Nicardipine (Cardene) - Uses, Dose, Side effects

Nicardipine (Cardene) belongs to the class of dihydropyridine calcium channel blockers.

Nicardipine Uses:

Angina:
- It is used in the treatment of chronic stable angina (oral immediate-release product only).
Hypertension:
- It is indicated for treating hypertension (oral immediate/ sustained release or intravenous forms).
- Intravenous administration may be used for the short term when oral treatment cannot be given.

Guideline recommendations:

The 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults recommends if single-agent therapy is to be given in the absence of comorbidities, thiazide-like diuretics or dihydropyridine calcium channel blockers are preferred due to prevention of heart failure and stroke.

ACE inhibitors and ARBs can also be given as monotherapy. Combination therapy is initially preferred in high-risk patients (such as stage 2 hypertension, atherosclerotic cardiovascular disease risk ≥10%).

Off Label Use of Nicardipine (Cardene) in Adults:
- Arterial hypertension in acute ischemic stroke.
- Control of blood pressure in patients with spontaneous intracranial hemorrhage.
- Perioperative hypertension.
- Subarachnoid hemorrhage associated cerebral vasospasm.

Nicardipine (Cardene) dosage in adults:

Note: Cardene SR has been discontinued in the US for more than 1 year.

Nicardipine (Cardene) dose for the treatment of Angina:

Immediate-release:
- 20 mg per oral thrice daily.
- usual dosage: 20 to 40 mg 3 times daily (allow ≥3 days between dose increases)

Nicardipine (Cardene) dose for the treatment of Hypertension:

Immediate-release:
- Initial oral dose of 20 mg thrice daily.
- The usual dosage: 20 to 40 mg 3 times daily (allow ≥3 days between dose increase)
Sustained-release:
- The initial dose of 30 mg b.i.d daily
- The usual dosage: 30 to 60 mg per oral b.i.d daily

Nicardipine (Cardene) dose for the treatment of Acute hypertension:

An initial intravenous dose of 5 mg/hour that can be increased by 2.5 mg/hour every 5 minutes (for fast titration) to every 15 minutes (for slow titration) up to a maximum of 15 mg/hour.
Adjust infusion rate according to the desired response
Consider reduction to 3 mg/hour after response in rapid titration.
The infusion should be stopped if severe hypotension/tachycardia occurs.

Nicardipine (Cardene) dose for the treatment of Arterial hypertension in acute ischemic stroke (off-label use):

In patients eligible for reperfusion treatment except BP >185/110 mm Hg start intravenous dose 5 mg/hour, titrate by 2.5 mg/hour at 5- to 15-minute intervals (maximum dose: 15 mg/hour).
If BP still remains >185/110 mm Hg, alteplase should not be given.
Management of BP during and after reperfusion treatment to maintain BP ≤180/105 mm Hg:
- If systolic BP >180 to 230 mm Hg or diastolic >105 to 120 mm Hg start with 5 mg/hour titrate by 2.5 mg/hour at 5- to 15-minute intervals
- (maximum dose: 15 mg/hour).
- If hypertension is refractory or diastolic BP >140 mm Hg, consider other intravenous antihypertensives (eg, nitroprusside).
Substitution for oral therapy (approximate equivalents):
- 20 mg every 8 hours oral, equivalent to 0.5 mg/hour intravenous infusion
- 30 mg every 8 hours oral, equivalent to 1.2 mg/hour intravenous infusion
- 40 mg every 8 hours oral, equivalent to 2.2 mg/hour intravenous infusion
Conversion to oral antihypertensive agent:
- Oral antihypertensive should be started once that intravenous nicardipine is stopped.

Nicardipine (Cardene) Dose in Childrens

Nicardipine dose in children for the treatment of hypertension:

Note: Use should be reserved for acute severe hypertension.

Infants, Children, and Adolescents:
- Continuous intravenous infusion, Bolus dose:
  - Initially 30 mcg/kg to a maximum dose: 2 mg/dose, followed by continuous infusion: 0.5 to 1 mcg/kg/minute titrated according to BP.

Pregnancy Risk Factor C

Certain animal reproduction studies have shown negative results.
It can also be used to treat severe hypertension during pregnancy or preterm labor.
Nicardipine can cross the placenta, causing changes to the fetal heart rate or neonatal hypotension.

Nicardipine use during breastfeeding:

Breast milk contains a small amount of Nicardipine.
Some manufacturers do not recommend breastfeeding.

