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Nicardipine Hydrochloride (Capsule)

Source:http://www4.wiwiss.fu-berlin.de/dailymed/resource/drugs/3517

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Nicardipine Hydrochloride (Capsule)
dailymed-instance:dosage
Angina: 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. At least three days should be allowed before increasing the nicardipine hydrochloride dose to ensure achievement of steady state plasma drug concentrations.<br/>Concomitant Use With Other Antianginal Agents:<br/>Hypertension: The dose of nicardipine hydrochloride 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. The maximum blood pressure lowering effect occurs approximately 1 to 2 hours after dosing. To assess the adequacy of blood pressure response, the blood pressure should be measured at trough (8 hours after dosing). Because of the prominent peak effects of nicardipine, blood pressure should be measured 1 to 2 hours after dosing, particularly during initiation of therapy. At least three days should be allowed before increasing the nicardipine dose to ensure achievement of steady state plasma drug concentrations.<br/>Concomitant Use With Other Antihypertensive Agents, Beta-blockers:<br/>Special Patient Populations:<br/>Renal Insufficiency: Although there is no evidence that nicardipine impairs renal function, careful dose titration beginning with 20 mg TID is advised.<br/>Hepatic Insufficiency: Nicardipine 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.<br/>Congestive Heart Failure: Caution is advised when titrating nicardipine dosage in patients with congestive heart failure.
dailymed-instance:descripti...
Nicardipine hydrochloride capsules for oral administration each contain 20 mg or 30 mg of nicardipine hydrochloride. Nicardipine hydrochloride is a calcium ion influx inhibitor (slow channel blocker or calcium channel blocker). Nicardipine hydrochloride is a dihydropyridine structure with the IUPAC (International Union of Pure and Applied Chemistry) chemical name 2-(Benzylmethylamino)ethyl methyl 1,4-dihydro-2,6-dimethyl-4-(m-nitrophenyl)-3,5-pyridinedicarboxylate monohydrochloride, and it has the following structural formula: NICARDIPINE HYDROCHLORIDECHNO���HCl Nicardipine hydrochloride is a greenish-yellow, odorless, crystalline powder that melts at about 169��C. It is freely soluble in chloroform, methanol, and glacial acetic acid, sparingly soluble in anhydrous ethanol, slightly soluble in n-butanol, water, 0.01 M potassium dihydrogen phosphate, acetone, and dioxane, very slightly soluble in ethyl acetate, and practically insoluble in benzene, ether and hexane. It has a molecular weight of 515.99. Each capsule, for oral administration, contains 20 mg or 30 mg of nicardipine hydrochloride. In addition, each capsule contains the following inactive ingredients: colloidal silicon dioxide, gelatin, magnesium stearate, pharmaceutical glaze, pregelatinized starch, propylene glycol, silicon dioxide, sodium lauryl sulfate, synthetic black iron oxide, FD&C Blue #2 Aluminum Lake, FD&C Red #40 Aluminum Lake, FD&C Blue #1 Aluminum Lake, and D&C Yellow #10 Aluminum Lake. The colorants used in the 20 mg capsules are titanium dioxide, D&C Yellow #10, and FD&C Green #3. The colorants used in the 30 mg capsules are titanium dioxide, yellow iron oxide, and FD&C Green #3.
dailymed-instance:clinicalP...
