Safety Of Nicardipine Research Articles

Utility of nicardipine in the management of hypertensive crises in adults with reduced ejection fractions

BackgroundNicardipine is commonly used in the management of hypertensive crises, except those involving cardiac contractility defects despite its ability to reduce afterload and pulmonary congestion. Consequently, there is limited literature evaluating nicardipine's role for this indication. The purpose of this study was to evaluate the efficacy and safety of nicardipine in adults with reduced ejection fractions presenting with acute heart failure with hypertension (AHF-H). MethodsThis was a retrospective study conducted at an academic Level 1 trauma center with an annual Emergency Department (ED) volume surpassing 100,000. The purpose of this study was to determine the efficacy and safety of nicardipine in adults with reduced ejection fractions presenting to the ED with AHF-H. Efficacy was determined by achievement of the physician prescribed blood pressure target range. The primary safety endpoints included the number of individuals who experienced bradycardia (< 60 beats per minute, bpm) or hypotension (systolic blood pressure, SBP, < 90 mmHg) while receiving nicardipine and for up to 15 min after its discontinuation. Patients were included if they were ≥ 18 years of age, received a continuous intravenous nicardipine infusion within six hours of presenting to the ED, and had an ejection fraction ≤ 40% per an echocardiogram obtained within three months of the study visit. Pregnant and incarcerated patients were excluded. ResultsOf the 500 patient charts reviewed, 38 met inclusion criteria. The median (interquartile, IQR) ejection fraction and brain natriuretic peptide (BNP) were 35% (25–40) and 731 pg/nL (418–3277), respectively. The median baseline heart rate and SBP were 90 bpm and 193 mmHg, respectively. The median physician specified SBP goal was 160 mmHg and all patients met this endpoint in a median time of 18 min. One (2.6%) patient in the total population developed both hypotension and bradycardia. This patient had an ejection fraction of 20%, was intubated, and received nicardipine in addition to esmolol for an aortic dissection without experiencing an adverse event until 30 min after dexmedetomidine was initiated. ConclusionIn this non-interventional study evaluating the use of nicardipine in patients with reduced ejection fractions presenting to the ED with AHF-H, nicardipine was found to be safe and effective. To our knowledge this is the largest study to date evaluating nicardipine in this patient population and positively contributes to the existing literature.

Comparison of Nicardipine with Clevidipine in the Management of Hypertension in Acute Cerebrovascular Diseases

In acute stroke, hypertension worsens outcomes. Guidelines do not mention a preferred antihypertensive agent. This present study aimed to compare the efficacy and safety of nicardipine and clevidipine in acute stroke. This retrospective review compared nicardipine with clevidipine for hypertension in acute stroke patients from March 17, 2015 to December 23, 2016. Ischemic and hemorrhagic stroke types were evaluated. Patients were excluded if under 18 years, had traumatic brain injury, had intracranial neoplasm, were on dialysis, had both study drugs during the stroke admission, or the study drug was infused for less than 1 hour. Efficacy outcomes were: time to goal blood pressure, percent time in goal, blood pressure range, and need for additional antihypertensive agents during the infusion. A composite of in-hospital death, 30-day readmission, rebleeding, ischemic to hemorrhagic conversion, and hematoma expansion were compared. Other clinical outcomes included length of intensive care unit and hospital stay, hypotension, bradycardia, tachycardia, onset of atrial fibrillation, and acute kidney injury. Mean time to goal blood pressure was 65.5 minutes and 65.8 minutes in the nicardipine and clevidipine group, respectively (P = .83). No efficacy outcome was significantly different between 2 groups after multivariate analysis. Both nicardipine and clevidipine are reasonable antihypertensive agents in stroke, although cost and volume restriction could differentiate preference.

