Nicarson Dosage/Direction for Use

Nicardipine injection is intended for IV infusion. Dosage must be individualized depending on the severity of hypertension and patient response during dosing.
Monitor BP and heart rate both during and after the infusion; avoid too rapid or excessive reduction in either systolic or diastolic BP during parenteral treatment.
Adults: Initial dose: Treatment should start with the continuous administration of nicardipine at the rate of 3-5 mg/h for 15 minutes. Rates can be increase by increments of 0.5 or 1 mg every 15 minutes. The infusion rate should not exceed 15 mg/hr.
Maintenance dose: When the target pressure is reached, the dose should be reduced progressively, usually to between 2 and 4 mg/h, to maintain the therapeutic efficacy.
Transition to an oral antihypertensive agent: discontinue nicardipine or titrate download while appropriate oral therapy is established. When an oral hypertensive agent is being instituted, consider the lag time of onset of the oral agent's affect. Continue blood pressure monitoring until desired effect is achieved.
A switch can also be made to oral nicardipine 20 mg capsules at dosage of 60 mg/day in 3 daily doses or to nicardipine 50 mg extended-release tablets, at dosage of 100 mg/day in 2 daily doses.
SPECIAL POPULATION: Older patients: Elderly may be more sensitive to nicardipine effects because of impaired renal &/or hepatic function. It is recommended to provide a continuous infusion of nicardipine starting at the dose of 1 to 5 mg/h, depending on the blood pressure and clinical situation. After 30 minutes, depending on the effect observed, the rate should be increased or decreased by increments of 0.5 mg/h. The rate should not exceed 15 mg/h.
Pregnancy: It is recommended to provide a continuous infusion of nicardipine starting at 1 to 5 mg/h, depending on the blood pressure and clinical situation. After 30 minutes, depending on the effect observed, this rate can be increased or decreased by increments of 0.5 mg/h.
Doses higher than 4 mg/h are generally not exceeded in the treatment of pre-eclampsia, however the rate should not exceed 15 mg/h.
Nicardipine should be used with particular caution in these patients. Since nicardipine is metabolized in the liver, it is recommended to use the same dose regimens as for elderly patients in patients with impaired liver function or reduced hepatic blood flow.
Renal Impairment: Infusion site reactions can occur, particularly with prolonged duration of administration and in peripheral veins.
It is advised to change the infusion site in case of any suspicion of infusion site irritation. The use of central venous line or of a greater dilution of the solution could reduce the risk of occurrence of infusion site reaction.
Pediatric population: The safety and efficacy of nicardipine IV has not been tested in controlled clinical trials in infants or children, thus special care is required in this population.