Cardepine Special Precautions

SR cap: Care must be taken when giving CARDEPINE to patients with liver or kidney dysfunction, hypotension and glaucoma.
Inj: Excessive Pharmacologic Effects: Carefully monitor patient's BP and heart rate since nicardipine decreases peripheral vascular resistance and occasionally causes excessive and poorly tolerated hypotension or tachycardia.
Use with caution in patients with acute cerebral infarction or hemorrhage, and systemic hypotension should be avoided in these patients.
Rapid Decreases in BP: Although nicardipine IV has not been associated with adverse effects secondary to an excessively rapid decrease in BP, reduction of BP should be accomplished over as long a time period as is compatible with patient's clinical status.
Use in Patients with Angina: Increases in frequency, duration, or severity of angina have been observed in chronic oral nicardipine therapy. There have been reports of induction or exacerbation of angina in less than 1% of patients with coronary artery disease given nicardipine.
Use in Patients with Congestive Heart Failure: Use with caution in patients with congestive heart failure, especially in those receiving concomitant beta-adrenergic blocking agents, since nicardipine has been shown in some in vitro and clinical studies to have negative inotropic effect and may precipitate or worsen heart failure. If concomitant beta-blocker is intended to be withdrawn, beta-blocker withdrawal should be done by gradual dose reduction, preferably over 8 to 10 days.
Use in Patients with Impaired Liver Function: Use with caution in patients with impaired liver function or reduced hepatic blood flow since nicardipine is extensively metabolized in the liver. Nicardipine bioavailability and elimination half­-life are increased substantially in patients with severe hepatic impairment.
Use in Patients with Impaired Renal Function: Nicardipine IV should be used with caution and dosage titrated carefully in patients with impaired renal function.
Use in Patients with Pheochromocytoma: Administer with caution in patients with pheochromocytoma since there is limited clinical experience on the use of nicardipine IV in hypertension associated with pheochromocytoma.
Central Vein Infusion Site: Nicardipine IV should be administered through central veins rather than arteries or small peripheral veins (e.g., those on the dorsum of the hand or wrist) to decrease the possibility of venous thrombosis, phlebitis, local irritation, swelling, extravasation, and rarely, vascular impairment.
Use in Children: The safety and effectiveness of nicardipine in patients below 18 years old have not been established.
Use in Elderly: In general, dose selection for an elderly patient should be cautions, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant diseases or other drug therapy.