What is the initial infusion rate of nicardipine for hypertension?

Initial Infusion Rate for Nicardipine in Hypertension

Start nicardipine at 5 mg/hr as a continuous IV infusion. 1, 2, 3, 4

Starting Dose

• Begin at 5 mg/hr IV infusion for all patients with hypertensive emergencies, regardless of the specific clinical scenario 1, 4
• This initial rate is consistent across major guidelines including the ACC/AHA, European Society of Cardiology, and FDA labeling 1, 4

Titration Protocol

Standard Titration

• Increase by 2.5 mg/hr increments to achieve target blood pressure 1, 2, 3
• Maximum dose is 15 mg/hr 1, 2, 3, 4

Titration Timing (Choose Based on Clinical Urgency)

• For gradual blood pressure reduction: Increase every 15 minutes 1, 2, 3, 4
• For rapid blood pressure reduction: Increase every 5 minutes 1, 2, 3, 4

The choice between 5-minute versus 15-minute intervals depends on the clinical scenario—use 5-minute intervals for compelling conditions like aortic dissection where rapid control is critical, and 15-minute intervals for most other hypertensive emergencies where gradual reduction is safer 1

Maintenance Dosing

• Once target BP is achieved, reduce to 3 mg/hr as a maintenance infusion 1, 2
• This lower maintenance rate helps sustain blood pressure control while minimizing adverse effects 1, 2

Pharmacokinetic Considerations

• Onset of action: 5-15 minutes after starting infusion 1, 2, 3
• Duration of action: 30-40 minutes after discontinuation 1, 2, 3
• These rapid pharmacokinetics make nicardipine highly titratable and allow for quick adjustments 1, 2, 3

Critical Preparation Requirements

• Single-dose vials (25 mg/10 mL) MUST be diluted before use 4
• Pre-mixed flexible containers (0.1 mg/mL or 0.2 mg/mL) are ready to use without dilution 4
• Failure to dilute concentrated vials is a common error that can lead to dosing mistakes 4

Common Pitfalls to Avoid

• Do NOT confuse mg/hr with mg/kg/min—nicardipine IV dosing is always in mg/hr, not weight-based 2, 3
• Change infusion site every 12 hours to minimize peripheral venous irritation and phlebitis 4, 5
• Avoid small veins (dorsum of hand or wrist) to reduce risk of thrombophlebitis 4
• Do not use in advanced aortic stenosis—this is an absolute contraindication 1, 4

Monitoring Requirements

• Continuous blood pressure monitoring during active titration 2, 3
• Monitor heart rate as nicardipine can cause reflex tachycardia (approximately 10 beats/minute increase) 1, 5
• If hypotension or excessive tachycardia occurs, discontinue immediately and restart at lower doses (3-5 mg/hr) once stabilized 4