Home Drug Guide Nicardipine Hydrochloride

Drug Guide

Generic Name

Nicardipine Hydrochloride

Brand Names Cardene, Cardene In 4.8% Dextrose In Plastic Container, Cardene In 0.86% Sodium Chloride In Plastic Container, Cardene In 0.83% Sodium Chloride In Plastic Container, Cardene In 5.0% Dextrose In Plastic Container, Cardene SR

Classification

Therapeutic: Antihypertensive, Vasodilator

Pharmacological: Calcium Channel Blocker (Dihydropyridine)

FDA Approved Indications

Hypertensive crises
Chronic stable angina
Vasospastic angina

Mechanism of Action

Nicardipine selectively inhibits the influx of calcium ions into vascular smooth muscle and cardiac muscle, leading to vasodilation and decreased blood pressure.

Dosage and Administration

Adult: Typically starts at 5 mg/hr, titrate up every 5-15 min to a maximum of 15 mg/hr based on response and tolerability.

Pediatric: Use not well established; consulting specific pediatric guidelines is recommended.

Geriatric: Start at lower doses due to increased sensitivity; monitor closely.

Renal Impairment: Use with caution; dose adjustments may be necessary.

Hepatic Impairment: Use with caution; adjust dosing as needed.

Pharmacokinetics

Absorption: Rapid after IV administration.

Distribution: Widely distributed; crosses the placenta.

Metabolism: Primarily hepatic via CYP3A4.

Excretion: Metabolites excreted in urine and feces.

Half Life: Approx 2.5 to 4 hours.

Contraindications

Hypersensitivity to nicardipine or other dihydropyridines.
Severe aortic stenosis.

Precautions

Monitor for hypotension, tachycardia, and allergic reactions.
Use with caution in patients with heart failure or liver impairment.
Pregnancy Category C; use only if potential benefit justifies potential risk.

Adverse Reactions - Common

Headache (Common)
Flushing (Common)
Dizziness (Common)
Reflex tachycardia (Common)

Adverse Reactions - Serious

Hypotension (Serious)
Arrhythmias (Serious)
Palpitations (Serious)
Allergic reactions including rash, pruritus (Serious)

Drug-Drug Interactions

Simvastatin (may increase risk of myopathy)
Beta-blockers (additive effect on heart rate and blood pressure)

Drug-Food Interactions

Grapefruit juice (may increase plasma levels)

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, heart rate, and rhythm regularly during therapy. Watch for signs of hypersensitivity.

Diagnoses:

Impaired tissue perfusion related to vasodilation
Risk for hypotension

Implementation: Administer IV infusion as prescribed, monitor vitals closely, titrate dose based on response.

Evaluation: Assess reduction in blood pressure and symptom relief, monitor for adverse effects.

Patient/Family Teaching

Instruct patient to report any dizziness, headache, or signs of allergic reaction.
Advise on the importance of reporting chest pain or irregular heartbeat.
Explain the purpose of medication and adherence importance.

Special Considerations

Black Box Warnings:

None specifically for nicardipine, but caution with hypotension and reflex tachycardia.

Genetic Factors: None established.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Severe hypotension, reflex tachycardia, dizziness, possibly collapse.

Treatment: Discontinue drug, provide supportive care, consider vasopressors if hypotension persists, and administer activated charcoal if ingestion was recent.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended storage conditions.