Nicardipine Dosage

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Hypertension

Oral:
Immediate release:
Initial dose: 20 mg orally 3 times a day
Maintenance dose: 20 to 40 mg orally 3 times a day

Sustained release:
Initial dose: 30 mg orally twice a day
Maintenance dose: 30 to 60 mg orally twice a day

IV infusion:
As substitute for oral therapy:
The following IV infusion rates are required to produce an average plasma level corresponding to a given oral dose at steady state:
20 mg orally every 8 hours is equivalent to 0.5 mg/hour via IV infusion
30 mg orally every 8 hours is equivalent to 1.2 mg/hour via IV infusion
40 mg orally every 8 hours is equivalent to 2.2 mg/hour via IV infusion

For initiation of therapy in patient not receiving oral nicardipine:
Initial dose: 5 mg/hour by IV infusion
The infusion rate may be increased by 2.5 mg/hour every 5 to 15 minutes (rapid and gradual titration, respectively) up to a maximum of 15 mg/hour, until desired blood pressure reduction is achieved. The infusion rate should be decreased to 3 mg/hour following achievement of the blood pressure goal using rapid titration.

Maintenance dose: The rate of infusion should be adjusted as needed to maintain desired response.

If oral nicardipine is to be used after IV nicardipine, the first dose should be administered 1 hour prior to discontinuation of the IV infusion.

Usual Adult Dose for Angina Pectoris Prophylaxis

Oral:
Immediate release:
Initial dose: 20 mg orally 3 times a day
Maintenance dose: 20 to 40 mg orally 3 times a day

Sustained release:
Initial dose: 30 mg orally twice a day
Maintenance dose: 30 to 60 mg orally twice a day

IV infusion:
The following IV infusion rates are required to produce an average plasma level corresponding to a given oral dose at steady state:
20 mg orally every 8 hours is equivalent to 0.5 mg/hr IV infusion
30 mg orally every 8 hours is equivalent to 1.2 mg/hr IV infusion
40 mg orally every 8 hours is equivalent to 2.2 mg/hr IV infusion

Initiation of therapy: 5 mg/hour by IV infusion
May increase by 2.5 mg/hour every 5 to 15 minutes up to a maximum of 15 mg/hour

Usual Adult Dose for Congestive Heart Failure

Oral:
Immediate release:
Initial dose: 20 mg orally 3 times a day
Maintenance dose: 20 to 40 mg orally 3 times a day

Sustained release:
Initial dose: 30 mg orally twice a day
Maintenance dose: 30 to 60 mg orally twice a day

IV infusion:
The following IV infusion rates are required to produce an average plasma level corresponding to a given oral dose at steady state:
20 mg orally every 8 hours is equivalent to 0.5 mg/hr IV infusion
30 mg orally every 8 hours is equivalent to 1.2 mg/hr IV infusion
40 mg orally every 8 hours is equivalent to 2.2 mg/hr IV infusion

Initiation of therapy: 5 mg/hour by IV infusion
May increase by 2.5 mg/hour every 5 to 15 minutes up to a maximum of 15 mg/hour

Renal Dose Adjustments

The manufacturer recommends caution during titration of this drug in patients with renal dysfunction. IV nicardipine should be titrated slowly in such patients.

Liver Dose Adjustments

Oral:
Immediate release: The manufacturer recommends caution when administering to patients with severe liver dysfunction. An initial dose of 20 mg orally twice a day is recommended. The dose should be titrated according to clinical findings, maintaining the twice a day regimen.

Sustained release: The manufacturer recommends caution when administering to patients with liver dysfunction. This formulation has not been studied in patients with severe liver dysfunction.

IV: The manufacturer recommends titrating slowly in patients with liver dysfunction or reduced hepatic blood flow. Lower dosages should be considered and response should be monitored closely in such patients.

Dose Adjustments

At least 3 days should be allowed before increasing the dose to assure steady state levels.

The IV infusion should be discontinued if hypotension or tachycardia occurs. Following stabilization of blood pressure and heart rate, the infusion should be restarted at low doses (such as 3 to 5 mg/hour) and titrated to maintain desired response.

Precautions

Use in patients with advanced aortic stenosis is contraindicated because of the afterload reduction effect of nicardipine.

Because nicardipine decreases peripheral resistance, close monitoring of blood pressure and heart rate during administration is required. Nicardipine, like other calcium channel blockers, may occasionally produce symptomatic hypotension or tachycardia. Systemic hypotension should be avoided when administering the drug to patients who have sustained an acute cerebral infarction or hemorrhage.

Nicardipine should be titrated slowly, particularly when used in combination with a beta-blocker, in patients with heart failure or significant left ventricular dysfunction due to possible negative inotropic effects.

No dosage adjustment is recommended based on age. Steady-state pharmacokinetics were similar between elderly (greater than 65 years of age) patients and young health subjects in clinical studies. However, caution is advised in dose selection because of a greater incidence of reduced organ function, concomitant disease, or drug therapy in the elderly.

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Data not available

Other Comments

To assess the adequacy of blood pressure response, the blood pressure should be measured at trough. Because of prominent peak effects, blood pressure should be measured 1 to 2 hours after dosing with the immediate release formulation and 2 to 4 hours after dosing with the sustained release formulation, particularly during initiation of therapy or following a dose increase.

IV nicardipine should be administered through large peripheral veins or central veins rather than arteries or small peripheral veins to reduce the risk of venous thrombosis, phlebitis, local irritation, swelling, extravasation, and vascular impairment. To minimize the risk of peripheral venous irritation, the nicardipine infusion site should be changed every 12 hours.

Hide
(web1)