Nicardipine

Nicardipine is a prescription medication used to treat Hypertension and Chronic Stable Angina. 

Nicardipine is available under the following different brand names: Cardene IV, Cardene SR. 

Adult dosage

Capsule

• 20mg
• 30mg

Capsule, extended release

Note: Cardene SR has not been available in the US for more than a year

• 30mg
• 45mg
• 60mg

Infusion solution

• 20mg/200mL
• 40mg/200mL

Injectable solution

• 2.5mg/mL

Hypertension

Adult dosage

• Orally: 20-40 mg (conventional) every 8 hours or 30-60 mg (extended-release) every 12 hours
• IV: 5 mg/hour by slow infusion (50mL/hour) initially; may be increased by 2.5 mg/hour every 15 minutes; not to exceed 15 mg/hour
• IV as substitute for conventional Oral treatment: 
  • Oral dose: 20 mg every 8 hours; equivalent IV infusion: 0.5 mg/hour
  • Oral dose: 30 mg every 8 hours; equivalent IV infusion: 1.2 mg/hour
  • Oral dose: 40 mg every 8 hours; equivalent IV infusion: 2.2 mg/hour
  • If transitioning to oral nicardipine, initiate oral dosage 1 hour before discontinuance of IV

Chronic Stable Angina

Adult dosage

• 20-40 mg (conventional) orally every 8 hours
• Start at 20 mg, and allow 3 days between dose increases to achieve steady-state plasma drug concentration; usual dosage range, 60-120 mg/day

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”.

Common side effects of Nicardipine include:

• headache, 
• dizziness, 
• swelling in your feet, 
• weakness, 
• flushing (warmth, redness, or tingly feeling), and
• nausea

Serious side effects of Nicardipine include:

• hives, 
• difficulty breathing, 
• swelling of your face, lips, tongue, or throat, 
• lightheadedness, 
• pounding heartbeats, 
• fluttering in your chest, and
• severe or ongoing chest pain

Rare side effects of Nicardipine include:

• none 

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.  Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first

• Nicardipine has severe interactions with at least 14 other drugs. 
• Nicardipine has serious interactions with at least 74 other drugs. 
• Nicardipine has moderate interactions with at least 252 other drugs. 
• Nicardipine has minor interactions with at least 30 other drugs. 

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drugs interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Contraindications

• Hypersensitivity to nicardipine or other calcium-channel blockers
• Advanced aortic stenosis

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Nicardipine?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Nicardipine?”

Cautions

• May cause symptomatic hypotension or tachycardia; titrate slowly to avoid systemic hypotension and possible negative inotropic effects with congestive heart failure (CHF), angina, and left ventricular dysfunction (particularly during treatment initiation, after dose increase, or after withdrawal of beta blocker)
• To reduce possibility of venous thrombosis, phlebitis, and vascular impairment, do not use small veins, such as those on dorsum of hand or wrist; avoid intraarterial administration or extravasation
• Caution should be exercised when using the drug in congestive heart failure patients, particularly in combination with a beta-blocker; nicardipine gives no protection against dangers of abrupt beta-blocker withdrawal; any such withdrawal should be by gradual reduction of dose of beta-blocker, preferably over 8 to 10 days
• Closely monitor response in patients with angina, congestive heart failure, impaired hepatic function, portal hypertension, and renal impairment and pheochromocytoma
• Peripheral edema may occur
• Exacerbation of angina or MI reported with dosage titration of dihydropyridine calcium-channel blockers
• With acute cerebral infarction or hemorrhage, titrate slowly to avoid systemic hypotension
• Use with caution in patients with hypertrophic cardiomyopathy and mild-to-moderate aortic stenosis
• Use with caution in hepatic or renal impairment; lower doses may be required
• Use with caution in hypertension associated with pheochromocytoma and portal hypertension when administering IV
• Change infusion site every 12 hours to minimize risk of peripheral venous irritation
• Blood pressure starts to fall within min of infusion; calcium channel blockers, may occasionally produce symptomatic hypotension; caution is advised to avoid systemic hypotension when administering drug to patients who have sustained acute cerebral infarction or hemorrhage
• Extended-release form not recommended for angina

Pregnancy and Lactation

• Use with caution if benefits outweigh risks during pregnancy. 
• Unknown whether drug is excreted in breast milk; avoid use.