ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY Guidelines for Use

of Intravenous Nicardipine Major Indications Short term treatment of hypertension when oral therapy is not feasible; added to AAMC formulary for the management of hypertension in stroke patients.

Mechanism of Action Nicardipine inhibits the transmembrane influx of calcium ions into cardiac muscle and smooth muscle without altering the serum calcium concentrations. This action will alter the contractile processes of cardiac and smooth muscle that are dependent on the movement of extracellular calcium into the cells via specific ion. Pharmacokinetics Onset of Effect 1-2 minutes Peak Effect 2.7 minutes Duration of Effects 44 minutes*
*becomes prolonged after long term infusions (>4 days)

IV

Dosing and Administration Initial dose: Titration: Maximum dose: 5 mg/hr Increase infusion by 2.5 mg/hr every 5-15 minutes until desired effect is achieved 15 mg/hr

Monitoring Continuous EKG Continuous Blood Pressure Contraindications Advanced Aortic Stenosis Severe CHF Severe hypotension or Cardiogenic shock

Adverse Effects Cardiovascular: Hypotension, Tachycardia, EKG changes, Orthostatic Hypotension, Ventricular Extrasystoles. Rarely: AV Block, ST segment depression, inverted T wave. CNS: Headache, dizziness GI: Nausea and vomiting

MISC: Sweating, thrombocytopenia, injection site reactions

Comments 1. Prolonged therapy with IV Nicardipine may require dosage reductions due to drug accumulation. 2. Due to irritation of the injection site, the manufacturer recommends that if the infusion is administered via peripheral IV line, the IV site should be changed every 12 hours to minimize peripheral venous irritation. 3. The medication may exhibit a prolonged duration of effect in those patients with renal and/or hepatic insufficiency. IV Nicardipine should be titrated carefully in patients with renal dysfunction and severe hepatic dysfunction. 4. No significant difference has been observed in the antihypertensive effect of IV Nicardipine in elderly patients (>65 years) compared with other adult patients in clinical studies. 5. For treatment of overdosage, the infusion should be stopped and standard measures including monitoring of cardiac and respiratory functions should be implemented. The patient should be positioned so as to avoid cerebral anoxia. Note: In treatment of acute hypertension in chronic hypertensives, discontinuation of infusion produced a 50% decrease in effect in approximately 30 minutes with gradually decreasing effect over the following 50 hrs.

ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY IV Additive Service Drug Name (Generic) Nicardipine Premixed Bags 20 mg / 200 ml
Nicardipine 25 mg ampoules (2.5 mg/ml, 10 ml) must be diluted before use

Storage Requirements
Store at room temp. Protect from light until ready to use. Ampoules should be protected from light until used and stored at room temperature.

Preparation None required

Resulting Concentration 0.1 mg/ml

Stability Per manufacturers expiration date on product Resulting solution is stable at room temperature for 24 hours.

Withdraw 33 ml from 250 ml bag of NSS or D5W. Inject 10 ml of Cardene IV 2.5 mg/ml.

0.1 mg/ml

Trade Name: Cardene IV Notes: 1. When determining the final concentration of the above admixture, the volume of the solution withdrawn and added, as well as the average volume of overfill was accounted for. 2. Nicardipine IV is not compatible with Sodium Bicarbonate containing solutions and Lactated Ringers. 3. The recommended dosing of nicardipine is 5 mg/hr initially with titration in 2.5 mg/hr increments every 5 minutes Dose 5 mg/hr 7.5 mg/hr 10 mg/hr 12.5 mg/hr 15 mg/hr Infusion Rate 50 ml/hr 75 ml/hr 100 ml/hr 125 ml/hr 150 ml/hr