Is Nicardia (nicardipine) an antihypertensive medication?

Nicardipine (Nicardia) is an Antihypertensive Medication

Yes, Nicardia (nicardipine) is definitely an antihypertensive medication indicated for the treatment of hypertension, as clearly stated in its FDA drug label. 1

Pharmacological Classification and Mechanism

• Nicardipine is a dihydropyridine calcium channel blocker (CCB) that works by blocking calcium influx through cell membrane channels, resulting in arterial vasodilation 2
• It primarily reduces blood pressure by decreasing total peripheral vascular resistance rather than by affecting cardiac output 3
• As a calcium channel blocker, nicardipine is recognized as one of the parenteral drugs for treatment of hypertensive emergencies in major guidelines 4

Clinical Indications

• Nicardipine has dual FDA-approved indications for both hypertension and chronic stable angina 1
• It can be used as monotherapy or in combination with other antihypertensive drugs such as beta-blockers or thiazide diuretics 1
• The oral form is typically dosed at 20-40 mg three times daily for hypertension, with at least 3 days between dose increases to ensure steady-state plasma concentrations 1

Efficacy in Hypertension Management

• Clinical trials have demonstrated that nicardipine produces dose-related decreases in both systolic and diastolic blood pressure 1
• In placebo-controlled studies, nicardipine administered three times daily showed statistically significant blood pressure reductions at both peak (1 hour post-dosing) and trough (8 hours post-dosing) 1
• There is a notable peak-to-trough difference in blood pressure effect, with approximately 50% of the antihypertensive effect lost by the end of the dosing interval 1

Role in Hypertensive Emergencies

• Intravenous nicardipine is specifically listed in guidelines as one of the parenteral drugs for treatment of hypertensive emergencies 4
• The American College of Cardiology recommends nicardipine as a preferred agent for specific hypertensive emergency scenarios including acute renal failure, eclampsia/preeclampsia, and perioperative hypertension 4
• Nicardipine has an onset of action of 5-10 minutes and a duration of action of 15-30 minutes, which may extend beyond 4 hours 4

Special Considerations

• Nicardipine has a favorable hemodynamic profile compared to some other antihypertensives, with less negative inotropic effect and less reflex tachycardia than nifedipine 5
• It can be safely administered to patients with certain types of conduction disturbances as it does not significantly affect sinoatrial and atrioventricular conduction 6
• When transitioning from intravenous to oral therapy, studies have shown that oral nicardipine can effectively maintain blood pressure control initially achieved with intravenous administration 7

Common Side Effects

• Side effects are generally dose-related and more frequent during the first few weeks of therapy 2
• Most common adverse effects include headache, flushing, and peripheral edema, which are typically minor and transient 2
• When administered intravenously, local phlebitis may develop at the infusion site, particularly with prolonged administration 5

Precautions

• Careful dose titration is advised in patients with renal insufficiency, starting with 20 mg three times daily 1
• In patients with severely impaired hepatic function, a starting dose of 20 mg twice daily is recommended with individual titration 1
• Caution is warranted when titrating nicardipine dosage in patients with congestive heart failure 1

Nicardipine represents an effective option in the antihypertensive armamentarium, with proven efficacy in both chronic hypertension management and acute hypertensive scenarios.