Nicardipine (Cardene) Dosage and Management for Hypertension and Angina
For hypertension, nicardipine should be administered at 20-40 mg orally three times daily, while for hypertensive emergencies, intravenous nicardipine should be initiated at 5 mg/hour and titrated up to a maximum of 15 mg/hour. For angina, the recommended oral dose is 20-40 mg three times daily, with at least 3 days between dose adjustments to ensure steady-state plasma concentrations are achieved 1.
Oral Nicardipine for Hypertension
Dosing Regimen
- Initial dose: 20 mg three times daily
- Effective dose range: 20-40 mg three times daily
- Titration: Allow at least 3 days before increasing dose to ensure steady-state plasma concentrations
- Blood pressure assessment:
- Measure at trough (8 hours after dosing) to assess adequacy of response
- Also measure 1-2 hours after dosing during initiation of therapy to capture peak effects
Special Populations
- Renal insufficiency: Start with 20 mg three times daily and carefully titrate
- Hepatic insufficiency: Start with 20 mg twice daily and titrate based on clinical findings
- Congestive heart failure: Use caution when titrating dose
Intravenous Nicardipine for Hypertensive Emergencies
Dosing Regimen
- Initial dose: 5 mg/hour
- Titration: Increase every 5 minutes by 2.5 mg/hour
- Maximum dose: 15 mg/hour 2
- Monitoring: Continuous blood pressure monitoring recommended
Clinical Considerations
- Onset of action is rapid, especially at higher doses
- No dose adjustment needed for elderly patients
- Contraindicated in advanced aortic stenosis
Nicardipine for Angina
Dosing Regimen
- Initial dose: 20 mg three times daily
- Effective dose range: 20-40 mg three times daily
- Titration: Allow at least 3 days between dose increases 1
Combination Therapy
- May be safely coadministered with:
- Nitrates (both short and long-acting)
- Beta-blockers
- Thiazide diuretics
Side Effects and Monitoring
Common Side Effects
Monitoring Parameters
- Blood pressure (both peak and trough effects)
- Heart rate (may increase by approximately 10 beats/minute)
- Signs of peripheral edema
Clinical Pearls and Pitfalls
Important Considerations
- Nicardipine has a short duration of action, requiring three-times-daily dosing for oral formulation
- The maximum blood pressure lowering effect occurs approximately 1-2 hours after oral dosing
- For IV administration, phlebitis may occur at the infusion site after prolonged use (>14 hours); rotate sites as needed 4
Contraindications and Cautions
- Avoid immediate-release dihydropyridine calcium channel blockers (including nicardipine) in unstable angina/NSTEMI without concomitant beta-blockade 2
- Use with caution in patients with severe hepatic dysfunction
- Use with caution in heart failure patients
Advantages
- Produces more selective coronary vasodilation compared to systemic effects
- Effective cerebral vasodilator, increasing cerebral blood flow
- Easily titratable when administered intravenously 5
Nicardipine is an effective agent for both hypertension and angina management, with predictable pharmacokinetics and a manageable side effect profile when dosed appropriately.