Nicardipine
CARDENE
Pronunciation: nye-KAR-di-peen
“Car dean’s Nice car dipping”
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.
Nicardipine prescription history
Animated chart of estimated U.S. prescriptions per year, Calcium-channel blockers (1981–2026). Nicardipine enters in 1989 (estimated).
FDA-approved for
- angina/hypertension (1988)
Principal riskReflex tachycardia; phlebitis peripherally
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityHypotension and edema therapeutically; overdose can cause prolonged vasodilatory or cardiogenic shock.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| 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
Available strengths
- cap 20, 30 mg
- inj 0.1, 0.2, 2.5 mg/mL
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
Cost
Generic entry1996
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Self-check
- Why can IV nicardipine suit acute neurological settings?
Easy titration without depressed contractility. - What local IV-site problem can occur with nicardipine?
Phlebitis.