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Cardepine

Nicardipine hydrochloride




Brand Name, Dosage Format and Strength
Cardepine   10 mg/10 mL  Solution for Injection


DOSAGE AND ADMINISTRATION

Nicardipine injection is intended for IV infusion. Dosage must be individualized depending on the severity of HTN and patient response during dosing.

Monitor BP and heart rate both during and after the infusion; avoid too rapid or excessive reduction in either SBP or DBP during parenteral treatment.

Preparation of infusion solution:
 
Dilution instructions: Nicardipine Injection must be diluted prior to administration. It is administered by slow continuous IV infusion at a concentration of 0.1 mg/mL. Nicardipine infusion solution is prepared by adding the necessary volume of nicardipine injection to a compatible infusion fluid. (see Table 1.)
Table 1. Nicardipine Injection Dilution Table
Format
Amount (Volume) of Nicardipine Injection
Volume of IV Infusion Solution Needed (Diluent)*
Total Volume of Infusion Solution
(mL Drug + mL Diluent)
Desired Final Concentration of Infusion Solution
2 mg
per    
2 mL
10 mg (10 mL) or
5 ampules
90 mL
100 mL
0.1 mg/mL
25 mg (25 mL) or 12½ ampules
225 mL
250 mL
0.1 mg/mL
10 mg
per  
10 mL
10 mg (10 mL) or
1 ampule
90 mL
100 mL
0.1 mg/mL
25 mg (25 mL) or 2½ ampules
225 mL
250 mL
0.1 mg/mL
Notes:
*Nicardipine injection has been found to be compatible and stable in glass or polyvinyl chloride containers with the following infusion fluids:
  -        Dextrose (5%) Injection
  -        Dextrose (5%) and Sodium Chloride (0.45%) Injection
  -        Dextrose (5%) and Sodium Chloride (0.9%) Injection
  -        Dextrose (5%) with 40 mEq Potassium
  -        Sodium Chloride (0.45%) Injection
  -        Sodium Chloride (0.9%) Injection
  • Nicardipine Injection is NOT compatible with Sodium Bicarbonate (5%) Injection or Lactated Ringer’s Injection.
  • The diluted solution is stable for 24 hrs at room temperature.

Dosage as a substitute for oral nicardipine:
 
For patients who are maintained on oral nicardipine therapy and are being switched to IV therapy, the infusion rates necessary to produce an average plasma concentration equivalent to steady state oral doses are as follows (see Table 2)
Table 2. Equivalent Oral and IV Nicardipine Doses
Oral Dose
Equivalent IV Infusion Rate
20 mg every 8 hrs
0.5 mg/hr
30 mg every 8 hrs
1.2 mg/hr
40 mg every 8 hrs
2.2 mg/hr
Dosage for initiation of therapy in patients not currently receiving antihypertensive therapy:
 
Administer nicardipine injection by slow continuous IV infusion at a concentration of 0.1 mg/mL. With constant infusion in patients not currently receiving antihypertensive therapy, BP begins to decrease within min. BP reaches approximately 50% of its ultimate reduction in about 45 min and does not reach final steady state for about 50 hrs. (see Table 3.)
  
 Table 3. Nicardipine IV Infusion Dosing and Titration
Indication/Effect
Initial Infusion Rate
Dose Titration
Maximum Dose
For gradual BP reduction
50 mL/hr
(5 mg/hr)
Increase infusion rate by 25 mL/hr (2.5 mg/hr) every 15 min if optimal BP is not achieved at initial dose.
150 mL/hr
(15 mg/hr)
For more rapid BP reduction
50 mL/hr
(5 mg/hr)
Increase infusion rate by 25 mL/hr (2.5 mg/hr) every 5 min if optimal BP is not achieved at initial dose.
150 mL/hr
(15 mg/hr)
Maintenance Dose: Adjust infusion rate as needed to maintain desired response. Following achievement of BP goal, decrease infusion rate to 30 mL/hr (3 mg/hr)
Or, as prescribed by a physician
 
Conditions requiring infusion adjustment:
 
Hypotension or tachycardia: Discontinue infusion in case of hypotension or tachycardia. When BP and heart rate have stabilized, restart nicardipine IV infusion at low doses (e.g., 30 to 50 mL/hr) and adjust to maintain desired BP.
 
Infusion site changes: It is recommended that the infusion site be changed every 12 hrs to minimize the risk of peripheral venous irritation.
 
Impaired cardiac, liver or renal function: Patients with CHF or impaired liver or renal function should be closely monitored when titrating nicardipine IV.
 
Transfer to oral antihypertensives:
 
When transferring treatment to an oral antihypertensive other than nicardipine oral cap or tab, therapy should be started upon discontinuation of nicardipine IV.
 
If nicardipine tabs or caps are to be used, the first dose of a thrice daily oral regimen should be taken 1 hr prior to discontinuation of nicardipine IV infusion.

Last Update: Aug 6, 2011


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