A comparison between nicardipine and urapidil used for management of intracerebral hemorrhage

Objective To compare the efficacy and safety of nicardipine versus urapidil in blood pressure (BP) management during the acute phase of intracerebral hemorrhage (ICH). Methods ICH patients admitted in Emergency Intensive Care Unit of Shenzhen People’s Hospital from March, 2013 through March, 2016 were retrospectively studied. Patients were enrolled as nicardipine group or urapidil group depending on the initial antihypertensive drug given at admission. The differences in rate of patients reached the goal BP within the first 24 h, time required for getting goal BP, blood pressure variability (BPV), rebleeding or hematoma expansion during the first 24 h, cerebral state index (CSI) within 7 days and 28-day mortality were compared between the two groups. The differences in adverse events including bradycardia, tachycardia and hypotension were also compared between two groups. An independent t test and χ2 test were performed to compare different variables. An analysis of variance of repeated measurement was performed to compare CSI within 7 days between two groups. Results Seventy-seven patients were included with 42 in nicardipine group and 55 in urapidil group. Rate of patients getting goal BP in nicardipine group was (94±5)% and (86±11)% in urapidil group (P 0.05). Through analysis of variance of repeated measurement, CSI in nicardipine group improves more rapidly than that in urapidil group (F=1 581.115, P=0.000). Hypotension, bradycardia and tachycardia were also comparable between groups (P>0.05). Conclusion Compared with urapidil, nicardipine produces effect more rapidly with more stable BP and higher rate of patients with ICH getting goal BP. Moreover, the application of nicardipine may be better to improve the CSI of ICH patients. Key words: Urapidil; Nicardipine; Blood pressure; Verebral hemorrhage; Acute phase; Cerebral state index

Effectiveness and Safety of Nicardipine and Labetalol Infusion for Blood Pressure Management in Patients with Intracerebral and Subarachnoid Hemorrhage

Nicardipine and labetalol are two commonly used antihypertensives for treating elevated blood pressures in the setting of intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). There are no studies comparing these two agents as continuous infusions. A retrospective chart review was conducted of patients admitted between November 2009 and January 2011 with ICH and SAH to compare effectiveness and safety between both agents. Percent time spent at goal was set as the primary outcome. The secondary outcomes included blood pressure variability, time to goal, incidence of bradycardia, tachycardia, and hypotension. A total of 81 patients were available for analysis, 10 initiated on labetalol (LAB), 57 on nicardipine (NIC), and 14 required the combination of these agents (COMB) to reach goal. We found no difference between NIC, LAB, and the COMB groups in the median percent time at goal [88 % (61-98); 93 % (51-99); 66 % (25-95), (p = NS)]. Median percentage of blood pressure variability, hypotension, and bradycardia were also comparable between groups, however, more tachycardia was observed in the COMB group versus both LAB and NIC groups (45 vs. 0 vs. 3 %; p < 0.001). Mean time to goal SBP in 24 patients who had BP readings available at 1st h of initiation was 32 ± 34 min in the NIC group and 53 ± 42 min in the LAB group (p = 0.03). Both agents appear equally effective and safe for blood pressure control in SAH and ICH during the initial admission hours. A prospective study is needed to validate these findings.

402: Maternal complications of nicardipine in treatment of preterm labor: a retrospective study of 819 patients

There is concern about maternal safety of using calcium channel blocker in pregnancy with minimal data on the safety of nicardipine. The aim of this study is to examine its maternal side effects when it is used for the treatment of preterm labor.

Efficacy and safety of nicardipine for the treatment of hypertensive emergencies

Efficacy and safety of nicardipine for the treatment of hypertensive emergencies

Effects of intravenous nicardipine in Chinese patients with hypertensive emergencies

The efficacy and safety of nicardipine, a dihydropyridine calcium channel blocker, was evaluated in an uncontrolled, double-masked, randomized study of 53 patients with hypertensive emergencies. Either nicardipine by intravenous bolus followed by constant intravenous infusion for 24 hours (<30 mg/h) (group I, n = 14) or nicardipine by constant intravenous infusion for 24 hours (<30 mg/h) (group II, n = 39) was assigned in a 1:3 ratio. Groups I and II both showed a therapeutic response (decrease in systolic blood pressure > 20 mm Hg and decrease in diastolic blood pressure > 10 mm Hg) 5 and 10 minutes after infusion, respectively. During constant intravenous infusion, blood pressure was stable in both groups. Adverse effects were transient and mild in both groups, except in one patient in group I. The present study demonstrated that the administration of nicardipine by infusion alone and by bolus and infusion are equally effective in the treatment of hypertensive emergency, with rapid onset of action and few adverse effects.

