nicardipine hydrochloride: clinical use

Prescribing considerations

• Use only under specialist supervision in a controlled hospital environment.
• Avoid abrupt or excessive blood-pressure reduction; account for possible reflex tachycardia.
• Use particular caution in older people and in renal or hepatic impairment, heart failure, pulmonary oedema, coronary ischaemia, acute cerebral infarction or raised intracranial pressure.
• Assess the infusion site regularly.
• The formulation contains sorbitol; hereditary fructose intolerance requires specific assessment.

Contraindications and cautions

• Hypersensitivity to nicardipine or an excipient
• Severe aortic stenosis
• Compensatory hypertension associated with an arteriovenous shunt or aortic coarctation
• Unstable angina
• Myocardial infarction within the preceding eight days

Monitoring

• Continuous blood-pressure and heart-rate monitoring during infusion
• Vital signs after stopping until stable
• Infusion-site condition
• Cardiac failure and pulmonary-oedema features
• Renal and hepatic function where clinically relevant
• Intracranial and cerebral perfusion pressures in patients at risk
• Digoxin or immunosuppressant concentrations when interacting treatment is present

Clinical pharmacology

A vascular-selective dihydropyridine that inhibits L-type calcium influx mainly in arterial smooth muscle. It lowers peripheral vascular resistance and is highly protein-bound and extensively metabolised through CYP3A4.

Formulation and product differences

• The selected product is a clear, pale-yellow solution in a brown-glass ampoule for continuous intravenous infusion.
• It should not be administered as an uncontrolled intravenous bolus.
• Peripheral administration requires appropriate dilution; compatibility and adsorption risks must be checked before mixing or selecting infusion equipment.
• The solution contains sorbitol, very little sodium and should be protected from light.

Injection

Route: Parenteral

Strengths: 10 mg/10 mL