Names and pronunciation
(nye-card′i-peen) Cardene IV
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Drug reference
(nye-card′i-peen) Cardene IV
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Func. class.: Calcium channel blocker, antianginal, antihypertensive
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Chem. class.: Dihydropyridine
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Do not confuse: niCARdipine/NIFEdipine/nimodipine Cardene/Cardizem
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ACTION: Inhibits calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle, periph- eral vascular smooth muscle; dilates coro- nary vascular arteries; increases myocar- dial oxygen delivery in patients with vasospastic angina
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USES: Chronic stable angina pectoris, hypertension
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CONTRAINDICATIONS: Sick sinus syndrome, 2nd-/3rd-degree heart block; hypersensitivity to this product or dihydropyridine; advanced aortic stenosis Precautions: Pregnancy, breastfeeding, children, geriatric patients, HF, hypoten- sion, hepatic injury, renal disease
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SIDE EFFECTS CNS: Headache, dizziness, anxiety, depression, confusion, paresthesia CV: Edema, hypotension, palpitations, tachycardia, angina GI: Nausea, vomiting, abdominal cramps, dry mouth INTEG: Rash, infusion-site discomfort, Stevens-Johnson syndrome OTHER: Myalgia (IV)
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INTERACTIONS Increase: effects of digoxin, neuromus- cular blocking agents, theophylline, other antihypertensives, nitrates, alcohol, quiNIDine Increase: hypotension—antihyperten- N sives, neuromuscular blockers, nitrates, protease inhibitors, fentanyl Increase: toxicity —cycloSPORINE, pra- zosin, carBAMazepine, quiNIDine, pro pranolol, cimetidine Decrease: antihypertensive effect— NSAIDs, rifampin, protease inhibitors Drug/Herb Increase: effect—ginkgo, ginseng, hawthorn Decrease: effect—ephedra, melatonin, St. John’s wort, yohimbe Drug/Food Increase: hypotensive effect—grapefruit, grapefruit juice, avoid use Decreased: absorption of high-fat foods
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TREATMENT OF OVERDOSE: Defibrillation, β-agonists, IV calcium, diuretics, atropine for AV block, vaso- pressor for hypotension (nik′o-teen) (OTC) Nicorette, Nic-Hit , Thrive Nicotrol
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DOSAGE AND ROUTES Hypertension • Adult: PO 20 mg tid initially; may in- crease after 3 days (range 20-40 mg tid) may increase to 60 mg bid or IV 5 mg/hr; may increase by 2.5 mg/hr q15min; max 15 mg/hr; extended-release 30 mg bid, titrate Angina • Adult: PO 20 mg tid; may be adjusted q3days; may use 20-40 mg tid Renal dose • Adult: PO 20 mg tid Hepatic dose • Adult: PO 20 mg bid
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Available forms: Capsules 20, 30 mg; extended-rel capsule 30, 45 mg; injec- tion 2.5 mg/mL, premixed 20 mg/200 mL, 40 mg/200 mL
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Administer: PO route • Without regard to meals • To start PO, give 1 hr prior to discon- tinuing IV nicardipine • Avoid use with grapefruit, grapefruit juice IV route • To convert from PO to IV for adults: if PO 20 mg q8hr, start infusion at 0.5 mg/ hr; if PO 30 mg q8hr, start infusion at 1.2 mg/hr; if PO 40 mg q8hr, start infusion at 2.2 mg/hr Continuous IV INFUSION • Dilute each 25 mg/240 mL of compat- ible sol (0.1 mg/mL), give slowly, titrate to patient response, change IV site q12hr • Stable at room temperature for 24 hr Solution compatibilities: D5W, D5/0.45% NaCl, D5/0.9% NaCl Y-site compatibilities: Alemtuzumab, amikacin, aminophylline, aztreonam, bivalirudin, butorphanol, calcium gluco- nate, CARBOplatin, caspofungin, ceFAZo- lin, ceftizoxime, chloramphenicol, cimetidine, CISplatin, clindamycin, cytarabine, DAPTOmycin, dexmedetomi- dine, diltiazem, DOBUTamine, DOCEtaxel, DOPamine, DOXOrubicin hydrochloride, enalaprilat, EPINEPHrine, epirubicin, erythromycin, esmolol, famotidine, fenoldopam, fentaNYL, genta- micin, hydrocortisone, HYDROmor- phone, labetalol, lidocaine, linezolid, LORazepam, magnesium sulfate, mech- lorethamine, methylPREDNISolone, met- roNIDAZOLE, midazolam, milrinone, morphine, nafcillin, nesiritide, nitroglyc- erin, nitroprusside, norepinephrine, octreotide, oxaliplatin, oxytocin, palono- setron, penicillin G potassium, potassium chloride/phosphate, quinupristin/dalfo- pristin, ranitidine, rocuronium, tacroli- mus, tirofiban, tobramycin, trime- thoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, vinCRIStine, voriconazole, zoledronic acid
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Assess: • Anginal pain: intensity, location, dura- tion; alleviating, precipitating factors • HF: weight gain, crackles, peripheral edema, jugular venous distention, dys- pnea, I&O • Cardiac status: B/P baseline and fre- quent intervals, pulse, respiration, ECG during long-term treatment • Potassium, renal, hepatic studies peri- odically if on long-term treatment • Allergic reactions (Stevens-Johnson syndrome): if rash is severe, with joint aches, mouth lesions, discontinue imme- diately • Hypertension: decreasing B/P; assess salt in diet, smoking, exercise, weight, monitor B/P often • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; cautious use in breastfeeding
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Evaluate: • Therapeutic response: decreased an- ginal pain, decreased B/P
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • How to take pulse and what to report • To avoid hazardous activities until sta- bilized on product, dizziness is no longer a problem • To limit caffeine consumption; to avoid alcohol products; to take without regard to food, avoid high-fat foods, to avoid grapefruit, grapefruit juice • Hypertension: to comply in all areas of medical regimen: diet, exercise, stress reduction, product therapy • To notify prescriber of irregular heart- beat, SOB, swelling of feet and hands, pronounced dizziness, constipation, nau- sea, hypotension, change in severity/pat- tern/incidence of angina • To rise slowly from sitting or lying down to prevent orthostatic hypotension
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PHARMACOKINETICS Metabolized by liver, excreted in urine 60%, feces 35%, half-life 2-5 hr PO: Onset ½-2 hr, peak 1-2 hr, duration 8 hr IV: Onset 1 min, peak 45 min, duration ≤8 hr
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• Adult: PO 20 mg tid initially; may in- crease after 3 days (range 20-40 mg tid) may increase to 60 mg bid or IV 5 mg/hr; may increase by 2.5 mg/hr q15min; max 15 mg/hr; extended-release 30 mg bid, titrate Angina
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• Adult: PO 20 mg tid; may be adjusted q3days; may use 20-40 mg tid Renal dose
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• Adult: PO 20 mg tid Hepatic dose
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• Adult: PO 20 mg bid
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