Nicardipine (Oral)

Nicardipine lowers blood pressure by dilating or relaxing the blood vessels to allow the fluid to flow more smoothly.

Overview

Nicardipine belongs to a class of drugs known as calcium channel blockers. It is also known as Nicardipine Hydrochloride (Nicardipine HCL) or by its brand name, Cardene (Cardene SR). It is a highly potent vasodilator and has anti-hypertensive attributes. The drug helps patients manage elevated levels of blood pressure either alone or together with an angiotensin-converting enzyme inhibitor. It works by vasodilation or relaxation of the blood vessels. When that happens, the heart muscles do not have to use too much energy to pump blood. It also allows the fluid to flow much easier through the vessels.

Movement of extracellular calcium through specific channels is involved in the contraction of smooth muscles and arteries. A calcium channel blocker like Nicardipine inhibits the influx of calcium across the membrane into the cells of cardiac and smooth muscles. Disruption of this movement and the resultant low levels of intracellular calcium prevents contraction and leading to the dilation of these blood vessels.

Hypertension has a high frequency of occurrence and many people today present with this condition. If not addressed, the disease may have adverse effects including causing damage to organs and organ systems. It affects the cardiovascular system (heart and blood vessels), the brain, and kidneys and other parts. Such effects result in diseases and organ failure, including heart attacks, stroke, heart disease, heart failure, and kidney problems, among others.

Cardene is also an effective therapy for angina. It manages this condition by increasing the supply of blood and oxygen to the heart. Unlike other angina medication, it does not present with cardio-depressant effects. It reduces the frequency of these attacks and improves one's ability to exercise. However, one should not use it to treat angina attacks upon occurrence, but rather as prevention therapy. Nicardipine also treats other conditions like asthma and coronary spasms.

Conditions it treats

Doctors prescribe this drug for:

  • High blood pressure and arterial hypertension
  • Chronic stable angina pectoris (chest pain)
  • Asthma, coronary spasms, migraines

Type Of Medicine

  • Calcium channel blocker
  • Antihypertensive agent
  • Vasodilator

Side Effects

Like most other medicines, undesirable effects may accompany the use of Nicardipine along with the intended purpose. Some people might be allergic to the drug and some of its components. Though rare, ensure that you inform your doctor immediately if you experience any symptoms relating to hypersensitivities such as an itching skin rash (hives), swollen face, lips, mouth, tongue, legs and arms, severe light-headedness that may result in fainting, difficulty in breathing, chest congestion, and severe chest pain.

Although it is used as angina therapy, individuals with heart disease may experience increased frequency angina, with intense pain in the chest or a heart attack after commencing the treatment or upon increase of dose. Let the doctor know if chest pain worsens or you experience signs of a heart attack or stroke such as unusual sweating, pain in the jaw and left arm and feeling winded or short of breath. Another rare but serious side effect that requires immediate medical attention is experiencing changes in vision.

Call the doctor immediately if you have an irregular heartbeat especially if your heart is pounding or beating too rapidly while using this medication. Heart rate may increase because of the drop in blood pressure as a result of the treatment.

Sometimes using this medicine may cause your blood pressure to decrease significantly. This effect is rare but may present at the beginning of therapy or when the doctor modifies your dose.

Other side effects that may result from the use of Nicardipine include:

Most of these side effects are manageable. Pacing yourself and getting enough rest might help with the excessive fatigue and getting up slowly from a lying down or sitting position will minimize the light-headedness. Report the occurrence or persistence of any of these side effects to your pharmacist or physician immediately. You may also reach out to the Food and Drug Association (FDA) at 1-800-FDA-1088 or report the effects at www.fda.gov/medwatch.

Dosage

You need a prescription to use Nicardipine. Do not take it over the counter to relieve chest pain. The doctor will prescribe this drug depending on a patient's medical condition, and the intended aim and the dose also will depend on response to treatment. This medicine is administered through the oral route (by mouth).

The drug comes in two forms of capsules; the conventional or regular capsule and the sustained release capsule, also known as the extended-release capsule. The regular kind is a 20-40 mg tablet that doctors recommend a patient should take three times each day with or without a meal. The extended-release capsule, on the other hand, is between 30 and 60mg with a recommended dose of twice daily. It is advisable to take the drugs around the same time every day so you won't forget. Swallow the pill whole. Do not crush, chew or split the capsule.