Efficacy of Nicardipine in Angina Pectoris

The dose-related efficacy and safety of nicardipine, a new calcium antagonist of the dihydropyridine class, was assessed by exercise tolerance testing in a randomized, double-blinded, placebo-controlled study in 19 patients with chronic, stable effort angina pectoris. Four patients were assigned to each of four treatment sequences receiving nicardipine three times daily in an extended Latin-Square study design. An increase in total exercise capacity, time to onset of angina and time to 1 mm ST segment depression was observed with nicardipine 90 mg/day compared to placebo (P less than .05). Gradual upward dose titration in 30 mg/day increments starting from 30 mg/day appeared to produce maximal increase in exercise capacity. Two patients developed adverse side effects attributable to the drug when administered nicardipine 90 mg/day directly from placebo.

Comparison of concomitant nicardipine hydrochloride and propranolol with propranolol alone in patients with essential hypertension

A twelve-week parallel study was conducted to compare the efficacy and safety of nicardipine plus propranolol with that of propranolol alone in 67 patients with mild to moderate essential hypertension. Efficacy data was analysed for 50 patients. The regimens used were 90 mg X day-1 of nicardipine and 120 mg X day-1 of propranolol. Both treatments significantly reduced supine and standing systolic and diastolic blood pressure from baseline values at all visits. At all visits, concomitant administration of nicardipine and propranolol produced a greater reduction in systolic and diastolic pressures than did propranolol alone, although the difference between treatments did not always reach statistical significance. Few adverse events were reported, and none was clinically important. We conclude that nicardipine taken concomitantly with propranolol is more effective than propranolol alone in treating patients with hypertension and that the combined regimen is well tolerated.

Comparative efficacy of nicardipine hydrochloride and atenolol in the treatment of chronic stable angina

Abstract 1 The efficacy and safety of nicardipine, 30 mg three times a day, were compared with atenolol, 100 mg once daily in a randomised, double-blind, 11-week, crossover study of 46 patients with stable angina pectoris. 2 Both drugs significantly decreased the frequency of angina and improved total exercise time, time to angina, and time to 1 mm ST-segment depression. No statistically significant differences were observed between nicardipine and atenolol in clinical responses or treadmill performance. 3 At maximum workload, the double product decreased significantly in patients taking atenolol and did not change in those using nicardipine. 4 During treatment with atenolol, statistically significant decreases were observed in heart rate and QTc interval; these parameters increased minimally on nicardipine. 5 The incidence and severity of adverse experiences associated with each treatment were similar and did not interfere with the study. The two major adverse experiences, myocardial infarction and sudden death, occurred only in patients receiving atenolol. 6 Nicardipine therapy compared favourably with atenolol therapy in patients with angina pectoris.

Nicardipine for angina pectoris at rest and coronary arterial spasm

The antiischemic effects and safety of nicardipine were assessed in 17 patients with angina at rest and coronary arterial spasm in a randomized placebo-controlled study over 8 to 13 weeks. Eleven patients had previously had unsatisfactory results with long-acting nitrates or other calcium blockers. The average daily dosage of nicardipine for optimal angina relief was 89 mg (range 40 to 160). During the double-blind phase, angina frequency decreased with nicardipine compared with placebo (mean 0.47 vs 2.11 attacks/day, p < 0.05). A similar decrease in nitroglycerin requirements occurred (0.51 vs 2.77 tablets/day, p < 0.05). During placebo periods, 51 episodes of ischemic ST-segment shifts occurred during 482 hours of ambulatory electrocardiographic monitoring and 12 (24%) were associated with angina. During nicardipine treatment, only 15 episodes of ST-segment shifts occurred during 498 hours of monitoring. In 1 patient a burning skin rash developed; otherwise, the drug was generally well tolerated. Thus, nicardipine is effective and safe in preventing symptomatic and asymptomatic ischemia in patients with coronary spasm. It may be particularly beneficial in patients with unsatisfactory responses to other therapy.