Nicardipine dose adjustment in renal disease:

Initial dose of 20 mg thrice daily (immediate release) or 30 mg b.i.d daily (sustained release) with slow titration.
There are no specific dosage adjustments fr intravenous preparation provided in the manufacturer’s labeling, titration should be slow with careful monitoring.

Nicardipine dose adjustment in liver disease:

Initial dose of 20 mg per oral b.i.d daily (immediate-release) with slow titration.
There are no specific dosage adjustments for intravenous preparation provided in the manufacturer’s labeling, titration should be slow with monitoring.

Side Effects of Nicardipine (Cardene):

Cardiovascular:
- Flushing
- Pedal Edema
- Exacerbation Of Angina Pectoris
- Hypotension
- Palpitations
- Tachycardia
- Chest Pain
- Extrasystoles
- Hemopericardium
- Hypertension
- Supraventricular Tachycardia
- Edema
Central Nervous System:
- Headache
- Dizziness
- Hypoesthesia
- Intracranial Hemorrhage
- Pain
- Somnolence
Dermatologic:
- Diaphoresis
- Skin Rash
Endocrine & Metabolic:
- Hypokalemia
Gastrointestinal:
- Nausea And Vomiting
- Nausea
- Dyspepsia
- Abdominal Pain
- Xerostomia
Genitourinary:
- Hematuria
Local:
- Injection Site Reaction
- Pain At Injection Site
Neuromuscular & Skeletal:
- Weakness
- Myalgia
- Paresthesia

Contraindication to Nicardipine (Cardene):

Hypersensitivity to nicardipine and any component of the formulation
Advanced aortic stasis

Warnings and precautions

Angina/Myocardial Infarction:
- Angina and MI are becoming more common.
- Patients with obstructive heart disease may experience reflex tachycardia, particularly if they are not taking combination beta-blockers.
Hypotension/syncope
- Hypotension may be accompanied by or without syncope, which is rare. It is important to monitor pulse and BP closely.
Peripheral edema
- Within 2 to 3 weeks after starting therapy, peripheral edema can be common.
Tachycardia
- It is important to monitor your heart rate closely.
Aortic stenosis
- Nicardipine can reduce coronary perfusion, which could lead to ischemia. Patients with advanced aortic narrowing should not use Nicardipine.
Heart failure:
- Combination beta-blockers may worsen symptoms in patients with severe left ventricular dysfunction or heart failure.
- Patients with heart failure should be advised not to use calcium channel blockers.
Hepatic impairment
- Patients with reduced liver function or reduced blood flow should reduce their doses.
Hypertrophic cardiomyopathy with outflow tract obstruction (HCM)
- Nicardipine may cause reduced afterload or worsening symptoms.
Renal impairment
- Patients with impaired renal function should be cautious when taking TItrate, as the clearance of Nicardipine is decreased.

