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  • Cardene IV
    (Nicardipine HCl) - EKR

    THERAPEUTIC CLASS

    Calcium channel blocker (dihydropyridine)

    DEA CLASS

    RX

    INDICATIONS

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

    ADULT DOSAGE

    Adults: Individualize dose. Patients Not Receiving PO 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). Max: 15mg/hr. Decrease rate to 3mg/hr after BP goal achieved with rapid titration. Equivalent PO Dose to IV Dose: 20mg q8h=0.5mg/hr; 30mg q8h=1.2mg/hr; 40mg q8h=2.2mg/hr. Transition to PO Nicardipine: Give 1st dose 1 hr prior to discontinuation of infusion. Hepatic Impairment/Reduced Hepatic Blood Flow: Consider lower dosages. Renal Impairment: Titrate gradually. Elderly: Start at low end of dosing range. (Cardene Premixed) Impending Hypotension/Tachycardia: D/C then restart at 3-5mg/hr when BP has stabilized and adjust to maintain desired BP.

    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 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 PO nicardipine is given with cimetidine. Elevated cyclosporine levels reported with PO nicardipine; closely monitor cyclosporine levels and reduce its dose accordingly.

    PREGNANCY

    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 BP and HR during administration. Monitor for symptomatic hypotension, tachycardia, induction or exacerbation of angina, and hepatic/renal function.

    PATIENT COUNSELING

    Advise to seek medical attention if adverse reactions occur.

    ADMINISTRATION/STORAGE

    Administration: IV route. Refer to PI for preparation and administration instructions. Cardene IV: Dilute before infusion. Cardene Premixed: No further dilution required. Storage: 20-25°C (68-77°F). Avoid elevated temperatures. Protect from light. Store in carton until ready to use. Diluted Sol: Stable at room temperature for 24 hrs. Premixed: Protect from freezing.