Mechanism of Action: Nicardipine is a calcium entry blocker (slow channel blocker or calcium ion antagonist) which inhibits the transmembrane influx of calcium ions into cardiac muscle and smooth muscle without changing serum calcium concentrations. The contractile processes of cardiac muscle and vascular smooth muscle are dependent upon the movement of extracellular calcium ions into these cells through specific ion channels. The effects of nicardipine are more selective to vascular smooth muscle than cardiac muscle. In animal models, nicardipine produces relaxation of coronary vascular smooth muscle at drug levels which cause little or no negative inotropic effect.<br/>Pharmacokinetics and Metabolism: Nicardipine is completely absorbed following oral doses administered as capsules. Plasma levels are detectable as early as 20 minutes following an oral dose and maximal plasma levels are observed within 30 minutes to two hours (mean T= 1 hour). While nicardipine is completely absorbed, it is subject to saturable first pass metabolism and the systemic bioavailability is about 35% following a 30 mg oral dose at steady state. When nicardipine hydrochloride was administered one (1) or three (3) hours after a high fat meal, the mean Cand mean AUC were lower (20% to 30%) than when nicardipine hydrochloride was given to fasting subjects. These decreases in plasma levels observed following a meal may be significant but the clinical trials establishing the efficacy and safety of nicardipine hydrochloride were done in patients without regard to the timing of meals. Thus the results of these trials reflect the effects of meal-induced variability. The pharmacokinetics of nicardipine are nonlinear due to saturable hepatic first pass metabolism. Following oral administration, increasing doses result in a disproportionate increase in plasma levels. Steady state Cvalues following 20, 30, and 40 mg doses every 8 hours averaged 36, 88, and 133 ng/mL, respectively. Hence, increasing the dose from 20 to 30 mg every 8 hours more than doubled Cand increasing the dose from 20 to 40 mg every 8 hours increased Cmore than 3-fold. A similar disproportionate increase in AUC with dose was observed. Considerable intersubject variability in plasma levels was also observed. Post-absorption kinetics of nicardipine are also non-linear, although there is a reproducible terminal plasma half-life that averaged 8.6 hours following 30 and 40 mg doses at steady state (TID). The terminal half-life represents the elimination of less than 5% of the absorbed drug (measured by plasma concentrations). Elimination over the first 8 hours after dosing is much faster with a half-life of 2 to 4 hours. Steady state plasma levels are achieved after 2 to 3 days of TID dosing (every 8 hours) and are 2-fold higher than after a single dose. Nicardipine is highly protein bound (>95%) in human plasma over a wide concentration range. Nicardipine is metabolized extensively by the liver; less than 1% of intact drug is detected in the urine. Following a radioactive oral dose in solution, 60% of the radioactivity was recovered in the urine and 35% in feces. Most of the dose (over 90%) was recovered within 48 hours of dosing. Nicardipine does not induce its own metabolism and does not induce hepatic microsomal enzymes. Nicardipine plasma levels were higher in patients with mild renal impairment (baseline serum creatinine concentration ranged from 1.2 to 5.5 mg/dL) than in normal subjects. After 30 mg nicardipine hydrochloride TID at steady state, Cand AUC were approximately 2-fold higher in these patients. Because nicardipine is extensively metabolized by the liver, the plasma levels of the drug are influenced by changes in hepatic function. Nicardipine plasma levels were higher in patients with severe liver disease (hepatic cirrhosis confirmed by liver biopsy or presence of endoscopically-confirmed esophageal varices) than in normal subjects. After 20 mg nicardipine hydrochloride BID at steady state, Cand AUC were 1.8 and 4-fold higher, and the terminal half-life was prolonged to 19 hours in these patients.<br/>Geriatric Pharmacokinetics: The steady-state pharmacokinetics of nicardipine in elderly hypertensive patients (���65 years) are similar to those obtained in young normal adults. After one week of nicardipine hydrochloride dosing at 20 mg three times a day, the C, T, AUC, terminal plasma half-life, and the extent of protein binding of nicardipine observed in healthy elderly hypertensive patients did not differ significantly from those observed in young normal volunteers.<br/>Hemodynamics: In man, nicardipine produces a significant decrease in systemic vascular resistance. The degree of vasodilation and the resultant hypotensive effects are more prominent in hypertensive patients. In hypertensive patients, nicardipine reduces the blood pressure at rest and during isometric and dynamic exercise. In normotensive patients, a small decrease of about 9 mmHg in systolic and 7 mmHg in diastolic blood pressure may accompany this fall in peripheral resistance. An increase in heart rate may occur in response to the vasodilation and decrease in blood pressure, and in a few patients this heart rate increase may be pronounced. In clinical studies mean heart rate at time of peak plasma levels was usually increased by 5 to 10 beats per minute compared to placebo, with the greater increases at higher doses, while there was no difference from placebo at the end of the dosing interval. Hemodynamic studies following intravenous dosing in patients with coronary artery disease and normal or moderately abnormal left ventricular function have shown significant increases in ejection fraction and cardiac output with no significantchange, or a small decrease, in left ventricular end-diastolic pressure (LVEDP). Although there is evidence that nicardipine increases coronary blood flow, there is no evidence that this property plays any role in its effectiveness in stable angina. In patients with coronary