====== Nicardipine ======

Nicardipine is a [[cardio:ccb:dhp|Dihydropyridine Calcium Channel Blocker]] (DHP CCB).

It is a potent arterial vasodilator available in both oral and intravenous formulations.

Used in:

  * [[cardio:hypertension:start|Hypertension]]
  * Hypertensive emergency (IV)
  * [[cardio:angina:start|Angina]]

→ [[cardio:ccb:start|Calcium Channel Blockers]]

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===== Mechanism of Action =====

Nicardipine blocks L-type calcium channels in vascular smooth muscle.

This results in:

  * ↓ Intracellular calcium
  * Potent arterial vasodilation
  * ↓ Systemic Vascular Resistance
  * ↓ Afterload

Minimal direct AV nodal suppression.

Primary action = vascular.

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===== Hemodynamic Effects =====

  * ↓ Blood pressure
  * ↓ Afterload
  * Possible reflex tachycardia
  * Preserves cardiac output

Compared to:

  * [[cardio:ccb:amlodipine|Amlodipine]] → more rapid onset
  * [[cardio:ccb:nifedipine|Nifedipine]] → smoother IV titration

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===== Clinical Use =====

Hypertensive Emergency (IV):

  * Common first-line IV antihypertensive
  * Easily titratable
  * Smooth BP reduction

Often used in:

  * Stroke
  * Intracranial hemorrhage
  * Aortic syndromes (with beta-blocker)

Chronic Hypertension (oral form):

  * Less commonly used than amlodipine

Angina:

  * Reduces afterload
  * Improves oxygen supply-demand balance

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===== Advantages in Hypertensive Emergency =====

  * Predictable titration
  * Does not significantly reduce cerebral blood flow
  * Rapid onset
  * Short half-life (IV)

Compared to:

  * [[cardio:hypertension:nitroprusside|Nitroprusside]] → less risk of cyanide toxicity
  * [[cardio:beta_blockers:labetalol|Labetalol]] → pure vasodilator (no beta blockade)

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===== Adverse Effects =====

Common:

  * Headache
  * Flushing
  * Peripheral edema
  * Reflex tachycardia

Caution in:

  * Severe hypotension
  * Advanced aortic stenosis

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===== Nicardipine vs Other DHPs =====

[[cardio:ccb:amlodipine|Amlodipine]]:
  * Long-acting oral agent
  * Slow onset

[[cardio:ccb:nifedipine|Nifedipine]]:
  * Oral only
  * Short-acting form discouraged

Nicardipine:
  * Potent
  * IV formulation available
  * Ideal for hypertensive emergency

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===== Clinical Pearls =====

  * DHP CCB
  * Strong arterial vasodilator
  * Preferred IV agent for hypertensive emergency
  * Reflex tachycardia possible
  * Does not slow AV node
  * Easy titration

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===== Related =====

  * [[cardio:ccb:start|Calcium Channel Blockers]]
  * [[cardio:ccb:dhp|Dihydropyridines]]
  * [[cardio:hypertension:start|Hypertension]]
  * [[cardio:angina:start|Anti-Anginal Therapy]]
  * [[cardio:beta_blockers:labetalol|Labetalol]]