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Pharmacy considerations for ready-to-use
CARDENE® I.V. (nicardipine hydrochloride)

Pharmacy guidelines

Dispensing the most ready-to-administer form of medication is recommended by leading hospital pharmacy organizations.

American Society of Health-System Pharmacists (ASHP) guidelines2:

The Joint Commission (TJC) guidelines3:

Institute for Safe Medication Practices (ISMP) recommendation4:


When there’s no time to waste, consider a premixed option


Premixed medications can allow pharmacy resources to be used more efficiently5-8

  • Admixed medications can impact pharmacy workflow and drug delivery in emergent situations due to labor-intensive processes and an increase in materials needed

Potential cost considerations associated with admixture preparations*8-12

Variable Costs Annual Fixed Costs
  • Stock solutions
  • Containers
  • Pharmacy transfer sets
  • Surgical gowns
  • Hair covers
  • Face masks
  • IV bags
  • Needles
  • Syringes
  • Sterile wipes
  • Pharmacy labor
  • Shelf life of equipment
  • Energy consumption
  • Cleansing and disinfecting costs

*Cost considerations can vary by hospital.

Premixed medications may reduce waste5,13,14

  • No additional materials needed
  • Unused product can be returned to inventory
  • Admixed medications may expire prior to use due to limitations on sterility or stability


FDA-approved premixed drugs can ensure accuracy15,16

Manufactured under current Good Manufacturing Practices (GMPs), FDA-approved premixed drugs meet the highest quality of standards in terms of sterility, accuracy, and consistency.

Hospital admixed preparations can result in3,16,17:

  • A shelf life typically not verified by stability testing postadmixture
  • Lower sterility assurance level compared compared with drugs manufactured under GMPs
  • Unregulated or unstandardized labels postadmixture

Compounding drugs in the absence of GMPs increases the potential for preparation errors18,19

  • In a study by Flynn et al., the observed error rate for compounding IV admixtures was 9% vs <1% when using ready-to-use IV products
  • Another study showed that more than 1/3 of infusions had concentrations outside the accepted pharmaceutical standards
  • Limiting the number of manipulations that must be performed to prepare a product can reduce the likelihood of errors

Differences between premixed drugs and hospital admixed preparations16-18

Premixed Drugs Hospital Admixed Preparation Drugs
In compliance with GMPs Not required postadmixture
Tested to ensure manufacturing quality (ie, identity, potency, purity, and sterility) prior to use Not required postadmixture
Dispensed for use with FDA-approved labeling Not required postadmixture

Drug Availability

In the US, the number of active drug shortages doubled between 2010 and 201420

Drug shortages have significant effects on pharmacists and patients and may be costly for the overall hospital system21:

  • Impact on patient care
  • Increased labor costs
  • Higher hospital expenses

National Drug Shortages: Active Shortages by Quarter

Since its introduction in 2008, there has never been a shortage of ready-to-use CARDENE® I.V. (nicardipine hydrochloride) Premixed Injection

January 1, 2010-December 31, 2014

Consider the value of supportive services

Ready-to-use CARDENE I.V. representatives are available to meet the needs of your organization:

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