What are the recommended blood pressure parameters for a Cardene (nicardipine) drip?

Blood Pressure Parameters for Cardene (Nicardipine) Drip

For patients requiring a nicardipine (Cardene) drip, the recommended initial dose is 5 mg/hr IV infusion, which can be titrated by increasing 2.5 mg/hr every 5 minutes to a maximum of 15 mg/hr until the desired blood pressure reduction is achieved. 1

General Blood Pressure Targets

When using nicardipine for blood pressure control, the parameters vary based on the clinical scenario:

Standard Hypertension Management

• Initial goal: 10-15% reduction in blood pressure in the first hour 2
• Do not reduce blood pressure by more than 25% within the first hour 3
• For most adults, target systolic BP of 120-129 mmHg and diastolic BP <80 mmHg 2

Specific Clinical Scenarios

Acute Ischemic Stroke

• Not eligible for thrombolytic therapy:

  • If BP <220/120 mmHg: Observation only
  • If BP >220 mmHg systolic or 121-140 mmHg diastolic: Use nicardipine starting at 5 mg/hr, titrate up by 2.5 mg/hr every 5 minutes to maximum of 15 mg/hr
  • Goal: 10-15% reduction in blood pressure 2

• Eligible for thrombolytic therapy:

  • Pre-treatment: Maintain BP <185/110 mmHg
  • During/after treatment:
    • Monitor BP every 15 minutes for 2 hours, then every 30 minutes for 6 hours, then hourly for 16 hours
    • For systolic >230 mmHg or diastolic 121-140 mmHg: Nicardipine 5 mg/hr, titrate up to 15 mg/hr 2

Acute Hemorrhagic Stroke

• Target: Systolic BP between 130-180 mmHg 2
• Immediate reduction with nicardipine if systolic BP >180 mmHg 2

Malignant Hypertension

• Goal: Reduce mean arterial pressure by 20-25% over several hours 2
• Nicardipine is a first-line alternative to labetalol 2

Administration Guidelines

1. Initial Dosing:

   • Start at 5 mg/hr IV infusion 1
   • For severe hypertension, higher initial rates (5-15 mg/hr) produce more rapid responses 1

2. Titration:

   • Increase by 2.5 mg/hr every 5 minutes for rapid reduction
   • Increase by 2.5 mg/hr every 15 minutes for gradual reduction
   • Maximum dose: 15 mg/hr 1

3. Maintenance:

   • Average maintenance dose for severe hypertension: 8.0 mg/hr
   • Average maintenance dose for postoperative hypertension: 3.0 mg/hr 1

Monitoring Requirements

• Continuous blood pressure monitoring during titration
• Monitor for signs of hypotension or tachycardia
• If hypotension occurs, discontinue infusion and restart at lower dose (3-5 mg/hr) after stabilization 1
• Change infusion site every 12 hours to minimize risk of peripheral venous irritation 1

Important Considerations and Precautions

• Nicardipine may increase heart rate by approximately 10 beats/minute 4

• Avoid small veins (e.g., dorsum of hand or wrist) to reduce risk of phlebitis 1

• Avoid intraarterial administration or extravasation 1

• Use with caution in patients with:

  • Angina
  • Congestive heart failure
  • Impaired hepatic function
  • Renal impairment 1

• Factors affecting dosing requirements include:

  • Gender (men typically require higher doses)
  • Age (younger patients typically require higher doses)
  • Body weight (higher weight correlates with higher total dose)
  • Initial systolic BP (higher initial BP requires higher doses) 5

Clinical Response Timeframes

• Mean time to therapeutic response for severe hypertension: 77 ± 5 minutes
• Mean time to therapeutic response for postoperative hypertension: 12 minutes 1

Remember that the primary goal when using nicardipine is controlled reduction of blood pressure without causing hypoperfusion of vital organs. The drug's rapid onset and offset of action make it particularly suitable for precise blood pressure control in acute settings.