View source for Nicardipine

==General==
*Type: [[Calcium Channel Blocker]], dihydropyridine
*Dosage Forms: Capsule, Infusion solution, Injectable solution
*Common Trade Names: [[Cardene]]

==Adult Dosing==
===[[Hypertension]]===
*PO: 20-40mg q8hr, or 30-60mg (extended release) q12hr
*IV: 5mg/hr by slow infusion (50ml/hr), titrate to maximum of 30mg/hr, then maintenance of 2.0 - 15.5mg/hr
*IV bolus dose of 2mg, then continuous infusion achieves same control of hypertension as starting infusion without bolus<ref>Tao P, Zheng DY, Yu XJ. Effects of intravenous nicardipine in Chinese patients with hypertensive emergencies. Curr Ther Res Clin Exp 1998 Mar; 59: 188-95.</ref>

===[[Intracranial hemorrhage]]===
*Start at 5mg/hr 
**Increase q5min by 2.5mg until the target blood pressure is achieved 
**Then, immediately titrate down to maintenance infusion of 3mg/hr

===Chronic [[Stable Angina]]===
*20-40mg PO q8hr
*Allow 3 days between dose increase

==Pediatric Dosing==
===Hypertension===
*0.5-3 mcg/kg/min IV
*Not approved by FDA; limited date available

==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: Category C
*Lactation: Unknown wether drug is excreted in breast milk; avoid use
*Renal Dosing
**Adult
*** PO: 20 mg TID (immediate release) or 30 mg BID (sustained release) with slow titration
*** IV: not defined, slow titration
**Pediatric
*** IV: not defined, slow titration
*Hepatic Dosing
**Adult
*** PO: 20 mg BID (immediate release) with slow titration
*** IV: not defined, slow titration
**Pediatric
*** IV: not defined, slow titration

==Contraindications==
*Allergy to class/drug

==Adverse Reactions==
===Serious===
*[[Headache]] (IV, 15%)

===Common===
*Flushing
*Peripheral Edema
*Pedal Edema
*[[Hypotension]]
*Exacerbation of [[angina]]

==Pharmacology==
*Half-life: 2-4 hr
*Metabolism: Metabolized in liver b CYP3A4 (first pass)
*Excretion: urine (60%), feces (35%)
*Mechanism of Action: 
**inhibits trasmembrane influx of extracellular calcium ions across membranes of myocardial cells and vascular smooth muscle cells without changing serum calcium concentrations; this inhibit cardiac and vascular smooth muscle contractions, thereby dilating maincoronary and systemic arteries.

==See Also==
*[[Subarachnoid hemorrhage]]
*[[Hemorrhagic stroke]]
*[[Hypertensive emergency]]
*[[Clevidipine]]

==References==
<references/>
[[Category:Pharmacology]]
[[Category:Cardiology]]
Nicardipine: Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.