CARDENE IN 0.83% SODIUM CHLORIDE IN PLASTIC CONTAINER
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Nicardipine is a dihydropyridine calcium channel blocker that inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle, causing vasodilation and reduced myocardial contractility.
| Metabolism | Hepatic via CYP3A4 and CYP2C8 |
| Excretion | Primarily hepatic metabolism; <1% excreted unchanged in urine. Biliary/fecal excretion accounts for approximately 35% of metabolites. |
| Half-life | Terminal elimination half-life is approximately 2-4 hours in healthy adults; prolonged to about 7 hours in cirrhosis or hepatic impairment. |
| Protein binding | >95% bound primarily to albumin. |
| Volume of Distribution | 0.6-1.5 L/kg; extensive tissue distribution with high affinity for vascular smooth muscle. |
| Bioavailability | Intravenous: 100%; Oral: approximately 35% due to extensive first-pass metabolism. |
| Onset of Action | Intravenous: 1-2 minutes; Oral: 20-30 minutes. |
| Duration of Action | Intravenous: blood pressure reduction lasts 5-15 minutes after infusion cessation; Oral: 3-6 hours for antihypertensive effect. |
| Molecular Weight | 515.6 |
Intravenous infusion of 5 mg/hour initially, titrated by 2.5 mg/hour every 15 minutes up to 15 mg/hour for acute hypertension. Typical infusion rate: 5-15 mg/hour.
| Dosage form | INJECTABLE |
| Renal impairment | No dosage adjustment required for mild to moderate renal impairment (CrCl >30 mL/min). For severe renal impairment (CrCl <30 mL/min), use with caution; no specific dose reduction recommended but monitor closely. |
| Liver impairment | In Child-Pugh Class A or B, reduce initial infusion rate to 2.5 mg/hour and titrate slowly. Avoid use in Child-Pugh Class C due to significant accumulation. |
| Pediatric use | For children ≥2 years: Initial intravenous infusion of 0.5-1 mcg/kg/minute, titrate by 0.5 mcg/kg/minute every 5-15 minutes to desired effect. Maximum: 5 mcg/kg/minute. |
| Geriatric use | Initiate at lower end of dosing range (2.5-5 mg/hour intravenous infusion) and titrate slowly due to increased sensitivity and potential for hypotension. |
| 1st trimester | Avoid due to potential teratogenicity (animal studies show adverse effects; human data limited). |
| 2nd trimester | Use only if benefit outweighs risk; monitor for hypotension and fetal growth restriction. |
| 3rd trimester | Avoid because of risk of fetal hypotension, oligohydramnios, and neonatal adverse effects. |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Placental transfer | Crosses placenta; detected in fetal plasma at maternal levels. |
| Breastfeeding | Excreted into breast milk in low amounts (less than 1% of maternal dose). Limited human data; caution advised due to potential for hypotension in infant. |
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | NICARDIPINE (CARDENE) - Teratogenic risk profile: First trimester: Limited human data; animal studies show no teratogenicity at clinically relevant doses. Second and third trimesters: No increased risk of major malformations reported; potential for maternal hypotension and fetal hypoxia with high doses. Avoid use in pregnancy-induced hypertension unless benefit outweighs risk. |
| Fetal Monitoring | NICARDIPINE (CARDENE) - Maternal-fetal monitoring: Monitor maternal blood pressure and heart rate frequently; fetal heart rate monitoring during intravenous administration in pregnancy due to risk of fetal bradycardia. Assess for signs of hypotension, peripheral edema, and hepatic function. |
| Fertility Effects | NICARDIPINE (CARDENE) - Fertility effects: No evidence of impaired fertility in animal studies. In humans, no known impact on fertility; however, calcium channel blockers may theoretically affect sperm motility. |
■ FDA Black Box Warning
No FDA boxed warning.
| Common Effects | fluid replacement |
| Serious Effects |
Hypersensitivity to nicardipine or any componentAdvanced aortic stenosis (risk of hemodynamic collapse)Hypotension (systolic BP <90 mmHg)Concomitant use with rifampin (reduces nicardipine efficacy)
| Precautions | Use caution in patients with heart failure, hepatic impairment, renal impairment, or acute cardiovascular disease. May cause hypotension, tachycardia, and peripheral edema. Monitor blood pressure and heart rate during infusion. Avoid abrupt discontinuation. Use with caution in patients with coronary artery disease due to possible reflex tachycardia. |
| Food/Dietary | Grapefruit products (fruit and juice) should be avoided as they inhibit CYP3A4 metabolism of nicardipine, increasing its serum concentration and risk of hypotension and other adverse effects. No other significant food interactions known. |
| Clinical Pearls | Cardene (nicardipine) IV is a dihydropyridine calcium channel blocker used for short-term treatment of hypertension when oral therapy is not feasible. It has rapid onset and is titratable. Monitor for hypotension, reflex tachycardia, and peripheral edema. Use with caution in patients with aortic stenosis, coronary artery disease, or heart failure. It is compatible with 0.83% sodium chloride; avoid adding other drugs. Protect from light. Titrate based on blood pressure response. Hypotension may be profound in volume-depleted patients. |
| Patient Advice | This medication is given intravenously to lower your blood pressure. Report any dizziness, lightheadedness, or fainting immediately. · You may experience swelling in your legs or ankles. Notify your healthcare provider if this becomes bothersome. · Avoid sudden changes in position (e.g., standing up quickly) to prevent falls. · Do not consume grapefruit or grapefruit juice while on this medication, as it can increase the drug's effects and risk of side effects. · Inform your doctor if you have a history of liver or kidney disease, heart problems, or if you are pregnant or breastfeeding. |
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