than preferred.
Presently with pharma 40mg Telemarstin I sit around 137/79 to 132/85 with 10mg pharma tadalafil ED as well.
I'd like a bit lower but probably need to go UGL or alternate route as my GP has the Telemarstin as acute but don't want to get too much on insurance or diagnosis. I also don't think going to 80mg tel would be best route.
Would love some specific feedback on what or where to go next. My other sources don't carry anything mentioned here.

Which country are you in?

 

[BigNewb]

Which country are you in?

US

 

[Ghoul]

US

You'd be better off, and the most current clinical guidance (supported by extremely strong evidence ), by leaving Telm at 40 and adding a low dose calcium channel blocker.

From what I understand insurance bases your risk, once you have documented hypertension, on how well controlled it is, not the meds you're taking for it.

With those numbers, your doc should be perfectly willing to add 5mg Amlodipine (which most people tolerate just fine), and you can even ask for a single pill combo with both.

You want to be as close to or just below 120/70 as you can get.

If you want to self treat, you can get 5mg Amlodipine, or better imo as we've been discussing 10mg Cildipidine (equivalent to 5mg Amlodipine) from the PCT vendors here very inexpensively. Under $35 for a year's supply.

They also offer Telm/amlodipine or Telm/cildipidine single pill combos,

 

[aljowa]

PCT24 offering Telm/Cild 40/10 combo now. ($1.30/10)

In aluminum/aluminum blister packs, shelf life is at least 3 years for those who are figuring out how much they can keep on hand,

Thanks a lot for putting this information out there. Good stuff. Positive vibes.