• Management of:
  • Hypertension,
  • Angina pectoris,
  • Vasospastic (Prinzmetal’s) angina.

Contraindicated in:

• Hypersensitivity
• Sick sinus syndrome
• 2nd- or 3rd-degree AV block (unless an artificial pacemaker is in place)
• SBP <90 mm Hg
• Advanced aortic stenosis.

Use Cautiously in:

• Severe hepatic impairment (dose ↓ recommended)
• Severe renal impairment (dose ↓ may be necessary)
• History of serious ventricular arrhythmias or HF
• OB: Lactation: Pedi: Safety not established
• Geri: Dose ↓/slower IV infusion rates recommended due to↑ risk of hypotension.

EENT: blurred vision, disturbed equilibrium, epistaxis, tinnitus.

Resp: cough, dyspnea, shortness of breath.

CV: ARRHYTHMIAS, HF, peripheral edema, bradycardia, chest pain, hypotension, palpitations, syncope, tachycardia.

GI: ↑liver function tests, anorexia, constipation, diarrhea, dry mouth, dysgeusia, dyspepsia, nausea, vomiting.

GU: dysuria, nocturia, polyuria, sexual dysfunction, urinary frequency.

Derm: dermatitis, erythema multiforme, flushing, ↑ sweating, photosensitivity, pruritus/urticaria, rash.

Endo: gynecomastia, hyperglycemia.

Hemat: anemia, leukopenia, thrombocytopenia.

Metab: weight gain.

MS: joint stiffness, muscle cramps.

Neuro: paresthesia, tremor , abnormal dreams, anxiety, confusion, dizziness, drowsiness, headache, jitteriness, nervousness, psychiatric disturbances, weakness.
Misc: STEVENS-JOHNSON SYNDROME, gingival hyperplasia.

Drug-Drug:

• Additive hypotension may occur when used concurrently with fentanyl, other antihypertensives, nitrates, acute ingestion of alcohol, or quinidine.
• Antihypertensive effects may be ↓ by concurrent use of NSAIDs.
• Cimetidine and propranolol may ↓ metabolism and ↑ risk of toxicity.
• May ↓ the metabolism of and ↑ risk of toxicity from cyclosporine, prazosin, quinidine, tacrolimus, or carbamazepine.

Drug-Food:

• Grapefruit and grapefruit juice↑ serum levels and effect.

(Generic available)

• Capsules: 20 mg; 30 mg;
• Injection: 2.5 mg/mL;
• Premixed infusion: 20 mg/200 mL D5W or 0.9% NaCl; 40 mg/200 mL 0.9% NaCl;

• PO (Adults): 20 mg 3 times daily, may ↑ every 3 days (range 20–40 mg 3 times daily).
• IV (Adults): Substitute for PO nicardipine — if PO dose is 20 mg every 8 hr, then infusion rate is 0.5 mg/hr; if PO dose is 30 mg every 8 hr, then infusion rate is 1.2 mg/hr; if PO dose is 40 mg every 8 hr, then infusion rate is 2.2 mg/hr. Patients not receiving PO nicardipine — initiate therapy at 5 mg/hr, may be increased by 2.5 mg every 5–15 min as needed (up to 15 mg/hr).

Cardene, Cardene IV

• Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction.

• Systemic vasodilation resulting in decreased BP.
• Coronary vasodilation resulting in decreased frequency and severity of attacks of angina.

Therapeutic Classification: antianginals, antihypertensives

Pharmacologic Classification: calcium channel blockers

Absorption: Well absorbed following oral administration but extensively metabolized, resulting in ↓ bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Mostly metabolized by the liver; 10% excreted unchanged by kidneys.

Half-life: 2–4 hr.

(cardiovascular effects)

†Following discontinuation.

• Advise patient to take medication exactly as directed, even if feeling well. Take missed doses as soon as possible unless almost time for next dose; do not double doses. May need to be discontinued gradually.
  • Instruct patient on technique for monitoring pulse. Instruct patient to contact health care professional if heart rate is <50 bpm.
  • Advise patient to avoid grapefruit or grapefruit juice during therapy.
  • Caution patient to change positions slowly to minimize orthostatic hypotension.
  • May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to avoid concurrent use of alcohol or OTC medications and herbal products, especially NSAIDs and cold preparations, without consulting health care professional.
  • Advise patient to notify health care professional if rash, irregular heartbeat, dyspnea, swelling of hands and feet, pronounced dizziness, nausea, constipation, or hypotension occurs or if headache is severe or persistent.
  • Caution patient to wear protective clothing and to use sunscreen to prevent photosensitivity reactions.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.
• Angina: Instruct patient on concurrent nitrate or beta-blocker therapy to continue taking both medications as directed and to use SL nitroglycerin as needed for anginal attacks.
  • Advise patient to contact health care professional if chest pain does not improve, worsens after therapy, or occurs with diaphoresis; if shortness of breath; or if persistent headache occurs.
  • Caution patient to discuss exercise restrictions with health care professional prior to exertion.
• Hypertension: Encourage patient to comply with other interventions for hypertension (weight reduction, low-sodium diet, smoking cessation, moderation of alcohol consumption, regular exercise, and stress management). Medication controls but does not cure hypertension.
  • Instruct patient and family in proper technique for monitoring BP. Advise patient to take BP weekly and to report significant changes to health care professional.

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