Nicardipine HCL
| (NYE-CAR-dih-peen HIGH-droe-KLOR-ide) |
| Cardene |
| Capsules: 20 mg, 30 mg |
| Cardene I.V. |
| Injection: 2.5 mg/mL |
| Cardene SR |
| Capsules, sustained-release: 30 mg, 45 mg, 60 mg |
| Class: Calcium channel blocker |
Action Inhibits movement of calcium ions across cell membrane in systemic and coronary vascular smooth muscle and myocardium.
Indications Treatment of chronic stable (effort-associated) angina (immediate-release capsules); management of hypertension (immediate- and sustained-release capsules; IV when oral therapy not feasible or desireable).
Contraindications Sick sinus syndrome; second- or third-degree atrioventricular (AV) block except with functioning pacemaker; advanced aortic stenosis.
Route/DosageAngina (Immediate-Release Only)
ADULTS: PO Usual initial dose 20 mg tid (range, 20 to 40 mg tid).
Hypertension
ADULTS: PO Immediate-release: Usual dose 20 mg tid (range, 20 to 40 mg tid). Sustained-release: Start with 30 mg bid (range, 30 to 60 mg bid). IV Individualize dosage based on severity of hypertension and response of patient during dosing.
InteractionsCyclosporine: May cause increased cyclosporine levels with possible toxicity. Other hypertensive agents: May have additive effects.
Lab Test Interferences None well documented.
Adverse ReactionsCV: Peripheral edema; palpitations; AV block; MI; angina; tachycardia; abnormal ECG. CNS: Dizziness; lightheadedness; asthenia; psychiatric disturbances; headache; paresthesia; somnolence; weakness. DERM: Rash. GI: Nausea; abdominal discomfort; cramps; dyspepsia; dry mouth; thirst. OTHER: Flushing; allergic reaction; myalgia.
PrecautionsPregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Antiplatelet effects: Calcium channel blockers may inhibit platelet function. Beta-blocker withdrawal: Patients withdrawn from beta-blockers while taking nicardipine may experience increased angina. Gradually taper beta-blocker dose. CHF: Use drug with caution in patients with CHF. Hepatic impairment: Adjust dosage and use drug with caution in patients with impaired hepatic function or reduced hepatic blood flow. Increased angina: Occasionally patients have increased frequency, duration, or severity of angina on starting or increasing dose. Renal impairment: Adjust dose in patients with renal dysfunction. Withdrawal: Abrupt withdrawal may cause increased frequency and duration of angina.
| PATIENT CARE CONSIDERATIONS |
|
Administration/Storage- Administer without regard to meals. Avoid giving with high-fat meals.
- If patient is taking sustained-released capsules, instruct patient to swallow capsule whole and not to chew, divide, or crush.
- If stopping medication, taper dose slowly. Stopping drug quickly could result in immediate angina.
- If patient has history of liver or renal disease, start with low doses and titrate.
- Do not increase dose for minimum of 3 days after starting medication or dose changes.
- When converting from immediate-release form to sustained-release form, note that dosage may differ.
- Store at controlled room temperature (56° to 86°F) in tight, light-resistant container.
Assessment/Interventions- Obtain patient history, including drug history and any known allergies.
- Evaluate cardiac, hepatic, renal, and thyroid function.
- Obtain baseline vital signs and monitor 1 to 2 hr and 8 hr after administration of immediate-release product and 2 to 4 hr and at end of dosing interval if sustained-release product is used.
- Obtain baseline ECG and any follow-up ECGs as ordered by health care provider.
- Assess for edema, dizziness, headache, sore throat, renal changes, palpitations, liver dysfunction, or flushing.
- If patient has history of liver, renal, or cardiac dysfunction, monitor patient closely for changes from baseline.
- If there are any changes from baseline assessment, notify health care provider.
- If used to treat angina, monitor frequency of anginal episodes and consumption of sublingual nitroglycerin.
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Patient/Family Education- Instruct patient to swallow sustained-release capsules whole and not to crush or chew.
- Caution patient that increased angina may occur initially when starting, changing dose, or stopping medication.
- Advise patient not to stop taking drug abruptly.
- Instruct patient to report the following symptoms to health care provider: any unusual bleeding, bruising, rash, palpitations, irregular heartbeat, shortness of breath, nausea, change in angina, constipation, changes in gums, dizziness, or swelling in hands or feet.
- Advise patient that drug may cause dizziness or drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
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