Nicardipine (Cardene) for High Blood Pressure
- Type of Drug: Calcium channel blocker.
- Prescribed for: Angina pectoris, high blood pressure, and congestive heart failure.
- Brand Name: Cardene, Cardene SR.
General Information of Nicardipine
Nicardipine is one of many calcium channel blockers available in the United States; some others are Diltiazem, Nifedipine, and Verapamil. These drugs work by slowing the passage of calcium into muscle cells. This causes the muscles in the blood vessels that supply your heart with blood to open wider, allowing more blood to reach heart tissues. They also decrease muscle spasm in those blood vessels. Nicardipine also reduces the speed at which electrical impulses are carried through heart tissue, adding to its ability to slow the heart and prevent the pain of angina. It can help to reduce high blood pressure by causing blood vessels throughout the body to widen, allowing blood to flow more easily through them, especially when combined with a diuretic, beta blocker, or other blood-pressure-lowering drug. Other calcium channel blockers are used to treat abnormal heart rhythms, Raynaud’s syndrome, migraine headache, and cardiomyopathy.
Cautions and Warnings
Nicardipine can slow your heart rate and interfere with normal electrical conduction in heart muscle. For some people, this can result in temporary heart stoppage; people whose hearts are otherwise healthy will not develop this effect.
Nicardipine should not be used if you have had a stroke or bleeding in the brain, or if you have advanced hardening of the arteries, (particularly the aorta), because the drug can cause heart failure.
People who take Nicardipine for congestive heart failure should be aware that the drug can still aggravate heart failure by reducing the effectiveness of the heart in pumping blood.
If you are also taking a beta blocker, its dosage should be reduced gradually rather than abruptly stopped when starting on Nicardipine.
Nicardipine dosage should be adjusted in the presence of kidney or liver disease, since both can prolong the release of Nicardipine from the body.
Nicardipine may cause angina pain when treatment is first started, when dosage is increased, or if the drug is rapidly withdrawn. This can be avoided by gradual dosage reduction.
Studies have shown that people taking calcium channel blockers (usually those taken several times a day and not those that are taken only once daily) have shown a tendency toward a greater chance of having a heart attack than people taking beta blockers or other medicines for the same purposes. Discuss this with your doctor to be sure you are receiving the best possible treatment.
Nicardipine Possible Side Effects
Calcium channel blocker side effects are generally mild and rarely cause people to stop taking these drugs.
- Most common: dizziness or light-headedness; fluid accumulation in the hands, legs, or feet; headache; weakness or fatigue; heart palpitations; angina pains and facial flushing.
- Less common: low blood pressure, abnormal heart rhythms, fainting, changes in heart rate (increase or decrease), heart failure, light-headedness, nausea, skin rash, nervousness, tingling in the hands or feet hallucinations, temporary memory loss, difficulty sleeping, weakness, diarrhea, vomiting, constipation, upset stomach, itching, unusual sensitivity to the sun, painful or stiff joints, liver inflammation, increased urination (especially at night), infection, allergic reactions, sore throat, and hyperactivity.
Drug Interactions
- Taking Nicardipine with a beta-blocking drug to treat high blood pressure is usually well tolerated, but may lead to heart failure in susceptible people.
- Blood levels of Cyclosporine may be increased by Nicardipine, increasing the chance for Cyclosporine-related kidney damage.
- The effect of Quinidine may be altered by Nicardipine.
- Cimetidine and Ranitidine may increase the amount of Nicardipine in the bloodstream.
- Combining Nicardipine with Fentanyl (a narcotic pain reliever) can cause very low blood pressure.
Food Interactions of Nicardipine
Nicardipine is best taken on an empty stomach, at least 1 hour before or 2 hours after meals, but it may be taken with food or milk if it upsets your stomach.
Avoid high-fat meals while on this drug, since such a meal taken up to 3 hours after a dose of Nicardipine can significantly reduce the amount of medicine absorbed into the bloodstream. Don’t drink grapefruit juice if you are taking Nicardipine.
Usual Dose
Capsules
20 to 40 mg 3 times a day.
Sustained-Release Capsules
30 to 60 mg twice a day.
Kidney Disease
20 mg 3 times a day, or 30 mg 2 times a day of the sustained-release capsules.
Liver Disease
20 mg twice a day (regular tablets).
Overdosage
The major symptoms of Nicardipine overdose are very low blood pressure and reduced heart rate. Nicardipine can be removed from the stomach by giving the victim Syrup of Ipecac to induce vomiting, but this must be done within 30 minutes of the actual overdose, before the drug can be absorbed into the blood. Once symptoms develop or if more than 30 minutes have passed since the overdose, the victim must be taken to a hospital emergency room for treatment. Always bring the prescription bottle with you.
Special Information of Nicardipine
Call your doctor if you develop any of the following symptoms: worsening angina pains; swelling of the hands, legs, or feet; severe dizziness; constipation or nausea; or very low blood pressure.
Some people may experience a slight increase in blood pressure just before their next dose is due. You will be able to see this effect only if you use a home blood pressure monitoring device. If this happens, contact your doctor.
If you take Nicardipine 3 times a day and forget a dose, take it as soon as you remember. If it is almost time for your next dose, take it and space the remaining doses evenly throughout the rest of the day.
If you take Nicardipine 2 times a day and forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose and continue with your regular schedule.
Special Populations
Pregnancy/Breast-feeding
In animal studies, large doses of Nicardipine have been shown to harm the developing fetus. Nicardipine should be avoided by pregnant women or women who may become pregnant while using it. In situations where it is deemed essential, the potential risk of the drug must be carefully weighed against any benefit it might produce.
Nicardipine passes into breast milk, and nursing mothers should consider bottle-feeding their babies if they must take this medicine.
Seniors
Older adults may be more sensitive to the side effects of Nicardipine. Because of the possibility of reduced kidney and/or liver function in older adults, they should receive smaller doses than younger adults, beginning with 20 mg 2 to 3 times a day and continuing with carefully increased doses.