Nicardipine
CARDENE
What it isDihydropyridine calcium channel blocker; hypertensive emergency and vasospasm.
Why this oneThe IV infusion is easily titrated and does not depress contractility, so it suits acute neurological settings.
What limits itReflex tachycardia. Phlebitis at peripheral sites; CYP3A4-dependent.
FDA-approved for
- angina/hypertension (1988)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Angina | adult | 20 mg TID | 20–40 mg TID | 40 mg TID |
| Hypertension | adult | 20 mg TID | 20–40 mg TID | 40 mg TID |
Titration Allow at least 3 days before increasing dose (steady state)
Renal Titrate carefully starting at 20 mg TID
Hepatic Start 20 mg BID and titrate on a twice-daily schedule (severe impairment)
Instructions
- Individualize dose
- Sublingual nitroglycerin may be used for acute anginal attacks
Contraindications
- Advanced aortic stenosis
Cautions
- Hypotension/tachycardia around peak effect
- Caution in congestive heart failure
- Monitor blood pressure at peak (1–2 h) and trough (8 h)
Adverse reactions
- Pedal edema
- Dizziness
- Headache
- Asthenia
- Flushing
- Palpitations
- Increased angina
Pregnancy Undefined
Lactation Undefined
NO BOXED WARNINGS
Principal riskReflex tachycardia; phlebitis peripherally
Cost, est. cash$10–$300/month
Generic entry1996
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityHypotension and edema therapeutically; overdose can cause prolonged vasodilatory or cardiogenic shock.
Mechanism of action: Nicardipine ballicule
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