Nicardipine: Drug Interaction

Risk Factor C (Monitor therapy)
Alfuzosin	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Alpha1-Blockers	May enhance the hypotensive effect of Calcium Channel Blockers.
Amphetamines	May diminish the antihypertensive effect of Antihypertensive Agents.
Antipsychotic Agents (Second Generation [Atypical])	Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]).
Aprepitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
ARIPiprazole	CYP2D6 Inhibitors (Weak) may increase the serum concentration of ARIPiprazole. Management: Monitor for increased aripiprazole pharmacologic effects. Aripiprazole dose adjustments may or may not be required based on concomitant therapy and/or indication. Consult full interaction monograph for specific recommendations.
Atosiban	Calcium Channel Blockers may enhance the adverse/toxic effect of Atosiban. Specifically, there may be an increased risk for pulmonary edema and/or dyspnea.
Barbiturates	May increase the metabolism of Calcium Channel Blockers. Management: Monitor for decreased therapeutic effects of calcium channel blockers with concomitant barbiturate therapy. Calcium channel blocker dose adjustments may be necessary. Nimodipine Canadian labeling contraindicates concomitant use with phenobarbital.
Barbiturates	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Benperidol	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Bosentan	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Brigatinib	May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents.
Brimonidine (Topical)	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Calcium Channel Blockers (Nondihydropyridine)	Calcium Channel Blockers (Dihydropyridine) may enhance the hypotensive effect of Calcium Channel Blockers (Nondihydropyridine). Calcium Channel Blockers (Nondihydropyridine) may increase the serum concentration of Calcium Channel Blockers (Dihydropyridine).
Calcium Salts	May diminish the therapeutic effect of Calcium Channel Blockers.
Carvedilol	NiCARdipine may enhance the hypotensive effect of Carvedilol. NiCARdipine may precipitate signs of heart failure in susceptible patients on Carvedilol NiCARdipine may increase the serum concentration of Carvedilol.
Clofazimine	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Clopidogrel	Calcium Channel Blockers may diminish the therapeutic effect of Clopidogrel.
CycloSPORINE (Systemic)	Calcium Channel Blockers (Dihydropyridine) may increase the serum concentration of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase the serum concentration of Calcium Channel Blockers (Dihydropyridine).
CYP3A4 Inducers (Moderate)	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
CYP3A4 Inhibitors (Moderate)	May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors).
Dapoxetine	May enhance the orthostatic hypotensive effect of Calcium Channel Blockers.
Deferasirox	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Dexmethylphenidate	May diminish the therapeutic effect of Antihypertensive Agents.
Diazoxide	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
DULoxetine	Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine.
Duvelisib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Efavirenz	May decrease the serum concentration of Calcium Channel Blockers.
Erdafitinib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Erdafitinib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Erdafitinib	May increase the serum concentration of P-glycoprotein/ABCB1 Substrates.
Fluconazole	May increase the serum concentration of Calcium Channel Blockers.
Fosaprepitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Fosnetupitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Grapefruit Juice	May increase the serum concentration of NiCARdipine.
Herbs (Hypertensive Properties)	May diminish the antihypertensive effect of Antihypertensive Agents.
Herbs (Hypotensive Properties)	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Hypotension-Associated Agents	Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents.
Ivosidenib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Larotrectinib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Levodopa-Containing Products	Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products.
Lormetazepam	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Magnesium Salts	Calcium Channel Blockers may enhance the adverse/toxic effect of Magnesium Salts. Magnesium Salts may enhance the hypotensive effect of Calcium Channel Blockers.
Melatonin	May diminish the antihypertensive effect of Calcium Channel Blockers (Dihydropyridine).
Methylphenidate	May diminish the antihypertensive effect of Antihypertensive Agents.
Molsidomine	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Naftopidil	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Netupitant	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Neuromuscular-Blocking Agents (Nondepolarizing)	Calcium Channel Blockers may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing).
Nicergoline	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nicorandil	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nitroprusside	Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside.
Palbociclib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Pentoxifylline	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Perhexiline	CYP2D6 Inhibitors (Weak) may increase the serum concentration of Perhexiline.
P-glycoprotein/ABCB1 Inhibitors	May increase the serum concentration of P-glycoprotein/ABCB1 Substrates. P-glycoprotein inhibitors may also enhance the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.).
Pholcodine	Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine.
Phosphodiesterase 5 Inhibitors	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Prostacyclin Analogues	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Quinagolide	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
QuiNIDine	Calcium Channel Blockers (Dihydropyridine) may decrease the serum concentration of QuiNIDine. Calcium Channel Blockers (Dihydropyridine) may increase the serum concentration of QuiNIDine. QuiNIDine may increase the serum concentration of Calcium Channel Blockers (Dihydropyridine).
Ranolazine	May increase the serum concentration of P-glycoprotein/ABCB1 Substrates.
Sarilumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Siltuximab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Simeprevir	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
SUNItinib	NiCARdipine may increase the serum concentration of SUNItinib.
Tacrolimus (Systemic)	Calcium Channel Blockers (Dihydropyridine) may increase the serum concentration of Tacrolimus (Systemic).
Tocilizumab	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers).
Yohimbine	May diminish the antihypertensive effect of Antihypertensive Agents.
Risk Factor D (Consider therapy modification)
Amifostine	Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered.
Antifungal Agents (Azole Derivatives, Systemic)	May enhance the adverse/toxic effect of Calcium Channel Blockers. Specifically, itraconazole may enhance the negative inotropic effects of verapamil or diltiazem. Antifungal Agents (Azole Derivatives, Systemic) may decrease the metabolism of Calcium Channel Blockers. Fluconazole and isavuconazonium likely exert weaker effects than other azoles and are addressed in separate monographs. Management: Concurrent use of felodipine or nisoldipine with itraconazole is specifically contraindicated. Frequent monitoring is warranted with any such combination; calcium channel blocker dose reductions may be required. Exceptions: Fluconazole; Isavuconazonium Sulfate.
CarBAMazepine	May increase the metabolism of Calcium Channel Blockers (Dihydropyridine). Management: Consider calcium channel blocker (CCB) dose adjustments or alternative therapy in patients receiving concomitant carbamazepine. Nimodipine Canadian labeling contraindicates concurrent use with carbamazepine.
CYP3A4 Inducers (Strong)	May increase the metabolism of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.
CYP3A4 Inhibitors (Strong)	May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors).
Dabrafenib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects).
Enzalutamide	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring.
Fosphenytoin	Calcium Channel Blockers may increase the serum concentration of Fosphenytoin. Management: Monitor for phenytoin toxicity with concomitant use of a calcium channel blocker (CCB) or decreased phenytoin effects with CCB discontinuation. Monitor for decreased CCB therapeutic effects. Nimodipine Canadian labeling contraindicates use with phenytoin.
Lorlatinib	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Avoid concurrent use of lorlatinib with any CYP3A4 substrates for which a minimal decrease in serum concentrations of the CYP3A4 substrate could lead to therapeutic failure and serious clinical consequences.
Macrolide Antibiotics	May decrease the metabolism of Calcium Channel Blockers. Management: Consider using a noninteracting macrolide. Felodipine Canadian labeling specifically recommends avoiding its use in combination with clarithromycin. Exceptions: Azithromycin (Systemic); Fidaxomicin; Roxithromycin; Spiramycin.
MiFEPRIStone	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Minimize doses of CYP3A4 substrates, and monitor for increased concentrations/toxicity, during and 2 weeks following treatment with mifepristone. Avoid cyclosporine, dihydroergotamine, ergotamine, fentanyl, pimozide, quinidine, sirolimus, and tacrolimus.
Mitotane	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane.
Obinutuzumab	May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion.
Phenytoin	Calcium Channel Blockers may increase the serum concentration of Phenytoin. Phenytoin may decrease the serum concentration of Calcium Channel Blockers. Management: Avoid use of nimodipine or nifedipine with phenytoin. Monitor for phenytoin toxicity and/or decreased calcium channel blocker effects with any concurrent use.
Rifamycin Derivatives	May decrease the serum concentration of Calcium Channel Blockers. This primarily affects oral forms of calcium channel blockers. Management: The labeling for some US and Canadian calcium channel blockers contraindicate use with rifampin, however recommendations vary. Consult appropriate labeling.
Sincalide	Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction.
St John's Wort	May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.
Stiripentol	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring.
Risk Factor X (Avoid combination)
Bromperidol	Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents.
Conivaptan	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Fusidic Acid (Systemic)	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
Idelalisib	May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).

