Nicardipine

GENERIC NAME: nicardipine

BRAND NAME: Cardene, Cardene SR, Perdipin

DRUG CLASS AND MECHANISM: Nicardipine belongs to a class of blood pressure reducing medications called calcium channel blockers (CCBs). Other medications in this class include diltiazem (Cardizem), amlodipine (Norvasc),felodipine (Plendil), verapamil (Calan, Isoptin), clevidipine (Cleviprex), and nifedipine(Adalat, Procardia). These medications block the movement of calcium into the smooth muscle cells surrounding the arteries of the body. Since calcium promotes contraction of muscle, blocking calcium entry into the muscle cells relaxes the arterial muscles and causes the arteries to become larger. This lowers blood pressure, which reduces the work that the heart must do to pump blood to the body. Reducing the work of the heart lessens the heart muscle's demand for oxygen and thereby helps prevent angina (heart pain) in patients with coronary artery disease. Unlike verapamil or diltiazem, nicardipine has little effect on heart muscle or on electrical conduction within the heart. The FDA approved nicardipine in December 1988.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS:

• Capsules: 20 and 30 mg.
• Capsules (sustained release): 30, 45, and 60 mg.
• Injection: 0.1, 0.2, and 2.5 mg/ml.

STORAGE: Nicardipine should be stored at room temperature, 15 to 30 C (59 to 86 F), and protected from light.

PRESCRIBED FOR: Oral nicardipine is used alone or in combination with other drugs for the treatment of high blood pressure. Conventional capsules (not sustained release) also are used for the treatment of angina (heart pain). Nicardipine injections are used for short-term treatment of blood pressure when oral medications are not possible or desirable.

DOSING: The recommended dose of nicardipine is 20-40 mg three times daily with conventional capsules or 30-60 mg twice daily with sustained release capsules. Intravenous infusion rates can range between 0.1 and 15 mg/hr.

DRUG INTERACTIONS: Rifampin, phenobarbital, phenytoin, oxcarbazepine (suspension oral Trileptal; oral Trileptal) and carbamazepine (Tegretol, Tegretol XR , Equetro, Carbatrol) may reduce blood levels of nicardipine by increasing its metabolism in the liver. Therapy should be monitored and drug doses should be adjusted accordingly.

Co-administration of nicardipine and cyclosporine results in increased cyclosporine blood levels. Cyclosporine blood levels should be monitored and its dosage reduced when taking nicardipine.

PREGNANCY: There are no adequate studies of nicardipine in pregnant women; Nicardipine has been used to treat the high blood pressure of preeclampsia during the third trimester of pregnancy.

NURSING MOTHERS: Animal studies show that nicardipine is secreted in breast milk. Nicardipine should be avoided by nursing mothers.

SIDE EFFECTS: Side effects of nicardipine include an increased heart rate due to the drop in blood pressure. Other side effects include swelling of the feet (edema),dizziness, headaches, flushing, palpitations, and nausea. Nicardipine sometimes can cause an increase in the frequency and duration of angina. The reason for this side effect is not clearly understood. Excessively low blood pressure can occur in rare instances, especially during initiation of treatment or following adjustments of dosage.