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  • Cardene IV
    (nicardipine hydrochloride)

    OTHER BRAND NAMES

    Cardene IV Premixed

    THERAPEUTIC CLASS

    Calcium channel blocker (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 PO therapy is not feasible or not desirable

    Patients Not Receiving Oral Nicardipine:
    Initial: 5mg/hr (50mL/hr) IV infusion
    Titrate: May increase by 2.5mg/hr (25mL/hr) every 5 min (for rapid titration) to 15 min (for gradual titration) if desired BP reduction is not achieved
    Max: 15mg/hr (150mL/hr)
    Decrease infusion rate to 3mg/hr (30mL/hr) after BP goal achieved w/ rapid titration

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

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

    DOSE MODIFICATION

    Renal Impairment
    Titrate gradually

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

    Elderly
    Use low initial doses

    Other Important Modifications
    Heart Failure: Titrate gradually

    Premixed:

    Impending Hypotension/Tachycardia: D/C then restart at 3-5mg/hr when BP has stabilized and adjust to maintain desired BP

    ADMINISTRATION

    IV route

    Premixed Sol
    Do not combine Cardene IV Premixed Inj w/ any product in the same IV line or premixed container
    No further dilution is required

    Ampules
    Administered by slow continuous infusion at a concentration of 0.1mg/mL
    Each ampul (25mg) should be diluted w/ 240mL of compatible IV fluid (yielding 250mL of sol at a concentration of 0.1mg/mL

    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 potassium; NaCl 0.45% inj, NaCl 0.9% inj

    IV Incompatibilities
    Sodium bicarbonate (5%) inj, USP or lactated Ringer's inj, USP

    HOW SUPPLIED

    Inj: 2.5mg/mL [10mL], 0.1mg/mL [200mL], 0.2mg/mL [200mL]

    CONTRAINDICATIONS

    Advanced aortic stenosis.

    WARNINGS/PRECAUTIONS

    May induce or exacerbate angina in coronary artery disease (CAD) patients. Caution with 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. May occasionally produce symptomatic hypotension or tachycardia. Avoid systemic hypotension when administering in sustained acute cerebral infarction or hemorrhage. Caution in hepatic/renal impairment, reduced hepatic blood flow, and in elderly.

    ADVERSE REACTIONS

    Headache, hypotension, tachycardia, N/V.

    DRUG INTERACTIONS

    Titrate slowly with β-blockers in HF or significant left ventricular dysfunction due to possible negative inotropic effects. Increased nicardipine levels when oral nicardipine is given with cimetidine; frequently monitor response. Elevated cyclosporine levels reported with oral nicardipine; closely monitor cyclosporine levels and reduce its dose accordingly.

    PREGNANCY AND LACTATION

    Category C, not for use in nursing.

    MECHANISM OF ACTION

    Calcium channel blocker (dihydropyridine); inhibits transmembrane influx of Ca2+ ions into cardiac muscle and smooth muscles without changing serum Ca2+ concentrations.

    PHARMACOKINETICS

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

    ASSESSMENT

    Assess for advanced aortic stenosis, HF, CAD, left ventricular dysfunction, sustained 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 with 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. Diluted Sol: Stable at room temperature for 24 hrs. Premixed: Protect from freezing.