CARDENE IN 0.86% SODIUM CHLORIDE IN PLASTIC CONTAINER
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Cardene (nicardipine) is a dihydropyridine calcium channel blocker that inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle, leading to vasodilation and reduced afterload.
| Metabolism | Hepatic via CYP3A4. |
| Excretion | Renal (70-80% as metabolites, <1% unchanged), fecal (20-30%) |
| Half-life | Terminal half-life 8.6 hours; in hepatic impairment, half-life may be prolonged up to 2-fold |
| Protein binding | >95% bound to albumin and alpha-1-acid glycoprotein |
| Volume of Distribution | 0.3 L/kg; extensive tissue distribution consistent with high lipophilicity |
| Bioavailability | IV: 100% (not applicable for oral; oral bioavailability ~35% due to first-pass metabolism) |
| Onset of Action | IV: 1-2 minutes |
| Duration of Action | IV: 30 minutes to 1 hour; infusion dose-dependent, titrated to effect |
| Molecular Weight | 515.99 |
Intravenous infusion: Initial dose 5 mg/hour, titrate by 2.5 mg/hour every 5 minutes as needed to maximum 15 mg/hour. For maintenance, reduce to 3 mg/hour after blood pressure controlled. Label strength: 0.1 mg/mL in 0.86% NaCl.
| Dosage form | INJECTABLE |
| Renal impairment | No specific adjustment recommended for renal impairment; use caution. |
| Liver impairment | Contraindicated in Child-Pugh Class C. Child-Pugh A-B: Reduce initial dose to 0.5 mg/hour and titrate slowly; maximum infusion rate 2 mg/hour. |
| Pediatric use | Safety and efficacy not established; no standard dosing available. |
| Geriatric use | Elderly patients: Start at lower end of dosing range (initial 3 mg/hour); titrate cautiously due to increased sensitivity and falls risk. |
| 1st trimester | Not recommended; associated with fetal bradycardia and hypotension. Use only if benefit outweighs risk. |
| 2nd trimester | May cause fetal bradycardia, hypotension, and uteroplacental insufficiency. Use caution. |
| 3rd trimester | May cause neonatal bradycardia, hypotension, and hypoglycemia. Avoid near term. |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Placental transfer | Crosses placenta; fetal plasma concentrations ~50% of maternal levels. |
| Breastfeeding | Nicardipine is excreted into breast milk in small amounts. Monitor infant for bradycardia, hypotension, and feeding difficulties. |
| Lactation Rating | L3 (Moderately Safe) - limited data, but potential for adverse effects in infant. |
| Teratogenic Risk | First trimester: Limited data, no evidence of major malformations in animal studies. Second/third trimester: May cause fetal hypoxia, placental hypoperfusion, and intrauterine growth restriction due to maternal hypotension. Avoid in preeclampsia due to risk of fetal distress. |
| Fetal Monitoring | Monitor maternal blood pressure, heart rate, and fetal heart rate. Assess for signs of placental insufficiency and fetal growth. Monitor renal function and electrolytes. |
| Fertility Effects | No adverse effects on fertility reported in animal studies; human data limited. Theoretical risk of reduced uterine blood flow with chronic use. |
■ FDA Black Box Warning
No FDA boxed warning exists for Cardene IV.
| Common Effects | fluid replacement |
| Serious Effects |
Hypersensitivity to nicardipine or any componentAdvanced aortic stenosisSevere hypotension (systolic BP <90 mmHg)Cardiogenic shock
| Precautions | May cause hypotension, especially in patients with reduced preload or on beta-blockers., Use with caution in patients with congestive heart failure due to potential negative inotropic effects., May increase angina frequency in patients with coronary artery disease., Peripheral edema may occur., Monitor blood pressure and heart rate closely during infusion. |
| Food/Dietary | No specific food interactions; maintain a low-sodium diet as recommended for hypertension. Avoid excessive grapefruit juice consumption as it may increase drug levels. |
| Clinical Pearls | Cardene IV (nicardipine) is a calcium channel blocker used for short-term treatment of hypertension when oral therapy is not feasible. Protect from light; do not use if discolored or contains precipitate. Titrate based on blood pressure response; monitor for hypotension, tachycardia, and peripheral edema. Use with caution in patients with heart failure, severe aortic stenosis, or impaired hepatic function. Administer via central line if peripheral IV access is limited due to phlebitis risk. |
| Patient Advice | This medication is given intravenously to lower blood pressure quickly. · Report any symptoms of low blood pressure such as dizziness, fainting, or excessive tiredness. · Notify your healthcare provider if you experience swelling in your ankles or feet, irregular heartbeat, or difficulty breathing. · Avoid pregnancy while on this medication; use effective contraception. · You may need frequent blood pressure monitoring during treatment. |
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