Is it safe to administer a Cardene (nicardipine) drip at 2.5 mg/hour?

From the Guidelines

Administering a Cardene (nicardipine) drip at 2.5 mg/hour is generally considered safe, but it is on the lower end of the recommended dosing range. The recommended dosing range for nicardipine is typically between 5-15 mg/hour, with a starting dose of 5 mg/hour and titration up or down based on blood pressure response 1. According to the 2019 European Heart Journal study, the dose of nicardipine can be increased every 15-30 minutes with 2.5 mg until goal BP is reached, and then decreased to 3 mg/h 1. The 2018 Circulation guideline also supports this dosing range, with an initial dose of 5 mg/h and increases of 2.5 mg/h every 5 minutes to a maximum of 15 mg/h 1. Key considerations when administering nicardipine include:

• Continuous blood pressure monitoring with measurements every 5-15 minutes during initiation and dose adjustments
• Reducing blood pressure by no more than 25% in the first hour
• Monitoring for side effects such as reflex tachycardia, headache, flushing, and potential hypotension if the dose is too high for the individual patient. It is essential to consider the clinical context and individual patient factors, such as age, hepatic impairment, and sensitivity to calcium channel blockers, when determining the appropriate dose of nicardipine.

From the FDA Drug Label

When substituting for oral nicardipine therapy, use the intravenous infusion rate as follows: 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 initial infusion rate is 5 mg/hr and can be increased by 2.5 mg/hr, which means that 2.5 mg/hr is an incremental dose, not an initial dose. However, after stabilization, the patient can be restarted at low doses such as 3 to 5 mg/hr 2.

• The dose of 2.5 mg/hr is not explicitly mentioned as an initial or maximum dose, but rather as an incremental increase.
• It is not directly stated that 2.5 mg/hr is a safe or recommended dose, but rather that it can be used to increase the infusion rate.
• It is safe to administer a Cardene (nicardipine) drip at an initial rate of 5 mg/hr and then increase by 2.5 mg/hr, but the provided information does not directly support administering the drip at 2.5 mg/hr as an initial dose.

From the Research

Administration of Cardene Drip

• The administration of a Cardene (nicardipine) drip at 2.5 mg/hour is a consideration for managing certain cardiovascular conditions, including hypertension and angina pectoris.
• According to the available studies, nicardipine is effective in lowering blood pressure and improving symptoms in patients with hypertension and angina 3, 4.
• The drug has been shown to be well-tolerated, with side effects that are generally dose-related and transient, including headache, flushing, and peripheral edema 3, 5.

Safety and Efficacy

• A study published in 2024 evaluated the efficacy and safety of nicardipine in adults with reduced ejection fractions presenting with acute heart failure with hypertension (AHF-H) 6.
• The results of this study suggest that nicardipine is safe and effective in this patient population, with a low incidence of adverse events such as hypotension and bradycardia.
• Another study published in 2001 demonstrated the efficacy of nicardipine in preventing spasm in radial artery grafts during coronary artery bypass grafting (CABG) 7.

Dosage and Titration

• The dosage of nicardipine can be titrated according to the patient's response, with a typical starting dose of 0.25 microgram/kg/min 7.
• The maximum dose of nicardipine is not explicitly stated in the available studies, but it is generally recommended to start with a low dose and titrate upwards as needed to achieve the desired therapeutic effect.
• It is essential to monitor the patient's blood pressure and heart rate closely during nicardipine administration and adjust the dose accordingly to minimize the risk of adverse events 6.