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