Can Cardene (nicardipine) cause reflex tachycardia?

From the Guidelines

Yes, Cardene (nicardipine) can cause reflex tachycardia. This is a common side effect of calcium channel blockers, particularly dihydropyridines like nicardipine. When nicardipine dilates blood vessels, it reduces peripheral vascular resistance and lowers blood pressure. The body responds to this drop in blood pressure by activating the sympathetic nervous system, which increases heart rate as a compensatory mechanism to maintain cardiac output. This reflex tachycardia is more pronounced with short-acting formulations and rapid intravenous administration. The effect is typically dose-dependent, with higher doses or rapid infusions more likely to trigger significant heart rate increases. According to the most recent and highest quality study 1, nicardipine is listed as a drug that can cause headache and reflex-tachycardia as adverse effects. Patients with pre-existing cardiac conditions should be monitored closely when starting nicardipine therapy. The reflex tachycardia can be clinically significant in patients with coronary artery disease, as increased heart rate may worsen myocardial oxygen demand and potentially exacerbate angina or ischemia. In some cases, combining nicardipine with a beta-blocker may help mitigate this reflex tachycardia.

Some key points to consider when using nicardipine include:

• The usual dose range for nicardipine is an initial 5 mg/h, increasing every 5 min by 2.5 mg/h to a maximum of 15 mg/h, as stated in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
• Nicardipine is contraindicated in advanced aortic stenosis, and no dose adjustment is needed for elderly patients 1.
• The potential for reflex tachycardia should be considered when selecting an antihypertensive agent, especially in patients with underlying cardiac conditions.

Overall, the risk of reflex tachycardia with nicardipine use should be carefully weighed against the potential benefits of blood pressure reduction, and patients should be closely monitored for signs of adverse effects.

From the FDA Drug Label

Peak responses were not observed to be associated with adverse effects during clinical trials, but physicians should be aware that adverse effects associated with decreases in blood pressure (tachycardia, hypotension, etc.) could occur around the time of the peak effect. An increase in heart rate may occur in response to the vasodilation and decrease in blood pressure, and in a few patients this heart rate increase may be pronounced In clinical studies mean heart rate at time of peak plasma levels was usually increased by 5 to 10 beats per minute compared to placebo, with the greater increases at higher doses, while there was no difference from placebo at the end of the dosing interval Tachycardia 1.2 (0.2) 0.6 (0) Tachycardia 3.4 (1.2) 0. 5 (0)

Reflex Tachycardia can occur with Cardene (nicardipine) due to its vasodilatory effects, which can lead to a decrease in blood pressure and a subsequent increase in heart rate. The incidence of tachycardia was reported in clinical trials, with a higher frequency in patients receiving nicardipine compared to placebo 2, 2, 2.

From the Research

Cardene and Reflex Tachycardia

• Cardene, also known as nicardipine, is a calcium channel blocker used to treat high blood pressure and angina 3, 4.
• The medication works by relaxing blood vessels, which can lead to a decrease in blood pressure 3, 4.
• According to a study published in 1987, the decrease in blood pressure induced by nicardipine is related to a concurrent decrease in total peripheral vascular resistance, and the antihypertensive actions of nicardipine are maintained during long-term administration without the development of tachyphylaxis 3.
• Although nicardipine may increase the heart rate acutely, tachycardia does not occur during long-term therapy 3.
• The combined use of nicardipine and beta blockers may be beneficial in the treatment of hypertension, as beta blockers may prevent reflex tachycardia and other consequences of peripheral vasodilatation 3.
• A study published in 2006 found that a bolus dose of IV nicardipine attenuated the hypertensive response, but not the increase in tachycardia, after laryngoscopy and tracheal intubation in anaesthetised patients 5.
• Another study published in 2012 reported a case of severe amlodipine intoxication, which developed important bradyarrhythmias, but noted that in most cases of severe intoxication, important hypotension and reflex tachycardia are usually observed 6.

Key Findings

• Nicardipine can cause an acute increase in heart rate, but this effect is not typically seen with long-term use 3.
• The combination of nicardipine and beta blockers may help prevent reflex tachycardia 3.
• Nicardipine has been shown to be effective in treating hypertension and angina, with a relatively good safety profile 3, 4.