What is the maximum recommended dose of Cardene (nicardipine)?

Maximum Dose of Cardene (Nicardipine)

The maximum recommended dose of intravenous nicardipine is 15 mg/hr for hypertensive emergencies and acute stroke management. 1, 2

Standard Dosing Protocol

Initial and Maximum Dosing:

• Start at 5 mg/hr IV infusion 1, 2
• Titrate by increasing 2.5 mg/hr every 5-15 minutes 1, 2
• Maximum dose: 15 mg/hr 1, 2
• Once blood pressure target is achieved, reduce to 3 mg/hr as maintenance dose 1

Context-Specific Maximum Doses

Acute Ischemic Stroke (Pre-thrombolytic)

• Maximum 15 mg/hr when blood pressure >185/110 mmHg before rtPA administration 1
• This is the standard ceiling dose endorsed by the American Heart Association 1

Hypertensive Emergencies in Pregnancy/Pre-eclampsia

• Maximum 15 mg/hr per European Society of Cardiology recommendations 1
• Same titration protocol applies 1

Postoperative Hypertension

• Loading infusion: 10-15 mg/hr for 25 minutes 3
• Maintenance: 3-5 mg/hr 3
• The 15 mg/hr ceiling remains the upper limit even during loading 3

Important Caveats

Higher doses studied but not recommended:

• Research has evaluated doses up to 0.15 mg/kg/hr (approximately 10.5 mg/hr for a 70 kg patient) in subarachnoid hemorrhage 4
• One study used doses of 4-15 mg/hour in severe hypertension, but this represents the same 15 mg/hr maximum 5
• Despite research exploring higher doses, clinical guidelines consistently cap the maximum at 15 mg/hr 1, 2

Dose-related adverse effects:

• Higher doses (approaching 15 mg/hr) increase risk of hypotension 4
• Flushing and headache are more common at maximum doses 2, 5
• Reflex tachycardia occurs but is less pronounced than with nifedipine 5

Critical Safety Points

Blood pressure monitoring requirements:

• Continuous monitoring during titration 2
• Every 15 minutes for first 2 hours in post-thrombolytic patients 1
• Every 30 minutes for next 6 hours, then hourly for 16 hours 1

Avoid excessive blood pressure reduction:

• Target only 10-15% reduction in first hour for most hypertensive emergencies 1
• Maximum 25% reduction in first day 1
• In acute stroke, excessive reduction risks neurological worsening 1

Contraindications at any dose:

• Advanced aortic stenosis 2
• Use with extreme caution in liver failure 2