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Nicardipine

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Nicardipine, Cardene

  • See Also
  1. Hypertensive Emergency
  2. Intravenous Antihypertensive
  3. Dihydropyridine Calcium Channel Blocker
  4. Clevidipine
  • Indications
  1. First-line management of Hypertensive Emergency (Hypertensive Crisis)
    1. Preferred over Labetalol, Nitroglycerin Drip, and Nitroprusside
    2. Use Esmolol in Hypertensive Crisis if Heart Rate control is needed (e.g. AAA or Aortic Dissection)
    3. Clevidipine, if available, is preferred over Nicardipine due to its shorter half life
  2. Other Indications (oral, rare chronic use)
    1. Hypertension
    2. Angina
  • Contraindications
  1. Severe Aortic Stenosis
  • Mechanism
  1. Second Generation Dihydropyridine Calcium Channel Blocker
  2. Similar activity to Nifedipine
  3. Pure arterial vasodilation
  4. Decreases Blood Pressure
  5. Does not effect Heart Rate or Preload
  1. Start: 5 mg/hour
  2. Maximum: 15 mg/hour
  3. Titrate
    1. Increase by 2.5 mg/hour every 5-15 minutes until Blood Pressure goal reached or maximum reached (15 mg/hour)
    2. Once goal Blood Pressure achieved, titrate down towards 3 mg/hour as long as Blood Pressure is controlled
    3. Exercise caution when titrating dose in renal Impairment
  4. Transitioning from IV Nicardipine to oral agents
    1. Administer oral Antihypertensive 1 hour after discontinuing IV infusion
  1. Not FDA approved for use in children
  2. Start 0.5 mcg/kg/min IV
  3. Maximum: 3 mcg/kg/min IV
  1. Start 20 mg orally three times daily
  2. Target 20 to 40 mg orally three times daily
  3. Maximum: 120 mg/day
  4. Transitioning from oral Nicardipine to temporary IV Nicardipine
    1. IV Dose 0.5 mg/hour if using Nicardipine 20 mg orally every 8 hours
    2. IV Dose 1.2 mg/hour if using Nicardipine 30 mg orally every 8 hours
    3. IV Dose 2.2 mg/hour if using Nicardipine 40 mg orally every 8 hours
  • Adverse Effects
  1. See Calcium Channel Blocker
  • Safety
  1. Pregnancy Category C
  2. Unknown safety in Lactation
  • Drug Interactions
  1. Nicardipine increases levels of other agents
    1. Cyclosporine
    2. Tacrolimus
  2. Other agents raise Nicardipine levels
    1. Cimetidine
  • Pharmacokinetics
  1. Well absorbed orally
  2. Hepatic metabolism
  3. Plasma Half-Life: 15 minutes (some references report 30-40 minutes)
    1. Nicardipine's clinical effects resolve within 30 min (range 15 to 90 min) of stopping infusion
    2. Contrast with the much shorter half life with Clevidipine
  • Metabolism
  1. Reduce dose in significant renal or liver Impairment
  • Resources
  1. Nicardipine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=76fcb7e0-9034-4fcd-be14-ce7e9ccaee2a
  • References
  1. Orman and Weingart in Majoewsky (2012) EM:RAP 12(2): 6-7
  2. (2022) Presc Lett, Resource #381108, Comparison of Calcium Channel Blockers
  3. (2020) Med Lett Drugs Ther 62(1598): 73-80
  4. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 70-1
  5. Hamilton (2020) Tarascon Pocket Pharmacopoeia