What is the dose of Nicardipine (Calcium Channel Blocker)?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: May 18, 2025 • View editorial policy

From the Guidelines

Nicardipine should be administered intravenously for acute blood pressure management, with an initial dose of 5 mg/hour, which can be increased by 2.5 mg/hour every 5-15 minutes as needed, up to a maximum of 15 mg/hour, as recommended by the most recent guidelines 1.

Key Considerations

  • The dose of nicardipine can be adjusted based on patient response, with a maximum dose of 15 mg/hour 2, 3.
  • Patients with hepatic impairment may need dose reductions, and blood pressure should be monitored closely during administration 1.
  • Common side effects of nicardipine include headache, flushing, dizziness, and peripheral edema 1.

Administration Details

  • The initial dose of nicardipine is 5 mg/hour, which can be increased by 2.5 mg/hour every 5-15 minutes as needed 2, 3.
  • The maximum dose of nicardipine is 15 mg/hour, and the dose should be reduced to 3 mg/hour for maintenance once the target blood pressure is achieved 1.
  • Nicardipine works as a calcium channel blocker, preventing calcium from entering vascular smooth muscle cells, resulting in vasodilation and reduced blood pressure 1.

Special Considerations

  • Patients with advanced aortic stenosis should not receive nicardipine, and no dose adjustment is needed for elderly patients 2, 3.
  • Nicardipine has a relatively short half-life of 2-4 hours, requiring frequent dosing when given orally 1.

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 Individualize dosage based upon the severity of hypertension and response of the patient during dosing. In a drug-free patient, initiate therapy at 5 mg/hr. Increase the infusion rate by 2.5 mg/hr to a maximum of 15 mg/hr until desired blood pressure reduction is achieved.

The recommended dose of Nicardipine is:

  • For oral administration: 20-40 mg three times a day, with a starting dose of 20 mg three times daily.
  • For intravenous administration: initiate therapy at 5 mg/hr and increase the infusion rate by 2.5 mg/hr to a maximum of 15 mg/hr until desired blood pressure reduction is achieved [4] [5]. Key points to consider when dosing Nicardipine include:
  • Individualize the dose based on patient response
  • Start with a low dose and titrate as needed
  • Monitor blood pressure closely, especially during initiation of therapy
  • Be cautious when using Nicardipine in patients with certain medical conditions, such as congestive heart failure or impaired hepatic function.

From the Research

Nicardipine Dose Information

  • The dose of nicardipine can vary depending on the patient's condition and the route of administration.
  • In the study 6, intravenous nicardipine was administered at doses of 4 to 15 mg/hour to achieve a therapeutic goal of diastolic blood pressure 95 mm Hg or less or a decrease in diastolic blood pressure of more than 25 mm Hg.
  • The onset time to achieve therapeutic response was rapid at 15 mg/hour (0.31 +/- 0.13 hours) compared to lower doses.
  • In the study 7, oral nicardipine was administered at doses of 10 mg to 40 mg three times daily to achieve a target diastolic blood pressure of less than or equal to 95 mm Hg.
  • The target diastolic blood pressure was achieved in 33 patients, with 8 patients requiring 10 mg three times daily, 21 patients requiring 20 mg three times daily, 3 patients requiring 30 mg three times daily, and 1 patient requiring 40 mg three times daily.

Comparison with Other Medications

  • In the study 8, nicardipine was compared to clevidipine for blood pressure control in hypertensive crisis, and nicardipine achieved a systolic blood pressure goal of <160 mm Hg at 2-6 hours significantly more often than clevidipine.
  • In the study 9, nicardipine was compared to clevidipine in patients with hemorrhagic stroke, and there was no significant difference in time to goal systolic blood pressure between the two groups.
  • In the study 10, clevidipine was compared to nicardipine in the treatment of hypertensive urgency and emergency in critically ill patients, and time to goal blood pressure was similar between the two groups.

Administration and Safety

  • Nicardipine can be administered intravenously or orally, and the dose and route of administration should be individualized based on the patient's condition and response to treatment.
  • In the study 6, side effects of intravenous nicardipine were minimal, consisting of headache and flushing, and local phlebitis developed at the site of infusion in 7 patients.
  • In the study 9, nicardipine had a lower risk of rebound hypertension and bradycardia compared to clevidipine in patients with hemorrhagic stroke.

References

6
Research

Intravenous nicardipine for the treatment of severe hypertension.

The American journal of medicine, 1988

10
Research

Comparison of clevidipine vs nicardipine in the treatment of hypertensive urgency and emergency in critically ill patients.

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 2024

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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.

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