Monitoring parameters:

Different parameters such as BP and pulse monitoring is recommended.

Confirmed hypertension and known CVD or 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥10%:
- Target blood pressure <130/80 mm Hg is recommended.
Confirmed hypertension without markers of increased ASCVD risk:
- Target blood pressure <130/80 mm Hg may be reasonable.
Diabetes and hypertension: The American Diabetes Association (ADA) guidelines (ADA 2019):
- Patients 18-65 years without atherosclerotic disease and 10-year risk <15%:
  - Target blood pressure <140/90 mm Hg is recommended
- Patients 18-65 years and having atherosclerotic disease or 10-year ASCVD risk >15%:
  - Target blood pressure <130/80 mm Hg is advised.
- Patients >65 years of age (healthy):
  - Target blood pressure <140/90 mm Hg is recommended
- Patients >65 years of age (poor health):
  - Target blood pressure <150/90 mm Hg is recommended

How to administer Nicardipine (Cardene)?

The total oral daily dose of the immediate-release product differs from the daily sustained-release dose therefore caution should be exercised during conversion.
It can be taken without regard to meals, although sustained release if given with meal may decrease the fluctuation in plasma levels.
The tablet should not be chewed or crushed but swallowed as a whole. Do not open or cut capsules.
Intravenous preparation is given as a slow continuous infusion via central line/large peripheral vein.
By changing the site of infusion every 12 hours, peripheral venous irritation can be prevented.

Premixed bags:

Do not combine or run in the same line with other medications.

Mechanism of action of Nicardipine (Cardene):

It causes calcium ion to be blocked from entering "slow channels" and voltage-sensitive areas in the vascular smooth muscles and myocardium during depolarization.
This results in relaxation of the coronary vascular smooth muscles and coronary vasodilation. Patients with vasospastic gina have a higher rate of myocardial oxygen delivery.

