Nicardin Dosage/Direction for Use

Nicardipine hydrochloride (Nicardin) should be administered by continuous intravenous infusion only.
Nicardipine hydrochloride (Nicardin) should only be administered by specialists in well controlled environments, such as hospitals and intensive care units, with continuous monitoring of blood pressure.
The speed of administration must be accurately controlled by the use of an electronic syringe driver or a volumetric pump. Blood pressure and heart rate must be monitored at least every 5 minutes during the infusion, and then until vital signs are stable, but at least for 12 hours after the end of the administration of Nicardipine hydrochloride (Nicardin).
The antihypertensive effect will depend on the administered dose. The dosage regimen to achieve the desired blood pressure can vary depending on the targeted blood pressure, the response of the patient, and the age or status of the patient. Unless given by a central venous line, dilute to a concentration of 0.1-0.2 mg/mL before use.
Adults: Initial dose: Treatment should start with the continuous administration of Nicardipine hydrochloride (Nicardin) at a rate of 3-5 mg/h for 15 minutes. Rates can be increased by increments of 0.5 or 1 mg every 15 minutes. The infusion rate should not exceed 15 mg/h.
Maintenance dose: When the target pressure is reached, the dose should be reduced progressively, usually between 2 and 4 mg/h, to maintain the therapeutic efficacy.
Transition to an oral antihypertensive agent: Discontinue Nicardipine hydrochloride (Nicardin) or titrate downward while appropriate oral therapy is established. When an oral antihypertensive agent is being instituted, consider the lag time of onset of the oral agent's effect. Continue blood pressure monitoring until desired effect is achieved. A switch can also be made to oral nicardipine 20 mg capsules at dosage of 60 mg/day in 3 daily doses, or to nicardipine 50 mg extended-release tablets, at dosage of 100mg/day, in 2 daily doses.
Older patients: Clinical studies of nicardipine did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.
Elderly patients may be more sensitive to nicardipine effects because of impaired renal and/or hepatic function. It is recommended to provide a continuous infusion of Nicardipine hydrochloride (Nicardin) starting at the dose of 1 to 5 mg/h, depending on the blood pressure and clinical situation. After 30 minutes, depending on the effect observed, the rate should be increased or decreased by increments of 0.5 mg/h. The rate should not exceed 15 mg/h.
Pregnancy: It is recommended to provide a continuous infusion of Nicardipine hydrochloride (Nicardin) starting at 1 to 5 mg/h, depending on the blood pressure and clinical situation. After 30 minutes, depending on the effect observed, this rate can be increased or decreased by increments of 0.5 mg/h.
Doses higher than 4mg/h are generally not exceeded in the treatment of pre-eclampsia, however the rate should not exceed 15 mg/h.
Hepatic Impairment: Nicardipine hydrochloride (Nicardin) should be used with particular caution in these patients. Since Nicardipine is metabolized in the liver, it is recommended to use the same dose regimens as for elderly patients in patients with impaired liver function or reduced hepatic blood flow.
Renal Impairment: Nicardipine hydrochloride (Nicardin) should be used with particular caution in these patients. In some patients with moderate renal impairment, a significantly lower systemic clearance and higher area under the curve (AUC) have been observed. Therefore, it is recommended to use the same dose regimens as for elderly patients in patients with renal impairment.
Paediatric population: The safety and efficacy in low birth weight infants, newborns, nursing infants, infants, and children has not been established. Nicardipine hydrochloride (Nicardin) should only be used for life-threatening hypertension in pediatric intensive care settings or post-operative contexts.
Initial dose: In case of emergency, a starting dose of 0.5 to 5 mcg/kg/min is recommended.
Maintenance dose: The maintenance dosage of 1 to 4 mcg/kg/min is recommended.
Nicardipine hydrochloride (Nicardin) should be used with particular caution in children with renal impairment. In this case, only the lowest posology should be used.