Can you dilute Nicardipine (nicardipine) in Physiological Normal Saline Solution (PNSS)?

Nicardipine Dilution in Normal Saline Solution

Yes, nicardipine can be diluted in physiological normal saline solution (PNSS/0.9% sodium chloride), as this is explicitly listed as a compatible diluent in the FDA-approved prescribing information. 1

Compatible Diluents for Nicardipine

The FDA label specifies that nicardipine hydrochloride injection is compatible and stable in polyvinyl chloride containers for 24 hours at controlled room temperature with the following solutions: 1

• Sodium Chloride (0.9%) Injection, USP (normal saline/PNSS) 1
• Dextrose (5%) Injection, USP 1
• Dextrose (5%) and Sodium Chloride (0.45%) Injection, USP 1
• Dextrose (5%) and Sodium Chloride (0.9%) Injection, USP 1
• Dextrose (5%) with 40 mEq Potassium, USP 1
• Sodium Chloride (0.45%) Injection, USP 1

Standard Dilution Protocol

For single-dose vials, each 25 mg vial must be diluted with 240 mL of compatible intravenous fluid (including normal saline) to yield 250 mL at a concentration of 0.1 mg/mL. 1

For premixed flexible containers, nicardipine already comes prepared in 0.9% sodium chloride injection and does not require further dilution. 1

Incompatible Solutions to Avoid

Nicardipine is NOT compatible with: 1

• Sodium Bicarbonate (5%) Injection, USP 1
• Lactated Ringer's Injection, USP 1

Concentration Considerations for Phlebitis Prevention

While normal saline is compatible, maintaining nicardipine concentration below 130 µg/mL significantly reduces the risk of phlebitis. 2 A study in acute stroke patients demonstrated that diluting nicardipine to concentrations lower than 130 µg/mL reduced phlebitis incidence from 30% to 9.9% (OR 0.15; 95% CI 0.06-0.35; P < 0.001). 2

Administration Site Recommendations

• Change the infusion site every 12 hours if administered via peripheral vein to minimize phlebitis risk. 1
• Central venous access is preferred when available, as pediatric data showed no phlebitis in patients receiving nicardipine through central lines versus superficial thrombophlebitis in 2 of 2 patients receiving peripheral administration. 3
• The American College of Cardiology and European Heart Journal guidelines recommend nicardipine as a first-line or alternative agent for hypertensive emergencies, typically administered through central access when possible. 4

Preparation Safety Checks

Inspect the solution visually before administration—do not use if particulate matter, precipitate, crystallization is present, or if the container appears damaged. 1