Starting Rate for Cardene (Nicardipine) Drip
The recommended starting rate for a Cardene (nicardipine) drip is 5 mg/hour, with titration by increasing 2.5 mg/hour every 5 minutes to a maximum of 15 mg/hour until the desired blood pressure reduction is achieved. 1, 2
Dosing Protocol
Initial Dosing
- Start at 5 mg/hour IV infusion
- Titration: Increase by 2.5 mg/hour every 5 minutes
- Maximum dose: 15 mg/hour
- For rapid blood pressure reduction, titrate every 5 minutes; for gradual reduction, titrate every 15 minutes 2
Administration Considerations
- Single dose vials must be diluted before use
- Nicardipine is available as:
- 25 mg/10 mL (2.5 mg/mL) single-dose vial
- 20 mg in 200 mL (0.1 mg/mL) flexible container
- 40 mg in 200 mL (0.2 mg/mL) flexible container 2
Clinical Applications
Nicardipine is particularly useful in several clinical scenarios:
Hypertensive emergencies: When oral therapy is not feasible or rapid blood pressure control is needed 1
Stroke management: For patients with elevated blood pressure in ischemic stroke, especially those eligible for thrombolytic therapy with systolic BP >185 mmHg or diastolic >110 mmHg 1
Post-operative hypertension: Effective for controlling blood pressure after both cardiac and non-cardiac surgeries 3
Monitoring and Safety
- If hypotension or tachycardia occurs, discontinue the infusion
- After stabilization, restart at lower doses (3-5 mg/hour) 2
- To minimize peripheral venous irritation, change infusion site every 12 hours 2
- Monitor blood pressure frequently during titration
- Continuous cardiac monitoring is recommended during administration
Important Precautions
- Contraindicated in patients with advanced aortic stenosis 1, 2
- Use with caution in patients with:
- Heart failure
- Impaired hepatic function
- Renal impairment
- Angina 2
Advantages Over Other IV Antihypertensives
- More selective vasodilation compared to nitroprusside
- No risk of cyanide toxicity (unlike nitroprusside)
- Easily titratable with relatively rapid onset and offset of action 4
- Less reflex tachycardia than other vasodilators 5
Remember that the response to nicardipine is dose-dependent, with higher doses (15 mg/hour) achieving therapeutic response more rapidly (approximately 18-19 minutes) compared to lower doses 5.