Drug Action
Nicardipine is a dihydropyridine calcium- channel blocker.
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Drug reference
Nicardipine is a dihydropyridine calcium- channel blocker.
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Prophylaxis of angina ▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES ▶Adult: Initially 20 mg 3 times a day, then increased to 30 mg 3 times a day, dose increased after at least 3 days; usual dose 60–120 mg daily Mild to moderate hypertension ▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES ▶Adult: Initially 20 mg 3 times a day, then increased to 30 mg 3 times a day, dose increased after at least 3 days; usual dose 60–120 mg daily Life-threatening hypertension (specialist use only) | Post- operative hypertension (specialist use only) ▶BY CONTINUOUS INTRAVENOUS INFUSION ▶Adult: Initially 3–5 mg/hour for 15 minutes, increased in steps of 0.5–1 mg every 15 minutes, adjusted according to response, maximum rate 15 mg/hour, reduce dose gradually when target blood pressure achieved; maintenance 2–4 mg/hour ▶Elderly: Initially 1–5 mg/hour, then adjusted in steps of 500 micrograms/hour after 30 minutes, adjusted according to response, maximum rate 15 mg/hour Life-threatening hypertension in patients with hepatic or renal impairment (specialist use only) | Postoperative hypertension in patients with hepatic or renal impairment (specialist use only) ▶BY CONTINUOUS INTRAVENOUS INFUSION ▶Adult: Initially 1–5 mg/hour, then adjusted in steps of 500 micrograms/hour after 30 minutes, adjusted according to response, maximum rate 15 mg/hour Acute life-threatening hypertension in pregnancy (specialist use only) ▶BY CONTINUOUS INTRAVENOUS INFUSION ▶Adult: Initially 1–5 mg/hour, then adjusted in steps of 500 micrograms/hour after 30 minutes, adjusted according to response, usual maximum rate 4 mg/hour in treatment of pre-eclampsia (maximum rate 15 mg/hour)
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GENERAL CONTRA-INDICATIONS Acute porphyrias p. 1120. cardiogenic shock. significant or advanced aortic stenosis. unstable or acute attacks of angina SPECIFIC CONTRA-INDICATIONS ▶With intravenous use avoid within 8 days of myocardial infarction. compensatory hypertension ▶With oral use avoid within 1 month of myocardial infarction
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GENERAL CAUTIONS Congestive heart failure. elderly. increased risk of serious hypotension. ischaemic heart disease. pulmonary oedema. significantly impaired left ventricular function. stroke SPECIFIC CAUTIONS ▶With intravenous use Elevated intracranial pressure. portal hypertension CAUTIONS, FURTHER INFORMATION Manufacturer advises discontinue if ischaemic pain occurs or existing pain worsens within 30 minutes of initiating treatment or increasing dose.
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→Appendix 1: calcium channel blockers
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GENERAL SIDE-EFFECTS ▶Common or very common Hypotension ▶Frequency not known Pulmonary oedema. thrombocytopenia SPECIFIC SIDE-EFFECTS ▶With intravenous use Atrioventricular block. hepatic Cardiovascular system disorders. ischaemic heart disease. paralytic ileus ▶With oral use Abdominal distress. angina pectoris exacerbated. asthenia. dyspnoea. feeling hot. hepatic function abnormal. insomnia. nervous system disorder. renal impairment. tinnitus. urinary frequency increased SIDE-EFFECTS, FURTHER INFORMATION Systemic hypotension and reflex tachycardia with rapid reduction of blood pressure may occur — during intravenous use consider stopping infusion or decreasing dose by half.
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May inhibit labour. Not to be used in multiple pregnancy (twins or more) unless there is no other acceptable alternative. Toxicity in animal studies. Risk of severe maternal hypotension and fatal fetal hypoxia— avoid excessive decrease in blood pressure. For treatment of acute life-threatening hypertension only.
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Manufacturer advises avoid—present in breast milk.
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Dose adjustments ▶With oral use Manufacturer advises consider using lowest initial dose and extending dosing interval according to individual response. ▶With intravenous use See Indications and dose section.
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Dose adjustments ▶With oral use Consider using lowest initial dose and extending dosing interval according to individual response. ▶With intravenous use Use with caution—use lower initial dose.
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Monitor blood pressure and heart rate at least every 5 minutes during intravenous infusion, and then until stable, and continue monitoring for at least 12 hours after end of infusion.
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Intravenous nicardipine should only be administered under the supervision of a specialist and in a hospital or intensive care setting in which patients can be closely monitored. For intravenous infusion give continuously in Glucose 5%; dilute dose in infusion fluid to a final concentration of 100–200 micrograms/mL (undiluted solution via central venous line only) and give via volumetric infusion pump or syringe driver; protect from light; to minimise peripheral venous irritation, change site of infusion every 12 hours; risk of adsorption on to plastic of infusion set in the presence of saline solutions; incompatible with bicarbonate or alkaline solutions—consult product literature.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Solution for infusion ▶Nicardipine hydrochloride (Non-proprietary) Nicardipine hydrochloride 1 mg per 1 ml Nicardipine 10mg/10ml solution for injection ampoules | 5 ampoule P £50.00 Nicardipine hydrochloride 2.5 mg per 1 ml Cardene I.V. 25mg/10ml solution for infusion ampoules | 10 ampoule P s Capsule ▶Nicardipine hydrochloride (Non-proprietary) Nicardipine hydrochloride 20 mg Nicardipine 20mg capsules | 56 capsule P £8.38 DT = £7.65 Nicardipine hydrochloride 30 mg Nicardipine 30mg capsules | 56 capsule P £9.73 DT = £9.56 ▶Cardene (Astellas Pharma Ltd) Nicardipine hydrochloride 20 mg Cardene 20mg capsules | 56 capsule P £6.00 DT = £7.65 Nicardipine hydrochloride 30 mg Cardene 30mg capsules | 56 capsule P £6.96 DT = £9.56 eiiii F 168
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Initially 1–5 mg/hour, then adjusted in steps of
First-line fragment. Read the complete Indications and Dose section above.
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