Formulary
Nicardipine hydrochloride: Indications, Dosing, Side Effects and Interactions
For all calcium-channel blockers Calcium-channel blockers (less correctly called 'calcium-antagonists') interfere with the inward displacement of calcium ions...
MedNext Academy | 4 min read
Nicardipine hydrochloride: Indications, Dosing, Side Effects and Interactions
For all calcium-channel blockers Calcium-channel blockers (less correctly called 'calcium-antagonists') interfere with the inward displacement of calcium ions...
Drug action
For all calcium-channel blockers Calcium-channel blockers (less correctly called 'calcium-antagonists') interfere with the inward displacement of calcium ions through the slow channels of active cell membranes. They influence the myocardial cells, the cells within the specialised conducting system of the heart, and the cells of vascular smooth muscle. Thus, myocardial contractility may be reduced, the formation and propagation of electrical impulses within the heart may be depressed, and coronary or systemic vascular tone may be diminished. Drug action For nicardipine hydrochloride Nicardipine is a dihydropyridine calcium-channel blocker.
Indications and dose
**Prophylaxis of angina**
- **Adult** (By Mouth Using Immediate-Release Medicines): Initially 20 mg 3 times a day, then increased to 30 mg 3 times a day, dose increased after at least 3 days; usual dose 60-120 mg daily.
**Mild to moderate hypertension**
- **Adult** (By Mouth Using Immediate-Release Medicines): Initially 20 mg 3 times a day, then increased to 30 mg 3 times a day, dose increased after at least 3 days; usual dose 60-120 mg daily.
**Life-threatening hypertension (specialist use only), Post-operative hypertension (specialist use only) for nicardipine hydrochloride**
- **Neonate** (By continuous intravenous infusion): Initially 500 nanograms/kg/minute (max. per dose 5 micrograms/kg/minute), adjusted according to response; maintenance 1-4 micrograms/kg/minute.
- **Child** (By continuous intravenous infusion): Initially 500 nanograms/kg/minute (max. per dose 5 micrograms/kg/minute), adjusted according to response; maintenance 1-4 micrograms/kg/minute (max. per dose 250 micrograms/minute).
Cautions
For all calcium-channel blockers Elderly Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls). Cautions For nicardipine hydrochloride General cautions: Congestive heart failure; elderly; increased risk of serious hypotension; ischaemic heart disease; pulmonary oedema; significantly impaired left ventricular function; stroke Specific cautions: With intravenous use Elevated intracranial pressure; portal hypertension Cautions, further information Manufacturer advises discontinue if ischaemic pain occurs or existing pain worsens within 30 minutes of initiating treatment or increasing dose.
Contraindications
General contra-indications: Acute porphyrias ; cardiogenic shock; significant or advanced aortic stenosis; unstable or acute attacks of angina Specific contra-indications: With intravenous use Avoid within 8 days of myocardial infarction; compensatory hypertension With oral use Avoid within 1 month of myocardial infarction
Side effects
For all calcium-channel blockers Common or very common Abdominal pain; dizziness; drowsiness; fatigue; flushing; headache; hypotension; nausea; palpitations; peripheral oedema; skin reactions; tachycardia; vomiting Uncommon Angioedema; depression; erectile dysfunction; gingival hyperplasia; myalgia; paraesthesia; syncope Overdose Features of calcium-channel blocker poisoning include nausea, vomiting, dizziness, agitation, confusion, and coma in severe poisoning. Metabolic acidosis and hyperglycaemia may occur. In overdose, the dihydropyridine calcium-channel blockers cause severe hypotension secondary to profound peripheral vasodilatation. For details on the management of poisoning, see Calcium-channel blockers, under Emergency treatment of poisoning. Side-effects For nicardipine hydrochloride General side-effects: Frequency not known Pulmonary oedema; thrombocytopenia Specific side-effects: Frequency not known With intravenous use Atrioventricular block; hepatic disorders; ischaemic heart disease; paralytic ileus With oral use Abdominal distress; angina pectoris exacerbated; asthenia; dyspnoea; feeling hot; hepatic function abnormal; insomnia; nervous system disorder; renal impairment; tinnitus; urinary frequency increased Side-effects, further information Systemic hypotension and reflex tachycardia with rapid reduction of blood pressure may occur - during intravenous use consider stopping infusion or decreasing dose by half.
Interactions
**Other interactions (15):**
- However, some patients received the association nifedipine and dantrolene without harm.
- Immunosuppressants (ciclosporin, everolimus, sirolimus, tacrolimus temsirolimus) Increase in blood levels of the immunosuppressant, by inhibiting its metabolism.
- CYP3A4 inducers and inhibitors Nicardipine is metabolized by cytochrome P450 3A4.
- Co-administration of CYP 3A4 enzyme-inducing agents (e.g.carbamazepine, phenobarbital, phenytoin, fosphenytoin, primidone and rifampicin) may cause a decrease in the plasma concentrations of...
- Co-administration of CYP3A4 enzyme-inhibiting agents (such as cimetidine, clarithromycin, cobicistat, erythromycin, itraconazole, grapefruit juice, ketoconazole, nelfinavir, posaconazole, ritonavir,...
- Co-administration of calcium channel blockers with itraconazole has shown an increased risk of adverse events, in particular oedema due to a decreased metabolism of the calcium channel blocker in...
Pregnancy
Acute life-threatening hypertension in pregnancy (specialist use only) for nicardipine hydrochloride By continuous intravenous infusion Adult Initially 1-5 mg/hour, then adjusted in steps of 500 micrograms/hour after 30 minutes, adjusted according to response, usual maximum rate 4 mg/hour in treatment of pre-eclampsia (maximum rate 15 mg/hour).
Breast feeding
Manufacturer advises avoid-present in breast milk.
Hepatic impairment
For all calcium-channel blockers In general, manufacturers advise caution (risk of increased exposure). Hepatic impairment For nicardipine hydrochloride Dose adjustments With oral use: Manufacturer advises consider using lowest initial dose and extending dosing interval according to individual response. With intravenous use: See Indications and dose section.
Renal impairment
Life-threatening hypertension in patients with hepatic or renal impairment (specialist use only), Postoperative hypertension in patients with hepatic or renal impairment (specialist use only) for nicardipine hydrochloride By continuous intravenous infusion Adult Initially 1-5 mg/hour, then adjusted in steps of 500 micrograms/hour after 30 minutes, adjusted according to response, maximum rate 15 mg/hour.
Medicinal forms
Solution,Capsule,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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