Nicardipine HCL

A to Z Drug Facts

 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/Dosage

Angina (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.

 Interactions

Cyclosporine: May cause increased cyclosporine levels with possible toxicity. Other hypertensive agents: May have additive effects.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: 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.

 Precautions

Pregnancy: 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 Beta-blocker withdrawal: Patients withdrawn from beta-blockers while taking nicardipine may experience increased angina.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.

 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.

 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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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts