Nicardipine (Cardene)

Anesthesia Implications

Classification: Calcium Channel Blocker
Therapeutic Effects: Acute Hypertension Treatment
Time to Onset: IV: less than 5 minutes
Time to Peak: IV: 45 minutes

Contraindications

Use with caution in:
heart & head patients – can worsen CHF in patients with impaired ventricular function. Careful monitoring on heart patients in general and those with compromised/questionable intracranial pressures.

Primary Considerations

Dilates vasculature – this is the primary affect. Cerebral vasculature dilation reduces cerebral perfusion so use with caution in patients with compromised/questionable CPP. Nicardipine, however, helps balance cardiac supply and demand, which makes it a treatment choice for angina pectoris.

Drug interactions – Nicardipine potentiates effects of both depolarizing (succinylcholine) and nondepolarizing (eg. vecuronium, rocuronium) neuromuscular blockers. Nicardipine will have additive cardiac depressant affects with local anesthetics, volatile anesthestics and other vasodilators. If the patient is taking beta blockers, there is an increased chance of cardiac failure, bradycardia, and AV conduction abnormalities. Serum levels of the following drugs are increased (making higher the risk of toxicity): digoxin, benzodiazepines, carbamazepine, oral diabetic medications (eg metformin), propranolol, cyclosporine, quinidine, and theophylline. Nicardipine will decrease lithium’s affects.

Bicarbonate – DO NOT MIX – nicardipine is chemically incompatible with bicarbonate.

Dilution – Typically prepared by adding 10 ml (25 mg) to 240 mL of normal saline or D5W. This dilutes to 0.1 mg/mL

IV push dose

0.1 – 0.5 mg

IV infusion dose

5 – 15 mg/hr. Titrate up by 2.5 mg/hr every 5-15 minutes until desired pressures are reached. The infusion should be then titrated down to less than or equal to 3 mg/hr.

Method of Action

Dihydropyridine calcium channel blocker. As a calcium channel blocker, it inhibits the cellular influx of calcium. This is particularly the case in smooth (primary) and cardiac muscle. By inhibiting the contractile force of the heart and vasculature, systemic vascular resistance is effectively reduced and vasculature is dilated. There is no affect on the cardiac conduction system. A baroreceptor reflex is sometimes observed (increase in heart rate). Myocardial supply and demand are effectively balanced with nicardipine, which is why it is sometimes used to treat angina pectoris. However, in very few cases, it has been shown to cause/worsen angina.