Nicardipine Dosing for Blood Pressure Management in the Operating Room
For blood pressure management in the operating room, nicardipine is typically administered as an IV bolus of 5-15 mg over 1-2 minutes, followed by a continuous infusion starting at 5 mg/hour and titrated up by 2.5 mg/hour every 5-15 minutes to a maximum of 15 mg/hour based on blood pressure response. 1, 2
Nicardipine IV Push (Bolus) Dosing
- Initial bolus: 5-15 mg IV over 1-2 minutes
- May repeat bolus as needed based on blood pressure response
- For rapid blood pressure control in hypertensive emergencies
Nicardipine Continuous Infusion Dosing
- Starting dose: 5 mg/hour IV infusion
- Titration: Increase by 2.5 mg/hour every 5-15 minutes
- Maximum dose: 15 mg/hour
- Maintenance dose: Once target blood pressure is achieved, typically 3-5 mg/hour
Dosing Considerations
- For gradual blood pressure reduction: Increase dose every 15 minutes
- For rapid blood pressure reduction: Increase dose every 5 minutes
- If hypotension or tachycardia occurs, discontinue infusion and restart at lower dose (3-5 mg/hour) once stabilized 2
Blood Pressure Targets
- Aim for 10-15% reduction in blood pressure initially
- For hypertensive emergencies, reduce blood pressure by no more than 25% within the first hour
- Then aim for 160/100 mmHg within 2-6 hours
- Finally normalize blood pressure over 24-48 hours 3
Monitoring Requirements
- Continuous blood pressure monitoring during administration
- Monitor heart rate for reflex tachycardia
- Change IV site every 12 hours to minimize risk of peripheral venous irritation 2
Special Considerations
- In patients with advanced aortic stenosis, nicardipine is contraindicated 2
- For patients with hepatic or renal impairment, closer monitoring is required
- Most common side effects: headache (13%), hypotension (5%), tachycardia (4%), and nausea/vomiting (4%) 2
- For aortic dissection, nicardipine may be used in combination with beta-blockers to achieve target systolic BP ≤120 mmHg and heart rate ≤60 bpm 1
Practical Application
- Single dose vials must be diluted before use
- Available as 25 mg/10 mL (2.5 mg/mL) single-dose vial, 20 mg in 200 mL (0.1 mg/mL) or 40 mg in 200 mL (0.2 mg/mL) flexible containers 2
- Onset of action: 5-15 minutes
- Duration of action: 30-40 minutes after infusion is discontinued 1
Nicardipine's rapid onset, short duration of action, and titratable nature make it particularly suitable for blood pressure management in the operating room setting, allowing for precise control during critical periods of surgery.