Usual Adult Dose for Angina Pectoris Prophylaxis

IV INFUSION:
Substitution for Oral Nicardipine (the following IV infusion rates are required to produce an average plasma level corresponding to a given oral dose at steady state):
20 mg orally every 8 hours is equivalent to 0.5 mg/hour via IV infusion
30 mg orally every 8 hours is equivalent to 1.2 mg/hour via IV infusion
40 mg orally every 8 hours is equivalent to 2.2 mg/hour via IV infusion

Initiation of Therapy in Patients Not Receiving Oral Nicardipine:
5 mg/hour IV infusion; infusion rate may be increased by 2.5 mg/hour every 5 to 15 minutes (rapid and gradual titration, respectively) up to a maximum of 15 mg/hour, until desired blood pressure reduction is achieved; infusion rate should be decreased to 3 mg/hour following achievement of the blood pressure goal using rapid titration.

Transition from IV Nicardipine to an Oral Antihypertensive Agent:
If oral nicardipine is to be used after IV nicardipine, administer the first dose 1 hour prior to discontinuation of the IV infusion.
If an oral antihypertensive agent other than nicardipine is to be used after IV nicardipine, initiate therapy upon discontinuation of IV nicardipine.

Use: Short-term treatment of hypertension when oral therapy is not feasible or not desirable.

ORAL:
Immediate-release:
Initial dose: 20 mg orally 3 times a day
Maintenance dose: 20 to 40 mg orally 3 times a day

Comments: Dose may be increased using intervals of at least 3 days.

Uses:

• Management of chronic stable angina (effort-associated angina) alone or in combination with beta-blockers.
• Treatment of hypertension alone or in combination with other antihypertensive drugs.

Sustained-release:
Initial dose: 30 mg orally twice a day
Maintenance dose: 30 to 60 mg orally twice a day
Substitution for immediate-release nicardipine: Start at the current total daily dose of immediate-release nicardipine and titrate as needed.

Use: Treatment of hypertension alone or in combination with other antihypertensive drugs.

Usual Adult Dose for Hypertension

IV INFUSION:
Substitution for Oral Nicardipine (the following IV infusion rates are required to produce an average plasma level corresponding to a given oral dose at steady state):
20 mg orally every 8 hours is equivalent to 0.5 mg/hour via IV infusion
30 mg orally every 8 hours is equivalent to 1.2 mg/hour via IV infusion
40 mg orally every 8 hours is equivalent to 2.2 mg/hour via IV infusion

Initiation of Therapy in Patients Not Receiving Oral Nicardipine:
5 mg/hour IV infusion; infusion rate may be increased by 2.5 mg/hour every 5 to 15 minutes (rapid and gradual titration, respectively) up to a maximum of 15 mg/hour, until desired blood pressure reduction is achieved; infusion rate should be decreased to 3 mg/hour following achievement of the blood pressure goal using rapid titration.

Transition from IV Nicardipine to an Oral Antihypertensive Agent:
If oral nicardipine is to be used after IV nicardipine, administer the first dose 1 hour prior to discontinuation of the IV infusion.
If an oral antihypertensive agent other than nicardipine is to be used after IV nicardipine, initiate therapy upon discontinuation of IV nicardipine.

Use: Short-term treatment of hypertension when oral therapy is not feasible or not desirable.

ORAL:
Immediate-release:
Initial dose: 20 mg orally 3 times a day
Maintenance dose: 20 to 40 mg orally 3 times a day

Comments: Dose may be increased using intervals of at least 3 days.

Uses:

• Management of chronic stable angina (effort-associated angina) alone or in combination with beta-blockers.
• Treatment of hypertension alone or in combination with other antihypertensive drugs.

Sustained-release:
Initial dose: 30 mg orally twice a day
Maintenance dose: 30 to 60 mg orally twice a day
Substitution for immediate-release nicardipine: Start at the current total daily dose of immediate-release nicardipine and titrate as needed.

Use: Treatment of hypertension alone or in combination with other antihypertensive drugs.

Renal Dose Adjustments

IV: Use with caution; titrate slowly and monitor closely.

Oral:

• Immediate-release: Initial dose: 20 mg orally 3 times a day; titrate carefully.
• Sustained-release: Initial dose: 30 mg orally twice a day; titrate carefully.

Liver Dose Adjustments

IV: Lower dosages may be required; titrate slowly and monitor closely.

Oral: Use with caution.

• Immediate-release: Initial dose: 20 mg orally twice a day with individual titration based on clinical findings maintaining the twice a day schedule.
• Sustained-release: Severe liver dysfunction: Data not available (has not been studied).

Dose Adjustments

The IV infusion should be discontinued if there is concern of impending hypotension or tachycardia. Following stabilization of blood pressure, the infusion may be restarted at low doses (such as 3 to 5 mg/hour) and adjusted to maintain desired response.

Precautions

CONTRAINDICATIONS:

• Hypersensitivity to the active component
• Advanced aortic stenosis

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• IV: Administer through a central line or large peripheral vein and change the site of infusion every 12 hours (if administered peripherally); do not use plastic containers in series connections.

Storage requirements: The manufacturer product information should be consulted.

Reconstitution/preparation techniques: The manufacturer product information should be consulted.

IV compatibility: The manufacturer product information should be consulted.

Monitoring:

• Cardiovascular: Blood pressure and heart rate (the manufacturer product information should be consulted)