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  • Cardene IV
    (nicardipine hydrochloride)

    THERAPEUTIC CLASS

    Calcium channel blocker (CCB) (dihydropyridine)

    DEA CLASS

    RX

    INDICATIONS

    Short-term treatment of HTN when oral therapy is not feasible or not desirable.

    ADULT DOSAGE

    Hypertension

    Short-term treatment when oral therapy is not feasible or not desirable

    Patients Not Receiving Oral Nicardipine:
    Initial: 5mg/hr IV infusion
    Titrate: May increase by 2.5mg/hr every 5 min (for rapid titration) to 15 min (for gradual titration) if desired BP reduction is not achieved
    Max: 15mg/hr
    Decrease infusion rate to 3mg/hr after BP goal is achieved w/ rapid titration

    IV Dosage as a Substitute for Oral Nicardipine Therapy:
    20mg PO q8h=0.5mg/hr IV infusion
    30mg PO q8h=1.2mg/hr IV infusion
    40mg PO q8h=2.2mg/hr IV infusion

    Transition to Oral Antihypertensives:
    Transfer to Oral Nicardipine: Give 1st dose 1 hr prior to discontinuation of infusion
    Transfer to Oral Antihypertensive Other Than Nicardipine: Initiate therapy upon discontinuation of IV nicardipine

    DOSING CONSIDERATIONS

    Renal Impairment
    Titrate slowly

    Hepatic Impairment
    Impaired Function/Reduced Hepatic Blood Flow: Consider lower dosages and titrate slowly

    Elderly
    Use low initial doses

    Other Important Considerations
    Heart Failure: Titrate slowly

    D/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 BP

    ADMINISTRATION

    IV route

    Administer by a central line or through a large peripheral vein; change infusion site q12h if administered via peripheral vein

    Premixed Sol
    No 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

    Ampules
    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 inj
    D5 and NaCl 0.45% inj
    D5 and NaCl 0.9% inj
    D5 w/ 40mEq K+
    NaCl 0.45% inj
    NaCl 0.9% inj

    IV Incompatibilities:
    Sodium bicarbonate (5%) inj
    Lactated Ringer's inj

    HOW SUPPLIED

    Inj: 2.5mg/mL [10mL, ampule]; 0.1mg/mL, 0.2mg/mL [200mL, premixed sol]

    CONTRAINDICATIONS

    Advanced aortic stenosis.

    WARNINGS/PRECAUTIONS

    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.

    ADVERSE REACTIONS

    Headache, hypotension, tachycardia, N/V.

    DRUG INTERACTIONS

    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 nicardipine; closely monitor cyclosporine levels and reduce cyclosporine dose accordingly.

    PREGNANCY AND LACTATION

    Category C, caution in nursing.

    MECHANISM OF ACTION

    Calcium channel blocker (dihydropyridine); inhibits transmembrane influx of Ca2+ ions into cardiac muscle and smooth muscle w/o changing serum Ca2+ concentrations.

    PHARMACOKINETICS

    Distribution: Vd=8.3L/kg; plasma protein binding (>95%); minimally excreted in breast milk. Metabolism: Liver (rapid and extensive). Elimination: Urine (49%), feces (43%); T1/2=14.4 hrs.

    ASSESSMENT

    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.

    MONITORING

    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.

    PATIENT COUNSELING

    Advise to seek medical attention if adverse reactions occur.

    STORAGE

    20-25°C (68-77°F). Avoid excessive heat. Protect from light. Premixed Sol: Protect from freezing.