Nicardipine Intravenous Infusion for Adults

Who can administer

Administration RESTRICTED - see Appendix 1

Important information

  • Intravenous nicardipine should only be used to treat acute life-threatening hypertension, and post-operative hypertension (ref 1,2)
  • Should only be given in specialist unit or Intensive Care
  • Unlicensed drug

Available preparations

10mg in 10mL ampoule

Reconstitution

Not required- already in solution

  • Draw up using a filter needle
  • Dilute further prior to administration

Infusion fluids

Glucose 5% (ref 2,3)

Methods of intravenous administration

Continuous intravenous infusion (ref 2) (administer using a electronically controlled infusion device)

  • Peripheral line

    • Dilute to a concentration of 0.1 or 0.2mg/mL ( i.e. 100 to 200microgram/mL)
    • Example: add 50mg nicardipine to 450mL infusion fluid (100micrograms/mL)
    • Example: add 50mg nicardipine to 200mL infusion fliud (200micrograms/mL)
    • If administration is via a peripheral line- change line every 12 hours to minimise the risk of venous irritation (ref 2)
  • Central line
    • May be given undiluted via central line access device (ref 1,3)

Dose in adults

Life-threatening hypertension, Post-operative hypertension (Specialist use only)

  • Initially 3 to 5mg/hour for fifteen minutes, increased in steps of 0.5 to 1mg every fifteen minutes, adjusted according to response. A rapid titration of 2.5mg/hour every five minutes may be considered (ref 4)
  • Maximum rate 15mg/hour
  • Reduce dose gradually when target blood pressure achieved
  • Maintenance 2 to 4mg/hour
  • Use with caution and at lower doses in patients with liver or kidney problems
  • Elderly patients (ref 2)
    • Initially 1 to 5mg/hour, then adjusted in steps of 0.5mg/hour after 30 minutes, adjusted according to response
    • Maximum rate 15mg/hour
  • Renal or hepatic impairment(ref 2)
    • Initially 1 to 5mg/hour, then adjusted in steps of 0.5mg/hour after 30 minutes, adjusted according to response
    • Maximum rate 15mg/hour

Monitoring

  • Monitor blood pressure and heart rate at least every five minutes during the infusion and then until vital signs are stable, and for at least 12 hours after the end of the infusion
  • Rapid or excessive reduction in systolic or diastolic blood pressure during IV therapy should be avoided
  • Avoidance of hypotension is especially important in patients who have sustained an acute cerebral infarction or haemorrhage

Storage

Store below 250C

References

1: SPC (UK) 31st Dec 2020

2: BNF accessed online 7th Dec 2021

3: Injectable medicines administration guide Medusa accessed online 7th Dec 2021

4: Martindale - accessed online 7th Dec 2021

Therapeutic classification

Calcium channel blocker