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Calcium channel blocker (CCB) (dihydropyridine)
Short-term treatment when oral therapy is not feasible or not desirablePatients Not Receiving Oral Nicardipine: Initial: 5mg/hr IV infusionTitrate: May increase by 2.5mg/hr every 5 min (for rapid titration) to 15 min (for gradual titration) if desired BP reduction is not achievedMax: 15mg/hrDecrease infusion rate to 3mg/hr after BP goal is achieved w/ rapid titrationIV Dosage as a Substitute for Oral Nicardipine Therapy:20mg PO q8h=0.5mg/hr IV infusion30mg PO q8h=1.2mg/hr IV infusion40mg PO q8h=2.2mg/hr IV infusionTransition to Oral Antihypertensives: Transfer to Oral Nicardipine: Give 1st dose 1 hr prior to discontinuation of infusionTransfer to Oral Antihypertensive Agent Other Than Nicardipine: Initiate therapy upon discontinuation of IV nicardipine
Renal ImpairmentTitrate slowlyHepatic ImpairmentImpaired Function/Reduced Hepatic Blood Flow: Consider lower dosages and titrate slowlyElderlyUse low initial dosesAdverse ReactionsD/C infusion if there is concern of impending hypotension/tachycardia; may restart infusion at low doses (3-5mg/hr) when BP has stabilized and adjust to maintain desired BPOther Important ConsiderationsHeart Failure: Titrate slowly
Administer by a central line or through a large peripheral vein; change infusion site q12h if administered via peripheral vein.Premixed SolNo further dilution is required.Do not combine w/ any product in the same IV line or premixed container; do not add supplementary medication to the bag.Do not use plastic containers in series connections.AmpulesMust be diluted before infusion.Administer by slow continuous infusion at a concentration of 0.1mg/mL.Dilute each ampule (25mg) w/ 240mL of compatible IV fluid (yielding 250mL of sol at a concentration of 0.1mg/mL); diluted sol is stable for 24 hrs at room temperature.IV Compatibilities:Compatible and stable in glass or polyvinyl chloride containers for 24 hrs at controlled room temperature w/: D5 injD5 and NaCl 0.45% injD5 and NaCl 0.9% injD5 w/ 40mEq K+NaCl 0.45% injNaCl 0.9% injIV Incompatibilities:Sodium bicarbonate (5%) injLactated Ringer's inj
Inj: 2.5mg/mL [10mL, ampule]; 0.1mg/mL, 0.2mg/mL [200mL, premixed sol]
Advanced aortic stenosis.
May occasionally produce symptomatic hypotension or tachycardia. Avoid systemic hypotension when administering drug to patients who have sustained an acute cerebral infarction or hemorrhage. May induce or exacerbate angina in coronary artery disease (CAD) patients. Caution w/ heart failure (HF) or significant left ventricular dysfunction. To reduce possibility of venous thrombosis, phlebitis, local irritation, swelling, extravasation, and occurrence of vascular impairment, administer through large peripheral or central veins; change IV site q12h to minimize risk of peripheral venous irritation.
Headache, hypotension, tachycardia, N/V.
Titrate slowly when used in combination w/ β-blockers in patients w/ HF or significant left ventricular dysfunction due to possible negative inotropic effects. Increased nicardipine levels when oral nicardipine is given w/ cimetidine; frequently monitor response in patients receiving both drugs. Elevated cyclosporine levels reported w/ oral or IV nicardipine; closely monitor cyclosporine levels and reduce cyclosporine dose accordingly. May increase tacrolimus levels; closely monitor tacrolimus levels and adjust tacrolimus dose accordingly.
Pregnancy: Category C.Lactation: Minimally excreted into human milk. Caution in nursing.
CCB (dihydropyridine); inhibits transmembrane influx of Ca2+ ions into cardiac muscle and smooth muscle w/o changing serum Ca2+ concentrations.
Distribution: Vd=8.3L/kg; plasma protein binding (>95%); minimally excreted in breast milk. Metabolism: Liver (rapid and extensive) via CYP2C8, 2D6, and 3A4. Elimination: Urine (49%), feces (43%); T1/2=14.4 hrs.
Assess for advanced aortic stenosis, HF, CAD, left ventricular dysfunction, acute cerebral infarction or hemorrhage, hepatic/renal impairment, pregnancy/nursing status, and possible drug interactions.
Monitor for symptomatic hypotension, tachycardia, induction or exacerbation of angina, and other adverse reactions. Monitor BP and HR during administration. Closely monitor responses w/ impaired liver function or reduced hepatic blood flow.
Advise to seek medical attention if adverse reactions occur.
20-25°C (68-77°F). Avoid excessive heat. Protect from light. Premixed Sol: Protect from freezing.