Nicardipine

General

• Type: Calcium Channel Blocker, dihydropyridine
• Dosage Forms: Capsule, Infusion solution, Injectable solution
• Common Trade Names: Cardene

Adult Dosing

Hypertension

• PO: 20-40mg q8hr, or 30-60mg (extended release) q12hr
• IV: 5mg/hr by slow infusion (50ml/hr), titrate to maximum of 30mg/hr, then maintenance of 2.0 - 15.5mg/hr
• IV bolus dose of 2mg, then continuous infusion achieves same control of hypertension as starting infusion without bolus

Intracranial hemorrhage

• Start at 5mg/hr
  • Increase q5min by 2.5mg until the target blood pressure is achieved
  • Then, immediately titrate down to maintenance infusion of 3mg/hr

Chronic Stable Angina

• 20-40mg PO q8hr
• Allow 3 days between dose increase

Pediatric Dosing

Hypertension

• 0.5-3 mcg/kg/min IV
• Not approved by FDA; limited date available

Special Populations

• Pregnancy Rating: Category C
• Lactation: Unknown wether drug is excreted in breast milk; avoid use
• Renal Dosing
  • Adult
    • PO: 20 mg TID (immediate release) or 30 mg BID (sustained release) with slow titration
    • IV: not defined, slow titration
  • Pediatric
    • IV: not defined, slow titration
• Hepatic Dosing
  • Adult
    • PO: 20 mg BID (immediate release) with slow titration
    • IV: not defined, slow titration
  • Pediatric
    • IV: not defined, slow titration

Contraindications

• Allergy to class/drug

Adverse Reactions

Serious

• Headache (IV, 15%)

Common

• Flushing
• Peripheral Edema
• Pedal Edema
• Hypotension
• Exacerbation of angina

Pharmacology

• Half-life: 2-4 hr
• Metabolism: Metabolized in liver b CYP3A4 (first pass)
• Excretion: urine (60%), feces (35%)
• Mechanism of Action:
  • inhibits trasmembrane influx of extracellular calcium ions across membranes of myocardial cells and vascular smooth muscle cells without changing serum calcium concentrations; this inhibit cardiac and vascular smooth muscle contractions, thereby dilating maincoronary and systemic arteries.

Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

Indication	Dose	Context	Route	Population
Hypertensive emergency	5-15 mg/hr	1st line antihypertensive	IV drip	Adult
Intracranial hemorrhage (main)	5-15 mg/hr IV, titrate by 2.5 mg q5min	BP control in ICH	IV drip	Adult
Nontraumatic thoracic aortic dissection	5mg/hr, titrate by 2.5mg/hr q10min	Blood pressure control (vasodilator) after beta-blockade	IV	Adult
Stroke (main)	5-15 mg/hr IV, titrate by 2.5 mg/hr q5-15 min	BP control in acute stroke	IV drip	Adult
Traumatic intracerebral hemorrhage	5-15 mg/hr IV, titrate by 2.5 mg q5min	BP control in ICH	IV drip	Adult

See Also

• Subarachnoid hemorrhage
• Hemorrhagic stroke
• Hypertensive emergency
• Clevidipine

References

Nicardipine: Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.