nicardipine (Cardene, Cardene SR)
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Introduction
Tradename: Cardene.
Indications
Contraindications
patients with severe aortic stenosis
Precautions:
- patients with impaired renal or hepatic function
- patients with CHF
- pheochromocytoma
- may increase the frequency, severity & duration of angina during initiation of therapy
Dosage
Tabs: 20, 30 mg.
- IV infusion 2-15 mg/hr.
Sustained release: (Cardene SR)
Tabs: 30, 45, 60 mg
Pharmacokinetics
- metabolized in the liver by cyt P450 3A4
elimination via liver
1/2life = 1.0 hours
Adverse effects
- most common (1-10%)
- uncommon (< 1%)
- edema, tachycardia, syncope, abnormal EKG, insomnia, malaise, abnormal dreams, rash, vomiting, constipation, dyspepsia, xerostomia, nocturia, tremor
- drug adverse effects of calcium channel blockers
- drug adverse effects of renin-angiotensin-aldosterone system inhibitors (RAAS inhibitors)
- drug adverse effects of antihypertensive agents
Drug interactions
- possible hypotensive effect when used concurrently with fentanyl
- cimetidine increases levels of nicardipine
- nicardipine increases levels of cyclosporine
- increased negative inotropic effect of beta-blockers
- any drug that inhibits cyt P450 3A4 may increase levels of nicardipine
- any drug that induces cyt P450 3A4 may diminish levels of nicardipine
- drug interaction(s) of calcium channel blockers with ARBs
- drug interaction(s) of calcium channel blockers with ACE inhibitors
- drug interaction(s) of calcium channel blockers with diuretics
- drug interaction(s) of calcium channel blockers with erythromycin
- drug interaction(s) of calcium channel blockers with clarithromycin
- drug interaction(s) of renin-angiotensin-aldosterone inhibitors with trimethoprim-sulfamethoxazole
- drug interaction(s) of beta-adrenergic receptor antagonists with calcium channel blockers
- drug interaction(s) of NSAIDs & antihypertensives
Laboratory
Mechanism of action
- nicardipine is a 2nd generation Ca+2-channel antagonist
- nicardipine is an L-type Ca+2 channel blocker
- it elicits favorable responses in both myocardial oxygen balance & renal function parameters
- nicardipine decreases renal glomerular pressure by efferent arteriolar dilatation, thus diminishing proteinuria[2]
- thus nicardipine is considered a good alternative agent for the management of myocardial ischemia/infarction & acute renal failure
More general terms
Additional terms
References
- ↑ The Pharmacological Basis of Therapeutics, 8th ed. Gilman et al, eds. Permagon Press/McGraw Hill pg 774
- ↑ 2.0 2.1 Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998 (Cardene IV)
- ↑ Prescriber's Letter 13(3): 2006 Cytochrome P450 drug interactions Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220233&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Deprecated Reference