Home Drug Guide Nicardipine Hydrochloride

Drug Guide

Generic Name

Nicardipine Hydrochloride

Brand Names Cardene, Cardene In 4.8% Dextrose In Plastic Container, Cardene In 0.86% Sodium Chloride In Plastic Container, Cardene In 0.83% Sodium Chloride In Plastic Container, Cardene In 5.0% Dextrose In Plastic Container, Cardene SR

Classification

Therapeutic: Antihypertensive, Vasodilator

Pharmacological: Calcium Channel Blocker (Dihydropyridine)

FDA Approved Indications

  • Hypertensive crises
  • Chronic stable angina
  • Vasospastic angina

Mechanism of Action

Nicardipine selectively inhibits the influx of calcium ions into vascular smooth muscle and cardiac muscle, leading to vasodilation and decreased blood pressure.

Dosage and Administration

Adult: Typically starts at 5 mg/hr, titrate up every 5-15 min to a maximum of 15 mg/hr based on response and tolerability.

Pediatric: Use not well established; consulting specific pediatric guidelines is recommended.

Geriatric: Start at lower doses due to increased sensitivity; monitor closely.

Renal Impairment: Use with caution; dose adjustments may be necessary.

Hepatic Impairment: Use with caution; adjust dosing as needed.

Pharmacokinetics

Absorption: Rapid after IV administration.

Distribution: Widely distributed; crosses the placenta.

Metabolism: Primarily hepatic via CYP3A4.

Excretion: Metabolites excreted in urine and feces.

Half Life: Approx 2.5 to 4 hours.

Contraindications

  • Hypersensitivity to nicardipine or other dihydropyridines.
  • Severe aortic stenosis.

Precautions

  • Monitor for hypotension, tachycardia, and allergic reactions.
  • Use with caution in patients with heart failure or liver impairment.
  • Pregnancy Category C; use only if potential benefit justifies potential risk.

Adverse Reactions - Common

  • Headache (Common)
  • Flushing (Common)
  • Dizziness (Common)
  • Reflex tachycardia (Common)

Adverse Reactions - Serious

  • Hypotension (Serious)
  • Arrhythmias (Serious)
  • Palpitations (Serious)
  • Allergic reactions including rash, pruritus (Serious)

Drug-Drug Interactions

  • Simvastatin (may increase risk of myopathy)
  • Beta-blockers (additive effect on heart rate and blood pressure)

Drug-Food Interactions

  • Grapefruit juice (may increase plasma levels)

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, heart rate, and rhythm regularly during therapy. Watch for signs of hypersensitivity.

Diagnoses:

  • Impaired tissue perfusion related to vasodilation
  • Risk for hypotension

Implementation: Administer IV infusion as prescribed, monitor vitals closely, titrate dose based on response.

Evaluation: Assess reduction in blood pressure and symptom relief, monitor for adverse effects.

Patient/Family Teaching

  • Instruct patient to report any dizziness, headache, or signs of allergic reaction.
  • Advise on the importance of reporting chest pain or irregular heartbeat.
  • Explain the purpose of medication and adherence importance.

Special Considerations

Black Box Warnings:

  • None specifically for nicardipine, but caution with hypotension and reflex tachycardia.

Genetic Factors: None established.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Severe hypotension, reflex tachycardia, dizziness, possibly collapse.

Treatment: Discontinue drug, provide supportive care, consider vasopressors if hypotension persists, and administer activated charcoal if ingestion was recent.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.