artery disease, intra-coronary administration of nicardipine caused no direct myocardial depression. Nicardipine does, however, have a negative inotropic effect in some patients with severe left ventricular dysfunction and could, in patients with very impaired function, lead to worsened failure. "Coronary Steal", the detrimental redistribution of coronary blood flow in patients with coronary artery disease (diversion of blood from under perfused areas toward better perfused areas), has not been observed during nicardipine treatment. On the contrary, nicardipine has been shown to improve systolic shortening in normal and hypokinetic segments of myocardial muscle, and radio-nuclide angiography has confirmed that wallmotion remained improved during an increase in oxygen demand. Nonetheless, occasional patients have developed increased angina upon receiving nicardipine. Whether this represents steal in those patients, or is the result of increased heart rate and decreased diastolic pressure, is not clear. In patients with coronary artery disease nicardipine improves L.V. diastolic distensibility during the early filling phase, probably due to a faster rate of myocardial relaxation in previously under perfused areas. There is little or no effect on normal myocardium, suggesting the improvement is mainly by indirect mechanisms such as afterload reduction, and reduced ischemia. Nicardipine has no negative effect on myocardial relaxation at therapeutic doses. The clinical consequences of these properties are as yet undemonstrated.<br/>Electrophysiologic Effects: In general, no detrimental effects on the cardiac conduction system were seen with the use of nicardipine hydrochloride. Nicardipine increased the heart rate when given intravenously during acute electrophysiologic studies, and prolonged the corrected QT interval to a minor degree. The sinus node recovery times and SA conduction times were not affected by the drug. The PA, AH, and HV intervalsand the functional and effective refractory periods of the atrium were not prolonged by nicardipine and the relative and effective refractory periods of the His-Purkinje system were slightly shortened after intravenous nicardipine.<br/>Renal Function: There is a transient increase in electrolyte excretion, including sodium. Nicardipine does not cause generalized fluid retention, as measured by weight changes, although 7 to 8% of the patients experience pedal edema.<br/>Effects In Angina Pectoris: In controlled clinical trials of up to 12 weeks duration in patients with chronic stable angina, nicardipine increased exercise tolerance and reduced nitroglycerin consumption and the frequency of anginal attacks. The antianginal efficacy of nicardipine hydrochloride (20 to 40 mg) has been demonstrated in four placebo-controlled studies involving 258 patients with chronic stable angina. In exercise tolerance testing, nicardipine significantly increased time to angina, total exercise duration and time to 1 mm ST segment depression. Included among these four studies was a dose-definition study in which dose-related improvements in exercise tolerance at one and four hours post-dosing and reduced frequency of anginal attacks were seen at doses of 10, 20 and 30 mg TID. Effectiveness at 10 mg TID was, however, marginal. In a fifth placebo-controlled study, the antianginal efficacy of nicardipine was demonstrated at 8 hours post-dose (trough). The sustained efficacy of nicardipine has been demonstrated over long-term dosing. Blood pressure fell in patients with angina by about 10/8 mmHg at peak blood levels and was little different from placebo at trough blood levels.<br/>Effects In Hypertension: Nicardipine produced dose-related decreases in both systolic and diastolic blood pressure in clinical trials. The antihypertensive efficacy of nicardipine administered three times daily has been demonstrated in three placebo-controlled studies involving 517 patients with mild to moderate hypertension. The blood pressure responses in the three studies were statistically significant from placebo at peak (1 hour post-dosing) and trough (8 hours post-dosing) although it is apparent that well over half of the antihypertensive effect is lost by the end of the dosing interval. The results from placebo controlled studies of nicardipine given three times daily are shown in the following table: The responses are shown as differences from the concurrent placebo control group. The large changes between peak and trough effects were not accompanied by observed side effects at peak response times. In a study using 24 hour intra-arterial blood pressure monitoring, the circadian variation in blood pressure remained unaltered, but the systolic and diastolic blood pressures were reduced throughout the whole 24 hours. When added to beta-blocker therapy, nicardipine further lowers both systolic and diastolic blood pressure.
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Nicardipine hydrochloride is contraindicated in patients with hypersensitivity to the drug. Because part of the effect of nicardipine is 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.
dailymed-instance:supply
Nicardipine hydrochloride capsules are available containing 20 mg or 30 mg of nicardipine hydrochloride. The 20 mg capsule is a hard-shell gelatin capsule with a medium blue-green opaque cap and an ivory opaque body axially imprinted with MYLAN over 1020 in black ink on both the cap and the body. They are available as follows: NDC 0378-1020-77bottles of 90 capsules NDC 0378-1020-05bottles of 500 capsules The 30 mg capsule is a hard-shell gelatin capsule with a bluish green opaque cap and a rich yellow opaque body axially imprinted with MYLAN over 1430 in black ink on both the cap and the body. They are available as follows: NDC 0378-1430-77bottles of 90 capsules NDC 0378-1430-05bottles of 500 capsules Store at 20��to 25��C (68��to 77��F). [See USP for Controlled Room Temperature.] Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure.
