Nicarson

Acute life-threatening HTN, particularly in the event of: Malignant arterial HTN/hypertensive encephalopathy; aortic dissection, when short acting β-blocker therapy is not suitable, or in combination w/ β-blocker when β-blockade alone is not effective; severe pre-eclampsia, when other IV antihypertensive agents are not recommended or are contraindicated; post-op HTN.

IV Individualized dosage. Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. Max infusion rate: 15 mg/hr. Maintenance dose: 2-4 mg/hr. Childn Life-threatening HTN in intensive care setting or post-op context Initially 0.5-5 mcg/kg/min, in case of emergency. Maintenance: 1-4 mcg/kg/min. Pregnant women Initially 1-5 mg/hr. May be increased or decreased by increments of 0.5 mg/hr after 30 min depending on the effect observed. Doses >4 mg/hr are generally not exceeded in the treatment of pre-eclampsia. Max infusion rate: 15 mg/hr. Elderly, patient w/ hepatic impairment or reduced hepatic blood flow, patient w/ renal impairment Initially 1-5 mg/hr. Increase or decrease by increments of 0.5 mg/hr after 30 min depending on the effect observed. Max infusion rate: 15 mg/hr.

Hypersensitivity. Severe aortic stenosis, compensatory HTN (ie, in case of arteriovenous shunt or aortic coarctation), unstable angina, w/in 8 days after MI. Patients w/ rare hereditary problems of fructose intolerance.

Rapid pharmacologic reductions in BP may produce systemic hypotension & reflex tachycardia. Bolus administration or IV administration not controlled by use of an electronic syringe driver or a volumetric pump is not recommended. Reports of worsened portal vein HTN & portal-systemic collateral blood flow index in cirrhotic patients. Monitor ICP to allow calculation of cerebral perfusion pressure. Not recommended in ischemic stroke patients unless acute HTN precludes administration of adequate treatment (eg, thrombolysis) or there is other end-organ damage which is life-threatening in short term. Risk of infusion site reactions, particularly w/ prolonged duration of administration & in peripheral veins. Caution in patients w/ CHF or pulmonary oedema, particularly when these patients are receiving concomitant β-blockers; patients w/ suspected coronary ischemia; history of hepatic dysfunction or impaired hepatic function at treatment initiation; acute cerebral infarction. Caution when combined w/ a β-blocker in patients w/ decreased cardiac function. Decrease in BP should be progressive & always closely monitored during pregnancy due to risk of severe maternal hypotension & potentially fatal fetal hypoxia; caution if Mg sulphate is used concomitantly. Use for severe pre-eclampsia during 3rd trimester of pregnancy could potentially produce undesirable tocolytic effect which could potentially interfere w/ spontaneous induction of labour. Should not be used in multiple pregnancies or in pregnant women w/ compromised CV condition, except if there is no other acceptable alternative. Should not be used during breastfeeding. Special care is required in infants or childn.

Headache. Dizziness; lower limb edema, palpitations; hypotension, tachycardia; orthostatic hypotension; nausea, vomiting; flushing.

May enhance -ve inotropic effect of β-blockers & cause heart failure in patient w/ latent or uncontrolled heart failure. May cause fatal ventricular fibrillation w/ IV dantrolene. Possible risk of pulmonary edema or excessive decrease in BP w/ Mg sulphate. Plasma conc may be decreased w/ CYP3A4 enzyme-inducing agents (eg, carbamazepine, phenobarb, phenytoin, fosphenytoin, primidone & rifampicin). Plasma conc may be increased w/ CYP3A4 enzyme-inhibiting agents (eg, cimetidine, itraconazole & grapefruit juice). Increased risk of adverse events, particularly oedema, w/ itraconazole. Elevated plasma levels of cyclosporine, tacrolimus or sirolimus; digoxin. Potentiated antihypertensive effect w/ baclofen, α-blockers, TCAs, neuroleptics, opioids & amifostine. Antihypertensive effects may be decreased w/ IV corticosteroids & tetracosactide (except for hydrocortisone). Potential additive or synergistic hypotensive effect w/ inhalational anesth, as well as inhibition of baroreflex heart rate increase associated w/ peripheral vasodilators. Possible enhanced neuromuscular block w/ vecuronium.

Calcium Antagonists

C08CA04 - nicardipine ; Belongs to the class of dihydropyridine derivative selective calcium-channel blockers with mainly vascular effects. Used in the treatment of cardiovascular diseases.

Rx