Discontinuing Nicardipine Infusion
When discontinuing nicardipine infusion, gradually taper the rate down over the last 1-2 hours before stopping completely, and be prepared for blood pressure to return toward baseline within 30-50 minutes after complete discontinuation. 1
Timing and Offset of Action
- Nicardipine has a rapid offset: After stopping the infusion, blood pressure begins to rise with approximately 50% offset of the antihypertensive effect occurring within 30 minutes (±7 minutes) 1
- However, plasma levels and gradually decreasing antihypertensive effects persist for many hours after discontinuation 1
- The offset time (defined as diastolic blood pressure increase of ≥10 mm Hg) is independent of the duration of infusion - whether you've infused for 1 hour or 24 hours, the offset timing remains similar 2
Tapering Strategy
- Gradual tapering is recommended: Reduce the infusion rate progressively during the final 1-2 hours before complete discontinuation to prevent rebound hypertension 3
- This approach mirrors the recommendation for cyclical parenteral nutrition, where tapering down during the last 1-2 hours prevents adverse metabolic events 3
- Monitor blood pressure closely during and after tapering 1
Transition to Oral Therapy
If transitioning to oral antihypertensive agents:
- For oral nicardipine capsules (TID regimen): Administer the first oral dose 1 hour prior to discontinuing the IV infusion 1
- For other oral antihypertensives: Initiate oral therapy upon discontinuation of the nicardipine infusion 1
- This overlap strategy ensures continuous blood pressure control during the transition period 1
Monitoring After Discontinuation
- Close blood pressure monitoring is essential for at least 1-2 hours after stopping the infusion, as rebound hypertension can occur 1, 2
- If blood pressure rises excessively after discontinuation, restart the infusion at a low dose (3-5 mg/hr) and re-titrate as needed 1
- Heart rate should also be monitored, though nicardipine typically causes only modest increases (approximately 10 beats/minute) 2
Special Considerations
- Patients with impaired cardiac, hepatic, or renal function require particularly close monitoring during both titration and discontinuation 1
- Infusion site management: If administered via peripheral vein, change the infusion site every 12 hours to prevent phlebitis (which typically occurs after ≥14 hours at a single site) 1, 2
- The rapid offset of nicardipine is actually advantageous compared to longer-acting agents, allowing for quick adjustment if hypotension develops 4, 5