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dailymed-instance:overdosag...
Overdosage with a 600 mg single dose (15 to 30 times normal clinical dose) has been reported. Marked hypotension (blood pressure unobtainable) and bradycardia (heart rate 20 bpm in normal sinus rhythm) occurred, along with drowsiness, confusion and slurred speech. Supportive treatment with a vasopressor resulted in gradual improvement with normal vital signs approximately 9 hours post treatment. Based on results obtained in laboratory animals, overdosage may cause systemic hypotension, bradycardia (following initial tachycardia) and progressive atrioventricular conduction block. Reversible hepatic function abnormalities and sporadic focal hepatic necrosis were noted in some animal species receiving very large doses of nicardipine. For treatment of overdose standard measures (for example, evacuation of gastric contents, elevation of extremities, attention to circulating fluid volume and urine output) including monitoring of cardiac and respiratory functions should be implemented. The patient should be positioned so as to avoid cerebral anoxia. Frequent blood pressure determinations are essential. Vasopressors are clinically indicated for patients exhibiting profound hypotension. Intravenous calcium gluconate may help reverse the effects of calcium entry blockade.
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Nicardipine Hydrochloride
dailymed-instance:fullName
Nicardipine Hydrochloride (Capsule)
dailymed-instance:adverseRe...
In multiple-dose U.S. and foreign controlled short-term (up to three months) studies 1,910 patients received nicardipine alone or in combination with other drugs. In these studies adverse events were reported spontaneously; adverse experiences were generally not serious but occasionally required dosage adjustment and about 10% of patients left the studies prematurely because of them. Peak responses were not observed to be associated with adverse effects during clinical trials, but physicians should be aware that adverse effects associated with decreases in blood pressure (tachycardia, hypotension, etc.) could occur around the time of the peak effect. Most adverse effects were expected consequences of the vasodilator effects of nicardipine.<br/>Angina: The incidence rates of adverse effects in anginal patients were derived from multicenter, controlled clinical trials. Following are the rates of adverse effects for nicardipine (N = 520) and placebo (N = 310), respectively, that occurred in 0.4% of patients or more. These represent events considered probably drug-related by the investigator (except for certain cardiovascular events which were recordedin a different category). Where the frequency of adverse effects for nicardipine and placebo is similar, causal relationship is uncertain. The only dose-related effects were pedal edema and increased angina. In addition, adverse events were observed which are not readily distinguishable from the natural history of the atherosclerotic vascular disease in these patients. Adverse events in this category each occurred in<0.4% of patients receiving nicardipine and included myocardial infarction, atrial fibrillation, exertional hypotension, pericarditis, heart block, cerebral ischemia and ventricular tachycardia. It is possible that some of these events were drug-related.<br/>Hypertension: The incidence rates of adverse effects in hypertensive patients were derived from multicenter, controlled clinical trials. Following are the rates of adverse effects for nicardipine (N=1390) and placebo (N=211), respectively, that occurred in 0.4% of patients or more. These represent events considered probably drug-related by the investigator. Where the frequency of adverse effects for nicardipine and placebo is similar, causal relationship is uncertain. The only dose-related effect was pedal edema.<br/>Rare Events: The following rare adverse events have been reported in clinical trials or the literature: Body as a Whole: infection, allergic reaction Cardiovascular: hypotension, postural hypotension, atypical chest pain, peripheral vascular disorder, ventricular extrasystoles, ventricular tachycardia Digestive: sore throat, abnormal liver chemistries Musculoskeletal: arthralgia Nervous: hot flashes, vertigo, hyperkinesia, impotence, depression, confusion, anxiety Respiratory: rhinitis, sinusitis Special Senses: tinnitus, abnormal vision, blurred vision Urogenital: increased urinary frequency
dailymed-instance:indicatio...
I. Stable Angina: Nicardipine hydrochloride capsules are indicated for the management of patients with chronic stable angina (effort-associated angina). They may be used alone or in combination with beta-blockers.<br/>II. Hypertension: Nicardipine hydrochloride capsules are indicated for the treatment of hypertension. They may be used alone or in combination with other antihypertensive drugs. In administering nicardipine hydrochloride it is important to be aware of the relatively large peak to trough differences in blood pressure effect.
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Nicardipine Hydrochloride