Nicardipine

Nicardipine is a Dihydropyridine Calcium Channel Blocker (DHP CCB).

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

Used in:

• Hypertension
• Hypertensive emergency (IV)
• Angina

→ Calcium Channel Blockers

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.

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

Compared to:

• Amlodipine → more rapid onset
• Nifedipine → smoother IV titration

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

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

Compared to:

• Nitroprusside → less risk of cyanide toxicity
• Labetalol → pure vasodilator (no beta blockade)

Common:

• Headache
• Flushing
• Peripheral edema
• Reflex tachycardia

Caution in:

• Severe hypotension
• Advanced aortic stenosis

Amlodipine:

• Long-acting oral agent
• Slow onset

Nifedipine:

• Oral only
• Short-acting form discouraged

Nicardipine:

• Potent
• IV formulation available
• Ideal for hypertensive emergency

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

• Calcium Channel Blockers
• Dihydropyridines
• Hypertension
• Anti-Anginal Therapy
• Labetalol