From the Research
The recommended Cardene (nicardipine) bolus dose for managing acute hypertension is typically 20 mcg/kg administered intravenously over 1-2 minutes, as supported by the most recent and highest quality study available 1.
Key Considerations for Administration
- The bolus dose can be followed by a continuous infusion starting at 5 mg/hour, which can be titrated by 2.5 mg/hour every 5-15 minutes as needed, up to a maximum of 15 mg/hour.
- For practical administration, the bolus should be diluted according to institutional protocols, usually in normal saline or D5W.
- Blood pressure should be monitored continuously or at least every 5 minutes during initial titration.
Mechanism of Action and Safety
- Nicardipine is a dihydropyridine calcium channel blocker that works by relaxing vascular smooth muscle, causing vasodilation and reducing peripheral vascular resistance.
- It has a rapid onset of action (within 1-5 minutes) and a relatively short duration, making it suitable for acute blood pressure management.
- Caution should be exercised in patients with heart failure, and dose adjustments may be necessary in hepatic impairment.
- The medication should be administered via a central line when possible or through a large peripheral vein to avoid extravasation.
Clinical Evidence
- Studies have shown that nicardipine is effective in reducing blood pressure in patients with acute hypertension, with a rapid onset of action and minimal side effects 2, 1.
- The choice of nicardipine over other antihypertensive agents may depend on individual patient factors, such as comorbidities and concomitant medications.