nicardipine hydrochloride


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Related to nicardipine hydrochloride: Cardene

nicardipine hydrochloride

Cardene, Cardene IV, Cardene SR

Pharmacologic class: Calcium channel blocker

Therapeutic class: Antianginal, antihypertensive

Pregnancy risk category C

Action

Inhibits calcium transport into myocardial and vascular smooth muscle cells, causing cardiac output and myocardial contractions to decrease

Availability

Capsules: 20 mg, 30 mg

Capsules (sustained-release): 30 mg, 45 mg, 60 mg

Injection: 2.5 mg/ml in 10-ml ampules

Indications and dosages

Chronic stable angina, given alone or with beta-adrenergic blockers

Adults: Titrate dosage individually, starting with 20 to 40 mg P.O. (immediate-release) t.i.d. Wait at least 3 days before increasing dosage.

Hypertension, given alone or with other antihypertensives

Adults: Titrate dosage individually, starting with 20 mg P.O. (immediate release) t.i.d. Wait at least 3 days before increasing dosage. Dosage range is 20 to 40 mg P.O. t.i.d. Patient may be switched to sustained-release capsules at nearest equivalent daily dosage of immediate-release capsules, starting with 30 mg P.O. b.i.d. Effective range is 30 to 60 mg/day.

Short-term treatment of hypertension when oral therapy isn't feasible or desirable

Adults: Continuous I.V. infusion of 0.5 mg/hour (equal to 20 mg P.O. q 8 hours), or 1.2 mg/hour (equal to 30 mg P.O. q 8 hours), or 2.2 mg/hour (equal to 40 mg P.O. q 8 hours)

Off-label uses

• Raynaud's disease

• Heart failure

• Migraine

Contraindications

• Hypersensitivity to drug

• Advanced aortic stenosis

Precautions

Use cautiously in:

• hepatic or mild renal impairment

• hypotension, heart failure, significant left ventricular dysfunction

• pheochromocytoma

• pregnant or breastfeeding patients (safety not established)

• children younger than age 18 (safety not established).

Administration

• Give immediate-release capsules without regard to meals; if GI upset occurs, give with meals. Don't give with grapefruit or grapefruit juice.

• Don't open, crush, break, or let patient chew sustained-release capsules. Give with meals, but not with high-fat meals, grapefruit, or grapefruit juice.

• For I.V. use, dilute each 25-mg ampule with 240 ml of compatible I.V. fluid (such as dextrose 5% in water, normal saline solution, dextrose 5% with normal saline solution, or half-normal saline solution) to a concentration of 0.1 mg/ml.

Don't dilute with sodium bicarbonate 5% or lactated Ringer's injection (incompatible).

• Don't mix with furosemide, heparin, or thiopental.

Give by slow I.V. infusion. Titrate dosage to blood pressure response.

Adverse reactions

CNS: dizziness, headache, asthenia, drowsiness, paresthesia

CV: hypotension, peripheral edema, chest pain, increased angina, palpitations, tachycardia

GI: nausea, dyspepsia, dry mouth

Musculoskeletal: myalgia

Skin: flushing

Interactions

Drug-drug. Cimetidine: increased nifedipine blood level

Cyclosporine: increased cyclosporine blood level

Fentanyl anesthesia: increased hypotension

Drug-food. Grapefruit, grapefruit juice: increased drug blood level and effects

High-fat meal (sustained-release form): decreased drug blood level

Drug-herbs. Ephedra (ma huang), yohimbine: antagonism of drug's anti-hypertensive effect

St. John's wort: decreased nifedipine blood level

Drug-behaviors. Alcohol use: additive hypotension, increased drowsiness or dizziness

Patient monitoring

• Assess vital signs and cardiovascular status.

• Monitor fluid intake and output. Assess for signs and symptoms of heart failure.

Patient teaching

• Tell patient he may take immediate-release capsules without regard to meals. If GI upset occurs, advise him to take them with food, but not with grapefruit or grapefruit juice.

• Tell patient not to open, crush, break, or chew sustained-release capsules. Instruct him to take them with meals, but not with high-fat meals, grapefruit, or grapefruit juice.

• Tell patient to monitor blood pressure and report abnormal findings.

Advise patient to immediately report chest pain or blood pressure drop.

• Instruct patient to consult prescriber before drinking alcohol or taking herbs or over-the-counter drugs (especially cold remedies).

• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, foods, herbs, and behaviors mentioned above.

nicardipine hydrochloride

(nī-kär′də-pēn′)
n.
A calcium channel blocker that acts as a vasodilator, used orally or intravenously to treat hypertension.
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References in periodicals archive ?
Furuya, "Haemodynamic effects of nicardipine hydrochloride. Studies during its use to control acute hypertension in anaesthetized patients," British Journal of Anaesthesia, vol.
-- Cardene IV (nicardipine hydrochloride injection).
DRUG DOSAGE COST/DAY [*] amlodipine besylate 2.5-10 mg once $1.32 (5 mg) (Norvasc) daily felodipine 2.5-10 mg once $0.96 (5 mg) (Plendil) daily isradipine 5-20 mg once daily $1.22 (5 mg) (DynaCirc CR) nicardipine hydrochloride 30-60 mg twice $1.40 (30 mg (Cardene SR) daily twice daily) nifedipine 30-120 mg once $1.38 (30 mg) (Procardia XL) daily nisoldipine 20-40 mg once daily $0.93 (20 mg) (Sular) DRUG COMMENT [+] amlodipine besylate Has specifically been shown to cut mortality due (Norvasc) to nonischemic causes in patients with heart failure when used with an ACE inhibitor.
has launched nicardipine hydrochloride injection, indicated for the short-term treatment of hypertension when oral therapy is not feasible or desirable.
Those products are acebutolol hydrochloride capsules, flecainide acetate tablets, guanfacine hydrochloride tablets, nicardipine hydrochloride capsules and sotalol hydrochloride AF tablets.