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Dihydropyridine calcium-channel blocker Pregnancy: US Pregnancy Category C. 'There are no adequate and well-controlled studies in pregnant women. Nicardipine hydrochloride capsules should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.' Breastfeeding - 'Studies in rats have shown significant concentrations of nicardipine in maternal milk following oral administration. For this reason it is recommended that women who wish to breastfeed should not take this drug.' Not from a UK SPC — UK product information may differ.

Nicardipine hydrochloride

Brand names: Cardene

Nicardipine is a dihydropyridine calcium-channel blocker, available orally and as an intravenous preparation used for controlled blood-pressure reduction in specialist settings such as hypertensive emergencies.

Adult dose

Dose: 20 mg three times daily initially, titrated within the range 20-40 mg three times daily
Route: Oral - immediate-release capsules
Frequency: Three times daily; 'At least 3 days should be allowed before increasing the nicardipine hydrochloride capsules dose to ensure achievement of steady-state plasma drug concentrations.'
SCOPE: this dose covers the page's PRIMARY route (oral) for the two indications the fetched label doses - hypertension and angina. The bundle contains NO intravenous nicardipine posology, so the IV infusion regimen also listed on this page (hypertensive emergency) is NOT covered here and must be sourced separately from an intravenous nicardipine SPC. HYPERTENSION (verbatim): 'The dose of nicardipine hydrochloride capsules should be individually adjusted according to the blood pressure response beginning with 20 mg three times daily. The effective doses in clinical trials have ranged from 20 mg to 40 mg three times daily.' ANGINA (verbatim): 'The dose should be individually titrated for each patient beginning with 20 mg three times daily. Doses in the range of 20 to 40 mg three times a day have been shown to be effective.' NO ABSOLUTE MAXIMUM DOSE is stated anywhere in the retrieved label: 40 mg three times daily is the top of the range 'shown to be effective', not a stated ceiling, so maxDose is left empty. TIMING OF EFFECT: 'The maximum blood pressure lowering effect occurs approximately 1 to 2 hours after dosing.' CONGESTIVE HEART FAILURE: 'Caution is advised when titrating nicardipine hydrochloride capsules dosage in patients with congestive heart failure.' ELDERLY: 'Pharmacokinetic parameters did not differ between elderly hypertensive patients (>=65 years) and healthy controls after 1 week of nicardipine hydrochloride capsules treatment at 20 mg tid ... In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function.' CO-ADMINISTRATION: 'Sublingual NTG may be taken as required to abort acute anginal attacks during nicardipine hydrochloride capsules therapy'; the capsules 'may be safely coadministered with short- and long-acting nitrates', with beta-blockers, and with thiazide diuretics. PAEDIATRIC: 'Safety and efficacy in patients under the age of 18 have not been established' - the label gives no paediatric dose; verify any paediatric use against a children's formulary.

Dose adjustments

Renal

Renal insufficiency - 'Although there is no evidence that nicardipine hydrochloride capsules impair renal function, careful dose titration beginning with 20 mg tid is advised.' No dose reduction or creatinine-clearance banding is given in the fetched label.

Hepatic

Hepatic insufficiency - 'Nicardipine hydrochloride capsules should be administered cautiously in patients with severely impaired hepatic function. A suggested starting dose of 20 mg twice a day is advised with individual titration based on clinical findings maintaining the twice a day schedule.'

Dose independently re-sourced from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the drug - 'Nicardipine hydrochloride capsules are contraindicated in patients with hypersensitivity to the drug.'
  • Advanced aortic stenosis - 'Because part of the effect of nicardipine hydrochloride capsules are secondary to reduced afterload, the drug is also contraindicated in patients with advanced aortic stenosis. Reduction of diastolic pressure in these patients may worsen rather than improve myocardial oxygen balance.'

Side effects

  • Hypotension and tachycardia around the time of peak effect - 'adverse effects associated with decreases in blood pressure (tachycardia, hypotension, etc.) could occur around the time of the peak effect.'
  • Vasodilator effects - 'Most adverse effects were expected consequences of the vasodilator effects of nicardipine hydrochloride capsules.'
  • Overall tolerability (1910 patients, studies up to 3 months) - 'adverse experiences were generally not serious but occasionally required dosage adjustment and about 10% of patients left the studies prematurely because of them.'
  • SOURCE LIMITATION: the ADVERSE REACTIONS text ends at the source-fetch limit immediately before the incidence table, so no individual reaction frequencies were retrieved - the reactions above are the only ones named in the fetched text.

Monitoring

  • Blood pressure at trough, 8 hours after dosing - 'To assess the adequacy of blood pressure response, the blood pressure should be measured at trough (8 hours after dosing).'
  • Blood pressure 1 to 2 hours after dosing, particularly during initiation - 'Because of the prominent peak effects of nicardipine, blood pressure should be measured 1 to 2 hours after dosing, particularly during initiation of therapy.'
  • Serum digoxin, if co-prescribed - 'serum digoxin levels should be evaluated after concomitant therapy with nicardipine hydrochloride capsules are initiated.'
  • Careful monitoring if cimetidine is co-prescribed - 'Cimetidine increases nicardipine hydrochloride capsules plasma levels. Patients receiving the two drugs concomitantly should be carefully monitored.'
  • Plasma cyclosporine, if co-prescribed - 'Concomitant administration of oral or intravenous nicardipine and cyclosporine results in elevated plasma cyclosporine levels though nicardipine inhibition of hepatic microsomal enzymes, including CYP3A4.'

Clinical monograph

How it works

It blocks L-type calcium channels in vascular smooth muscle, producing arterial vasodilatation with relative vascular selectivity over the myocardium, thereby reducing peripheral resistance and blood pressure.

Prescribing in practice

  • Intravenous use can cause excessive hypotension and reflex tachycardia and requires close blood-pressure monitoring with careful titration, usually via an infusion pump in a monitored environment.
  • Like other dihydropyridines it may cause flushing, headache, peripheral oedema and palpitations.
  • Avoid in advanced aortic stenosis, and consult the SPC for cautions, dilution and administration details.

Monitoring

Monitor blood pressure and heart rate closely, continuously during intravenous infusion and at the infusion site for irritation.

Counselling the patient

  • Explain that the intravenous form is given in hospital with frequent blood-pressure checks.
  • Advise that headache, flushing and ankle swelling are common and usually settle.

Evidence & guidelines

Nicardipine is an established dihydropyridine calcium-channel blocker; refer to current prescribing references for licensed indications.

Reference: ESC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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