Dosage and Management of Cardene (Nicardipine) for Hypertension and Angina
For hypertension, Cardene (nicardipine) should be administered at 20-40 mg orally three times daily for oral therapy, or started at 5 mg/hour IV with titration up to 15 mg/hour for intravenous therapy. For angina, the recommended dose is 20-40 mg orally three times daily.
Oral Nicardipine Dosing
For Hypertension:
- Starting dose: 20 mg three times daily 1
- Dose range: 20-40 mg three times daily 1, 2
- Allow at least 3 days before increasing dose to ensure steady-state plasma concentrations 1
- Blood pressure response should be measured:
- At trough (8 hours after dosing) to assess adequacy of response
- 1-2 hours after dosing to assess peak effects, particularly during initiation 1
For Angina:
- Starting dose: 20 mg three times daily 1
- Effective dose range: 20-40 mg three times daily 1, 2
- Allow at least 3 days before increasing dose 1
- Significant improvement in exercise tolerance and time to onset of angina has been demonstrated at doses of 30-40 mg three times daily 2
Intravenous Nicardipine Dosing for Hypertensive Emergencies
- Initial dose: 5 mg/hour 3
- Titration: Increase by 2.5 mg/hour every 5 minutes 3
- Maximum dose: 15 mg/hour 3
- No dose adjustment needed for elderly patients 3
Special Populations
Renal Insufficiency:
- Careful dose titration beginning with 20 mg three times daily is advised 1
- No evidence that nicardipine impairs renal function 1
Hepatic Insufficiency:
- Start with 20 mg twice daily in patients with severely impaired hepatic function 1
- Individual titration based on clinical findings, maintaining twice daily schedule 1
Congestive Heart Failure:
- Caution is advised when titrating nicardipine dosage in patients with congestive heart failure 1
Concomitant Use with Other Agents
For Angina:
- May be safely coadministered with short- and long-acting nitrates 1
- May be safely coadministered with beta-blockers 1
- Sublingual nitroglycerin may be taken as required to abort acute anginal attacks during nicardipine therapy 1
For Hypertension:
- May be safely coadministered with thiazide diuretics 1
- May be safely coadministered with beta-blockers 1
- Can be added to basic regimen of beta-blocker, ACE inhibitor, and thiazide diuretic if either angina or hypertension remains uncontrolled 3
Side Effects and Monitoring
Common side effects include:
Most adverse effects occur in the first 3 months of treatment 4. The incidence of adverse effects appears to be dose-related 4.
For IV administration, monitor for phlebitis at the infusion site, especially after 14 hours of infusion at a single site 5.
Clinical Considerations and Cautions
- Rapid-release, short-acting dihydropyridines (like immediate-release nifedipine) must be avoided in the absence of concomitant beta blockade due to increased adverse potential 3
- Nicardipine has a short duration of action and is easily titratable when given intravenously 6
- Nicardipine has less negative inotropic effect and produces less reflex tachycardia than nifedipine 5
- Avoid use in patients with advanced aortic stenosis 3
- For IV therapy, intra-arterial BP monitoring is recommended for precise titration in hypertensive emergencies
Nicardipine is a dihydropyridine calcium channel blocker that reduces cell transmembrane inward calcium flux, inhibiting both myocardial and vascular smooth muscle contraction. It has prominent peripheral arterial dilatory effects with minimal effects on AV or sinus node function 3.