What is the dosage of Nicardipine (Nicardipine hydrochloride)?

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Last updated: May 18, 2025 • View editorial policy

From the Guidelines

Nicardipine should be dosed at 5 mg/hour IV initially, which can be increased by 2.5 mg/hour every 5-15 minutes up to a maximum of 15 mg/hour for acute blood pressure control, as recommended by the most recent guidelines 1. The dosing of nicardipine is crucial in managing hypertensive emergencies, and the initial dose of 5 mg/hour IV can be titrated up to achieve the desired blood pressure control.

  • The dose can be increased by 2.5 mg/hour every 5-15 minutes, with a maximum dose of 15 mg/hour.
  • Once the target blood pressure is reached, the dose should be reduced to 3 mg/hour and adjusted as needed.
  • Nicardipine works as a calcium channel blocker that primarily affects vascular smooth muscle, causing vasodilation and reducing peripheral resistance, making it particularly effective for hypertensive emergencies 2.
  • When administering nicardipine, monitor blood pressure frequently to avoid hypotension, especially during dose titration, and heart rate should also be monitored as reflex tachycardia can occur 3.
  • Nicardipine should be used cautiously in patients with heart failure or hepatic impairment, and dosage adjustments may be necessary in these populations, as it is metabolized by the liver, so lower doses may be needed in patients with hepatic dysfunction 4. Key considerations for nicardipine dosing include:
  • Initial dose: 5 mg/hour IV
  • Titration: increase by 2.5 mg/hour every 5-15 minutes
  • Maximum dose: 15 mg/hour
  • Maintenance dose: 3 mg/hour once target blood pressure is reached
  • Monitoring: frequent blood pressure and heart rate monitoring, especially during dose titration.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Angina The dose should be individually titrated for each patient beginning with 20 mg three times daily. Doses in the range of 20 to 40 mg three times a day have been shown to be effective. The dose of nicardipine hydrochloride capsules should be individually adjusted according to the blood pressure response beginning with 20 mg three times daily. The effective doses in clinical trials have ranged from 20 mg to 40 mg three times daily

The recommended dose of Nicardipine is 20-40 mg three times a day, with a starting dose of 20 mg three times daily, and should be individually titrated for each patient.

  • The dose may be increased after at least 3 days to ensure achievement of steady-state plasma drug concentrations.
  • Key considerations for dosing include the patient's response to the medication and their individual characteristics, such as renal or hepatic insufficiency 5.

From the Research

Nicardipine Dosage

  • The dosage of nicardipine varies depending on the patient's condition and the route of administration.
  • For intravenous administration, the dosage can range from 4 to 15 mg/hour, with a therapeutic goal of achieving a diastolic blood pressure of 95 mm Hg or less, or a decrease in diastolic blood pressure of more than 25 mm Hg 6.
  • In one study, intravenous nicardipine titration started with 10 mg/hr and was increased slowly every 4 minutes by 1 mg/hr until the target supine diastolic blood pressure of 90 mmHg was achieved 7.
  • For oral administration, the dosage can range from 20 to 30 mg three times daily, with the option to add other antihypertensive medications such as beta blockers or diuretics if necessary 8, 9.

Administration Routes

  • Nicardipine can be administered intravenously or orally.
  • Intravenous administration is often used for severe hypertension, while oral administration is used for mild to moderate hypertension.
  • The onset of action for intravenous nicardipine is rapid, with a therapeutic response achieved within 0.31 to 1.11 hours, depending on the dose 6.
  • Oral nicardipine has also been shown to be effective in lowering blood pressure, with significant decreases in systolic and diastolic blood pressure observed after 4-5 weeks of treatment 8.

Side Effects

  • Common side effects of nicardipine include headache, flushing, and ankle edema.
  • Local phlebitis can occur at the site of infusion, especially after prolonged infusion times 6.
  • Reflex tachycardia can occur, but this is usually mild and does not correlate with plasma nicardipine levels 6.
  • Overall, nicardipine is considered to be a safe and effective medication for the treatment of hypertension, with minimal side effects 6, 8, 9.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Intravenous nicardipine for the treatment of severe hypertension.

The American journal of medicine, 1988

Research

Intravenous nicardipine for the treatment of severe hypertension. A dose-titration infusion to therapeutic response.

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 1995

Research

Nicardipine in severe hypertension: oral therapy following intravenous treatment.

International journal of clinical pharmacology, therapy, and toxicology, 1990

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.