For angina pectoris or pain in the chest, the doctor typically prescribes that a patient should take the conventional capsule (20-40mg) three times a day.

Make sure you follow the dosage instructions as given by the doctor. If you miss any dose, take it immediately once you remember but if the time nears to take the next pill, do not double dose. Skip the dose you missed and continue with the prescription as directed by the doctor. Continue the dose to completion even if you do not feel better but let the doctors know so that they are able to deal with it appropriately. They may decide to increase the dose, substitute the regular for the extended-release capsule and in given conditions even choose to prescribe the injectable version of the drug. It may be essential to take this medicine regularly for maximum efficiency.

If you overdose or suspect that a patient has overdosed, contact the local poison control center at 1-800-222-1222 right away and ensure that you explain the details of what happened, including the when, how and how much. Immediately call 911 if the patient faints or is not breathing for emergency medical attention.

Major Drug Interactions

Drugs taken concurrently may interact with one another thus changing each other's pharmacological effects such as absorption or effectiveness in the body. Some will produce new adverse effects. Others may even increase the risk of occurrence of severe side effects. Other interactions may also produce positive effects. There are medications that a healthcare practitioner will check and advise against while using Nicardipine.

Ensure that you especially mention the following if you are using them:

  • Azole antifungals (e.g., itraconazole)
  • Diuretics
  • Carbamazepine (Equetro, Carbatrol, Tegretol)
  • Rifamycins (e.g., rifabutin)
  • Other heart and blood pressure medicines like beta-blockers
  • Vitamins
  • Cyclosporine (Sandimmune, Neoral)
  • Digoxin (Lanoxin)
  • Quinidine
  • Macrolide antibiotics (e.g., erythromycin)
  • Cimetidine (Tagamet)
  • St. John's Wort
  • Fentanyl (Duragesic, Actiq)
  • Theophylline
  • Ranitidine (Zantac)

The ingredients in some of the above drugs may elevate your blood pressure or result in an increased heart rate. Medications like carbamazepine, phenobarbital oxcarbazepine and phenytoin increase liver metabolism of Nicardipine so that it is destroyed and eliminated quickly. That effect results in low levels of the drug in the blood and hence reduces its efficiency. An opposite effect may result from drug interactions with antifungals like itraconazole or clarithromycin. These decrease the rate at which the liver breaks Nicardipine down so that it is at very high levels in the blood which may bring about toxicity.

Be sure to make inquiries on NSAIDs and pain medicine like ibuprofen, any cough or flu medication or dietary supplements that you are taking before you begin a dose of Cardene.

Others medications that may interact with Nicardipine include:

  • Acenocoumarol
  • Acetaminophen
  • 2-hydroxy-1,4-naphthoquinone
  • 7,8-Dichloro-1,2,3,4-tetrahydroisoquinoline
  • Abiraterone
  • Udenafil
  • Trimethaphan
  • 4-Methoxyamphetamine
  • Trimazosin
  • Aceclofenac
  • 2-mercaptobenzothiazole
  • Afatinib
  • Toloxatone
  • Prucalopride
  • Ajmaline
  • Tramadol
  • Sarilumab
  • Alfuzosin
  • Alosetron
  • Codeine
  • Ubidecarenone
  • Casein
  • Calcium Phosphate
  • Calcium lactate
  • Calcium Citrate
  • Calcium lactate gluconate
  • Calcium glubionate
  • Calcium Chloride
  • Calcium gluconate
  • Calcium pangamate
  • Calcium levulinate
  • Calcium Gluceptate
  • Calcium Carbonate
  • Calcium Acetate
  • Acemetacin
  • Saxagliptin
  • Rilpivirine
  • Topotecan
  • Tolvaptan
  • Yohimbine
  • Vardenafil
  • Urapidil
  • Adinazolam
  • Travoprost
  • Acemetacin
  • Thioridazine
  • Fesoterodine
  • Dabigatran etexilate
  • Clopidogrel
  • Tacrolimus
  • Silodosin
  • Mifepristone
  • Lumacaftor
  • Ranolazine
  • Tamoxifen
  • Luliconazole
  • Pazopanib
  • Ramelteon
  • Nintedanib
  • Vemurafenib
  • Stiripentol
  • Propafenone
  • Panobinostat
  • Trans-2-phenylcyclopropylamine
  • Trandolapril
  • Alogliptin
  • Simeprevir
  • Palbociclib
  • Osimertinib
  • Netupitant
  • Fluconazole
  • Lorpiprazole
  • Ivacaftor
  • Fusidic Acid
  • Cobicistat
  • Aliskiren
  • Almotriptan
  • Fosaprepitant
  • Dasatinib
  • Parecoxib
  • Ospemifene
  • Darunavir
  • Ceritinib
  • Acebutolol

