Maximum Nicardipine Infusion Rate
The ceiling dose for intravenous nicardipine is 15 mg/hr, which is the absolute maximum supported by all major guidelines including the American Heart Association and American College of Cardiology. 1, 2
Standard Dosing Protocol
- Start at 5 mg/hr and titrate by increasing 2.5 mg/hr every 5-15 minutes until desired blood pressure reduction is achieved 1, 2
- Maximum dose is 15 mg/hr regardless of clinical scenario 1, 2, 3
- Once target blood pressure is reached, reduce to 3 mg/hr as maintenance dose 2, 3
Important Dosing Considerations for Your Preparation
Your preparation of 10 mg in 10 mL (1 mg/mL concentration) means:
- At 15 mg/hr maximum rate, you would infuse 15 mL/hr 1, 2
- At the starting dose of 5 mg/hr, you would infuse 5 mL/hr 1, 2
- Titration increments of 2.5 mg/hr equal 2.5 mL/hr adjustments 1, 2
Critical Monitoring Requirements
- Monitor blood pressure every 15 minutes during active titration 2, 3
- Once stable, extend monitoring to every 30 minutes for 6 hours, then hourly 2, 4
- Nicardipine has an onset of action within 5-15 minutes and offset within 30-40 minutes after discontinuation 2, 4
When Maximum Dose Fails
If blood pressure remains uncontrolled at 15 mg/hr:
- Consider switching to sodium nitroprusside for refractory hypertension 2, 3
- Alternative option: Labetalol 10-20 mg IV bolus over 1-2 minutes, which may be repeated every 10-20 minutes up to 300 mg maximum 2, 3
Common Pitfalls to Avoid
- Never exceed 15 mg/hr - this is an absolute maximum with no evidence supporting higher doses 2, 3
- Administer through a central line or large peripheral vein to minimize infusion site reactions, especially with prolonged infusions beyond 14 hours at a single site 4, 5
- Avoid overly aggressive blood pressure reduction - aim for 10-15% reduction in mean arterial pressure within the first hour, not exceeding 25% reduction in the first 24 hours 1, 2
- Do not abruptly discontinue - taper gradually as rebound hypertension can occur 3