The onset of action:

Intravenous infusion is effective within minutes.
Oral: 0.5 to 2 hours

Peak effect:

Immediate capsules: 1 to 2 hours
Sustained-release capsules (at steady state): Sustained from 2 to 6 hours post-dose
Intravenous continuous infusion: 50% of the maximum effect is seen by 45 minutes

Duration:

Intravenous ≤8 hours upon discontinuation of continuous infusion, a 50% decrease in effect is seen in half an hour with gradual discontinuing antihypertensive effects for ~50 hours
Oral: Immediate release: ≤8 hours
Sustained-release: 8 to 12 hours

Absorption:

Oral: ~100%, but large first-pass effect

Protein binding:

>95%

Metabolism:

Occurs in the liver, extensive first-pass effect (saturable) The major pathway is via cytochrome P450 isoenzyme CYP3A4, 2C8, and 2D6.

Bioavailability:

Oral: ~35%

Half-life elimination:

Follows dose-dependent (nonlinear) pharmacokinetics; “apparent” or calculated half-life is dependent upon serum concentrations.
Oral: Half-life over the first 8 hours is 2 to 4 hours; terminal half-life: 8.6 hours.
Serum concentrations decrease tri-exponentially after intravenous infusion; alpha half-life: 3 minutes; beta half-life: 45 minutes; terminal half-life: 14 hours
Note: Terminal half-life can only be seen after long-term infusions).

Time to peak, serum: Oral:

Immediate release: 30 to 120 minutes (mean: 1 hour)
Sustained release: 60 to 240 minutes

Excretion:

Urine (oral: 60% as metabolites; IV: 49% as metabolites; <1% as unchanged drug)
feces (oral: 35%; IV: 43%)
Clearance: Decreased in patients with liver impairment; may be decreased in patients with renal impairment

Nicardipine Brand Names (International):

Cardene IV
Antagonil
Barizin
Binicapin
Blistra
Cardene
Cardene SR
Cardepine
Cardepine SR
Cardibloc SR
Cardibrain
Cardilon
Cardimed
Cardipene
Carsive
Convertal
Dacarel
Dafil
Dipitenz
Flusemide
Karden
Lincil
Loxen
Loxen LP
Nerdipina
Nicafer
Nicardal
Nicardin
Nidaven
Nimicor
Perdipina
Perdipine
Perdipine LA
Ridene
Rydene
Tensilo
Vasonase
Xian Li

Nicardipine Brand Names in Pakistan:

Nicapress-R 40 mg (Amson Vaccines and Pharmaceuticals)

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Nicardipine (Cardene) - Uses, Dose, Side effects

Nicardipine Uses:

Angina:

Hypertension:

Guideline recommendations:

Off Label Use of Nicardipine (Cardene) in Adults:

Nicardipine (Cardene) dosage in adults:

Nicardipine (Cardene) dose for the treatment of Angina:

Nicardipine (Cardene) dose for the treatment of Hypertension:

Immediate-release:

Sustained-release:

Nicardipine (Cardene) dose for the treatment of Acute hypertension:

Nicardipine (Cardene) dose for the treatment of Arterial hypertension in acute ischemic stroke (off-label use):

Substitution for oral therapy (approximate equivalents):

Conversion to oral antihypertensive agent:

Nicardipine (Cardene) Dose in Childrens

Nicardipine dose in children for the treatment of hypertension:

Infants, Children, and Adolescents:

Pregnancy Risk Factor C

Nicardipine dose adjustment in renal disease:

Nicardipine dose adjustment in liver disease:

Side Effects of Nicardipine (Cardene):

Cardiovascular:

Central Nervous System:

Dermatologic:

Endocrine & Metabolic:

Gastrointestinal:

Genitourinary:

Local:

Neuromuscular & Skeletal:

Contraindication to Nicardipine (Cardene):

Warnings and precautions

Angina/Myocardial Infarction:

Hypotension/syncope

Peripheral edema

Tachycardia

Aortic stenosis

Heart failure:

Hepatic impairment

Hypertrophic cardiomyopathy with outflow tract obstruction (HCM)

Renal impairment

Monitoring parameters:

Confirmed hypertension and known CVD or 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥10%:

Confirmed hypertension without markers of increased ASCVD risk:

Diabetes and hypertension: The American Diabetes Association (ADA) guidelines (ADA 2019):