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Nicardipine should be used with caution in patients with acute cerebral infarction or hemorrhage and systemic hypotension should be avoided in these patients. In addition, frequency, duration, and severity of angina occasionally may increase during initiation of nicardipine therapy or upward adjustment of dosage.
Nicardipine should be used with caution and dosage titrated carefully in patients with congestive heart failure, especially in those receiving concomitant β-adrenergic blocking agents, since nicardipine has a negative inotropic effect in vitro in some patients and may precipitate or worsen heat failure. Peripheral edema occurring during the course of nicardipine therapy should be investigated, especially in patients with congestive heart failure, since it may indicate deterioration in left ventricular function induced by the drug.
Nicardipine is not a β-adrenergic blocking agent and offers no protection against abrupt withdrawal of β-adrenergic blocking agents. If nicardipine is initiated in patients currently receiving a β-adrenergic blocking agent with the intent to withdraw β-adrenergic blocking agent, this should be done by a gradual reduction in dosage, preferably 8-10 day.
Since nicardipine is extensively metabolized in the liver, the drug should be used with caution and in reduced dosage in patients with hepatic impairment or reduced hepatic blood flow. Bioavailability and the elimination half-life of nicardipine are increased in patients with severe hepatic impairment, in addition, IV nicardipine should be used with caution in patients with portal hypertension since the drug reportedly increases the hepatic venous pressure gradient by 4 mmHg in patients with cirrhosis at high doses (5 mg administered over 20 minutes).
Use in Pregnancy & Lactation: There are no adequate and controlled studies to date using nicardipine in pregnant women. Nicardipine should be used during pregnancy only when the potential benefits justify the possible risks to the fetus.
