Nicardipine

Brand names of nicardipine

  • Cardene
  • Cardene SR

Nicardipine is a calcium channel blocker and vasodilator used in the treatment of angina and hypertension. The medication works by inhibiting the entrance of calcium ions into the smooth muscles of the heart without changing the serum calcium concentration. Without the entry of calcium into the vascular smooth muscle, nicardipine therefore promotes relaxation of the muscles causing the arteries to dilate at the same time results in hypotensive effects. The decrease in blood pressure would also reduce cardiac workload thereby preventing the occurrence of angina or chest pain for those afflicted with coronary artery disease. It also increases the blood supply to the heart which also helps in controlling angina. Amlodipine (Norvasc), clevidipine (Cleviprex), nifedipine (Adalat,Procardia), diltiazem (Cardizem), felodipine (Plendil) are some medications belonging to this drug class. Nicardipine was approved in 1988 by the FDA and comes in either oral or intravenous preparations.

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Things you need to tell your physician before taking nicardipine

Prior to taking nicardipine, it is important to inform one's physician or pharmacist if one may be allergic to the drug or any of its contents. Likewise, the physician would also have a need to know regarding other forms of allergies that may be triggered by the intake of the medication. In addition, the doctor should also be informed if the patient is under medication of any prescription or nonprescription drugs.

The medical history including heart, liver or kidney diseases experienced by the patient should also be made known to the physician. Nicardipine has been found to increase electrolyte excretion including sodium. Nicardipine titration is also necessary for those with impaired renal function as well as those who have congestive heart failure. It is also important to discuss the mechanism, side effects and adverse effects that may be expected or experienced so as to be able to know how to counteract such effects. Nicardipine may cause drowsiness and should therefore be taken with precaution. Patients who take this drug are advised not to drive or use heavy machinery.

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In addition, patients who are pregnant, who have plans of becoming pregnant or those who are breastfeeding should also inform their physician that they are taking the medication. Patients who are undergoing surgery should also inform their doctors or dentists for dental operations that they are taking the drug.

Usage

Nicardipine may be used singularly or in conjunction with other medications in treating hypertension. It helps lower the risk for strokes, cardiac and kidney problems by promoting relaxation of the cardiac muscles. In addition, it increases the blood supply to the heart and improves oxygenation therefore making it an affective preventive medication against chest pain. Nicardipine needs to be taken regularly for it to be effective but it is not used to treat acute attacks of chest pain. It is important to consult one's doctor for medications that could relieve acute angina attacks. Sublingual nitroglycerine may be used during acute chest pain.

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Nicardipine is also used to treat congestive heart failure as it reduces cardiac after load without compromising myocardial contractility. However, caution should be undertaken if nicardipine is used to treat congestive heart failure alongside a beta-blocker.

How to use nicardipine

Nicardipine may come as a regular capsule or as an extended release capsule when in oral formulations.
It should be taken as directed by the physician but is usually taken thrice a day for the regular capsule and twice day for the extended release capsule. It is important to note that extended release capsule should not be chewed or crushed rather it should be swallowed whole to ensure absorption of the drug. Taking nicardipine should be done under the physician's orders and should not be taken more or less than what is prescribed. Over dosage of the drug may lead to systemic hypotension, lower cardiac rate after an initial tachycardia and may progress to atrioventricular conduction block.

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Nicardipine helps in lowering high blood pressure and prevents the occurrence of chest pain. However, it is not a cure for the said conditions. Proper dosage and titration is necessary to ensure the effectiveness of the medication. Nicardipine should not be stopped abruptly without notifying one's physician.

How nicardipine works

Nicardipine works by inhibiting the entry of calcium into the cardiac muscles thereby promoting relaxation and dilatation of the blood vessels. These, in turn, would lead to a lowered blood pressure, increased oxygenation to the heart and decreased cardiac workload. Nicardipine may also lead to an increased heart rate in response to the decreased blood pressure and vasodilatation.

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Careful monitoring of blood pressure is necessary when nicardipine is administered because of the potential risk of symptomatic hypotension.

Side effects

Serious:
  • breathing difficulty
  • chest pain
  • fainting
  • pounding or irregular heartbeat
  • wheezing or coughing
Common:
Less common:

Possible interactions

Herbal medicines or minerals:
Ginseng, hawthorn, saw palmetto, goldenseal, ma huang, yohimbe and licorice are herbal alternatives that are known to increase blood pressure. Taking nicardipine while using these herbal alternatives would make it pointless because of the counter-effects each would have on the other.
Calcium and garlic help in lowering blood pressure. Taking nicardipine with these substances might potentiate an extremely lowered blood pressure.
It is important to consult with one's physicians if planning to take herbal medicines alongside nicardipine.
Foods:
The potency of nicardipine decreases with food intake. Salt, grapefruit and grapefruit juice should be avoided when taking this medication.
Beverages:
Grapefruit juice should be avoided when taking nicardipine.
Alcohol:
Alcohol might potentiate an excessive drop in blood pressure and should therefore be used with caution or best avoided when under medication.
Tobacco smoking:
Nicotine reduces the potency of the medication.
Exposure to heat:
Excessive exposure to a hot environment may trigger low blood pressure. It is best to watch out for signs of weakness and light-headedness and other signs and symptoms which may indicate hypotension.
Heavy exercise or exertion:
Nicardipine has been shown to improve the ability to exercise without causing chest pains. However, too much exertion should still be avoided because of the existing heart condition.

Discontinuation

Nicardipine should not be discontinued abruptly without the doctor's permission. It is best to be done under the doctor's supervision so as to ensure gradual withdrawal from the medication. Dosage reduction should be done gradually, preferably over a period of 8 to 10 days. Possible rebound angina should be watched out for.

Storage instructions

Nicardipine should be stored in room temperature and should not be under direct light. Moisture should also be avoided. Different brands have different instructions on how to store the medication. It is best to check the prescription label to be able to store the medication effectively. The medication should be kept away from children's reach. It is best to consult the pharmacist or the local waste disposal unit regarding the proper disposal of the medication.

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