From the Guidelines
The initial drip rate for Cardene (nicardipine) in a hypertensive emergency is 5 mg/hour, administered as a continuous intravenous infusion. This recommendation is based on the most recent and highest quality study available, which is 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. The dose can be increased by 2.5 mg/hour every 5 minutes as needed, up to a maximum of 15 mg/hour, until the desired blood pressure is achieved.
Key Considerations
- The infusion rate should be adjusted based on continuous blood pressure and heart rate monitoring.
- Cardene should be diluted in compatible IV solutions such as D5W or normal saline to a concentration of 0.1 mg/mL (100 mcg/mL) for administration.
- Nicardipine works as a dihydropyridine calcium channel blocker that causes arterial vasodilation, reducing peripheral vascular resistance and blood pressure without significantly decreasing cardiac output.
- It has a rapid onset of action (within minutes) and a relatively short half-life, making it ideal for titration in emergency situations where precise blood pressure control is needed.
Important Notes
- Contraindications and precautions should be considered, such as advanced aortic stenosis, and no dose adjustment is needed for elderly patients 1.
- Continuous blood pressure and heart rate monitoring is essential during administration to prevent potential complications and ensure effective blood pressure control.
From the Research
Initial Drip Rate for Cardene in Hypertensive Emergency
The initial drip rate for Cardene (nicardipine) in a hypertensive emergency can be determined based on the available evidence.
- The study 2 suggests that nicardipine titration was performed using doses of 4 to 15 mg/hour to achieve therapeutic goal.
- Another study 3 mentions that IV nicardipine was effective in the short-term reduction of BP in patients with severe or postoperative hypertension, but does not specify the initial drip rate.
- Study 4 does not provide information on the initial drip rate for nicardipine in hypertensive emergency.
- Study 5 compares the effectiveness of nicardipine and nitroglycerin in patients with hypertensive acute heart failure syndrome, but does not specify the initial drip rate for nicardipine.
- Study 6 discusses the use of clevidipine, a different medication, in the management of acute hypertension, and does not provide information on the initial drip rate for nicardipine.
Recommended Initial Drip Rate
Based on the available evidence, the initial drip rate for Cardene (nicardipine) in a hypertensive emergency is typically started at a dose of 4 to 15 mg/hour, with titration to achieve the therapeutic goal 2.
- It is essential to monitor the patient's blood pressure and adjust the drip rate accordingly to achieve the desired therapeutic effect.
- The initial drip rate may vary depending on the patient's condition, and it is crucial to follow the recommended guidelines and consult with a healthcare professional for specific guidance.