Nicardipine

Aka: Nicardipine, Cardene

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II. 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)
  2. Other Indications (oral, rare chronic use)
    1. Hypertension
    2. Angina

III. Contraindications

  1. Severe Aortic Stenosis

IV. 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

V. Dosing: Adults with Hypertensive Emergency

  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

VI. Dosing: Children with Hypertensive Emergency

  1. Not FDA approved for use in children
  2. Start 0.5 mcg/kg/min IV
  3. Maximum: 3 mcg/kg/min IV

VII. Dosing: Oral for Hypertension or Angina

  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

VIII. Adverse Effects

  1. See Calcium Channel Blocker

IX. Safety

  1. Pregnancy Category C
  2. Unknown safety in Lactation

X. Drug Interactions

  1. Nicardipine increases levels of other agents
    1. Cyclosporine
    2. Tacrolimus
  2. Other agents raise Nicardipine levels
    1. Cimetidine

XI. Pharmacokinetics

  1. Well absorbed orally
  2. Short Half-Life

XII. Metabolism

  1. Reduce dose in significant renal or liver Impairment

XIII. Resources

  1. Nicardipine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=76fcb7e0-9034-4fcd-be14-ce7e9ccaee2a

XIV. 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

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