Keep a record of all the drugs and therapies you are on, whether prescription or otherwise (including vitamins, herbal products, nutritional supplements) and let the doctor know before starting a Cardene prescription. The doctor will determine whether you should continue to take the drug or discontinue a dose and advise accordingly.

Nicardipine has some disease interactions. Inform your physician beforehand if you suffer or have ever experienced liver disease, heart conditions like heart failure, stroke, and heart disease, and kidney problems. Also, let them know whether you are pregnant before they prescribe. Inform the physician if you are already taking the drug and have to undergo surgery.

Warnings

Follow treatment instructions precisely as your physician directs. Before you begin a dose, let the one prescribing know if you have allergic reactions to various drugs, foods, animals, and manufactured products like preservatives or dyes. Tell them if you have ever experienced hypersensitivity upon the use of this drug. Check the package or label for the ingredients it contains that might cause you to have an allergic reaction and let them advise you accordingly.

Since the drug interacts with various other treatments, ensure that you share the list of medicine you usually take, as well as any recent or current treatment that you are on. It also has contraindications for individuals suffering certain illnesses. If you have a structural heart problem such as aortic stenosis or any other heart-related conditions, consult the specialist on the steps to take. Inform them of your medical history especially if you suffer diseases of the liver and the kidney. And in case of surgery, seek medical advice too.

You can take the conventional capsules with food or without, depending on what the doctor directs you to do. One ought to, however, take the sustained release capsule with food but being careful to avoid meals with high levels of fat. Eating grapefruit or taking grapefruit juice is not advisable because it increases Nicardipine serum levels. Sometimes the healthcare specialist may prescribe a low-salt diet. Ensure that you consult them on taking salt substitutes that contain potassium and follow all dietary instructions carefully.

Taking drugs during pregnancy and breastfeeding typically depends on whether the benefits outweigh the risks. Although studies of the effects of Cardene in pregnant women are inadequate and have no conclusive results on fetal safety, always talk to your doctor about use while pregnant. Pregnant women with hypertension from preeclampsia occurring in the third trimester have used this drug to manage the condition. As for lactating mothers, it may not be safe for the infant because studies show that it is excreted in breast milk.

Storage

Store the drug at room temperature (15 to 30 degrees Celsius or 59 to 86 degrees Fahrenheit) in a cool and dry place. Make sure not to expose Nicardipine to direct heat and light and keep away from excess moisture. Do not store it in the bathroom. Retain this medicine in the container it came in from the manufacturer. Keep the lid tightly closed and keep it in a safe place away from the sight and reach of children. Properly discard all medicine that is not in use, or that is expired. The pharmacist or doctor should advise you on how to dispose of it correctly.

Summary

Hypertension is quite common, and its management is crucial to avoid conditions from worsening. Although drugs like Nicardipine do not cure these diseases, they are beneficial because they help ease the suffering and prevent adverse effects in hypertensive patients. Moreover, it aids in the management of various other conditions like asthma and angina, among others. While taking this drug, it is crucial to monitor your blood pressure levels regularly, and doctors will give you laboratory appointments so that they can assess your response to the drug. Be careful to follow the instructions provided, do not cease using the drug even when you feel it is not working unless your pharmacist or physician says so. Remember, do not take this medication during or immediately after an angina attack. Allow the medics to guide you appropriately.

Read the label for warnings and ask for explanations and clarifications where you do not understand. Take heed of all the precautions. Keep a list of allergens, medications, and therapies you are on and share that information with the doctor as well as a history of your medical conditions. Follow dosing instructions and act promptly in case of an overdose or severe and persistent side effects.

Resources
Last Reviewed:
March 26, 2018
Last Updated:
April 26, 2018