Nicardiin Drug Interactions

Enhancement of negative inotropic effect: Nicardipine may enhance the negative inotropic effect of beta-blockers and may cause heart failure in patients with latent or uncontrolled heart failure.
Dantrolene: In animal studies, administration of verapamil and intravenous dantrolene has caused fatal ventricular fibrillation. The combination of a calcium channel inhibitor and dantrolene is therefore potentially dangerous.
Magnesium: Due to the possible risk of pulmonary oedema or excessive decrease in blood pressure, caution should be taken if magnesium sulphate is used concomitantly.
CYP3A4 inducers and inhibitors: Nicardipine is metabolized by cytochrome P450 3A4. Co-administration of CYP 3A4 enzyme-inducing agents (e.g. carbamazepine, phenobarbital, phenytoin, fosphenytoin, primidone and rifampicin) may cause a decrease in the plasma concentrations of nicardipine.
Co-administration of CYP3A4 enzyme-inhibiting agents (e.g. cimetidine, itraconazole and grapefruit juice) may cause an increase in the plasma concentrations of nicardipine. Co-administration of calcium channel blockers with itraconazole has shown an increased risk of adverse events, in particular oedema due to a decreased metabolism of the calcium channel blocker in the liver.
Cyclosporine, tacrolimus and sirolimus: Concomitant administration of nicardipine and cyclosporine, tacrolimus or sirolimus results in elevated plasma cyclosporine, tacrolimus or sirolimus levels. Cyclosporine, tacrolimus or sirolimus levels should be monitored and dosage of immunosuppressant and/or nicardipine should be reduced, if required.
Digoxin: Nicardipine has been reported to increase the plasma levels of digoxin in pharmacokinetic studies. Digoxin levels should be monitored when concomitant therapy with nicardipine is initiated.
Potential additive antihypertensive effect: Concomitant medications which could potentiate the antihypertensive effect of nicardipine include baclofen, alpha-blockers, tricyclic antidepressants, neuroleptics, opioids and amifostine.
Decrease of antihypertensive effect: Nicardipine in combination with intravenous corticosteroids and tetracosactide (except for hydrocortisone used as replacement therapy in Addison's disease) may cause a decrease in the antihypertensive effect.
Inhalational anaesthetics: The co-administration of nicardipine with inhalational anaesthetics could induce a potential additive or synergistic hypotensive effect, as well as an inhibition by anaesthetics of the baroreflex heart rate increase associated with peripheral vasodilators. Limited clinical data suggests that the effects of inhaled anaesthetics (e.g. isoflurane, sevoflurane and enflurane) on nicardipine appear to be moderate.
Competitive neuromuscular blockers: Limited data suggest that nicardipine, as other calcium channel blockers, enhances neuromuscular block possibly by acting at the post-junctional region. Vecuronium infusion dose requirements could be reduced by the concurrent use of nicardipine. Reversal of neuromuscular block by neostigmine appears not to be affected by nicardipine infusion. No additional monitoring is required.