Resources and support for ready-to-use
CARDENE® I.V. (nicardipine hydrochloride)
Watch these webinars about CARDENE I.V.
Review patient profiles of hypertensive emergencies in stroke cases
The following are examples of clinical presentations in which acute hypertension may require treatment. Review the profiles to determine how you might intervene. These are not actual patients. Patient symptoms may vary; individual clinical evaluation should be done to determine the best course of therapy.
CARDENE I.V. is not indicated for the treatment or prevention of ICH, aSAH, or AIS.
Management guidelines for hypertensive emergencies
Ready-to-use CARDENE I.V. is a dihydropyridine calcium channel blocker.1 It is the only available FDA-approved premixed formulation of nicardipine hydrochloride, an antihypertensive agent recommended or included in the following guidelines, including American Heart Association (AHA)/American Stroke Association (ASA) acute ischemic stroke (AIS) guidelines.
2018 AHA/ASA Guidelines for the Early Management of Patients With Acute Ischemic Stroke (AIS)2
|For an AIS patient who is otherwise eligible for acute reperfusion therapy except that BP is >185/110 mmHg*||For an AIS patient who has either SBP >180–230 mmHg or DBP >105–120 mmHg*|
|Treatment options†||Treatment options†|
|Nicardipine 5 mg/h IV, titrate up by 2.5 mg/h every 5–15 min, maximum 15 mg/h; when desired BP reached, adjust to maintain proper BP limit; or||Nicardipine 5 mg/h IV, titrate up to desired effect by 2.5 mg/h every 5–15 min, maximum 15 mg/h; or|
|Clevidipine 1–2 mg/h IV, titrate by doubling the dose every 2–5 min until desired BP reached; maximum 21 mg/h; or||Clevidipine 1–2 mg/h IV, titrate by doubling the dose every 2–5 min until desired BP reached; maximum 21 mg/h; or|
|Labetalol 10–20 mg IV over 1–2 min, may repeat 1 time||Labetalol 10 mg IV followed by continuous IV infusion 2–8 mg/min|
|Other agents (eg, hydralazine, enalaprilat) may also be considered||If BP not controlled or DBP >140 mmHg, consider IV sodium nitroprusside|
2015 AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (ICH)3
- “For ICH patients presenting with SBP between 150 and 220 mm Hg and without contraindication to acute BP treatment, acute lowering of SBP to 140 mm Hg is safe (Class I; Level of Evidence A) and can be effective for improving functional outcome (Class IIa; Level of Evidence B).” (Revised from previous guideline)
- “For ICH patients presenting with SBP >220 mm Hg, it may be reasonable to consider aggressive reduction of BP with a continuous intravenous infusion and frequent BP monitoring (Class IIb; Level of Evidence C).” (New recommendation)
After the acute ICH period
- BP should be well controlled, particularly for patients with ICH location (Class I; Level of Evidence A). (New recommendation)
2012 AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (aSAH)4
- Between the time of aSAH symptom onset and aneurysmal obliteration, BP should be controlled with a titratable agent to balance the risk of stroke, hypertension-related rebleeding, and maintenance of cerebral perfusion pressure.
- “Nicardipine may give smoother blood pressure control than labetalol and sodium nitroprusside, although data showing different clinical outcomes are lacking”
- The magnitude of BP control to reduce the risk of rebleeding has not been established, but a decrease in SBP to <160 mm Hg is reasonable, after the acute treatment phase (Class IIa; Level of Evidence C). (New recommendation)
2003 JNC 7 report (for BP Reduction in Hypertensive Emergencies)*5
Examples of hypertensive emergencies include hypertensive encephalopathy, intracerebral hemorrhage, and dissecting aortic aneurysm, among others.
In patients with BP >180/120 mm Hg complicated by evidence of impending or progressive target-organ damage, the general goals for BP control include the following:
- Reduce mean arterial BP by no more than 25% within minutes to 1 hour
- If stable, reduce to 160/100 to 110 mm Hg within the next 2 to 6 hours
- Avoid excessive falls in pressure that may precipitate renal, cerebral, or coronary ischemia
- If this level of BP is well tolerated, further gradual reductions toward a normal BP can be implemented over the next 24 to 48 hours
- There are exceptions to the above recommendations. Please refer to guidelines
Standards and guidelines for dispensing and storing medications
Ready-to-use CARDENE I.V. supports The Joint Commission, American Society of Health-System Pharmacists, and Institute for Safe Medication Practices recommendations for the use of ready-to-use medications.7-9
- “Medications are dispensed in the most ready-to-administer forms commercially available…”7
- “Whenever possible, medications shall be available for inpatient use in single-unit packages and in a ready-to-administer form”8
- Drug concentrations must be standardized and limited7
- A system must be in place to safely provide medications to meet patient needs when the pharmacy is closed7,8
- Preparation of admixtures outside the pharmacy (eg, on nursing units) should be minimized8