Nicardipine is a second generation calcium channel blocker used in the treatment of hypertension and stable angina pectoris. Nicardipene therapy has been associated with a low rate of transient serum enzyme elevations, but has not been linked convincingly to instances of clinically apparent liver injury with jaundice.
Nicardipine (nye kar' di peen) belongs to the dihydropyridine class of calcium channel blockers and is used in the treatment of both angina pectoris and hypertension. Like other calcium channel blockers, nicardipine acts by blocking the influx of calcium ions into vascular smooth muscle and cardiac cells during depolarization. This inhibition of calcium flux results in a vasodilation and decrease in cardiac work and oxygen consumption. Nicardipine was approved in the United States in 1988 and in remains in wide use. Nicardipine is available in multiple generic forms and under the commercial name Cardene in regular and as extended- or sustained-release capsules in 20, 30, 45 and 60 mg amounts. The current indications vary by formulation, but include both hypertension and angina pectoris. The usual adult dose is 60 to 120 mg daily in 2 or 3 divided doses. Intravenous formulations are available for management of hypertensive emergencies. As with other calcium channel blockers, nicardipine is generally well tolerated and side effects are largely due to its vasodilating activities and can include headache, flushing, dizziness, fatigue, nausea, diarrhea, peripheral edema and skin rash.
Nicardipine has not been associated with significant increases in rates of elevations in serum aminotransferase or alkaline phosphatase levels, even with chronic long term therapy. Cases of idiosyncratic liver injury have not been published, although a single instance of marked serum enzyme elevations without jaundice has been reported with the use of intravenous nicardipine. Large trials of nicardipine have not mentioned liver injury, serum aminotransferase elevations or discontinuation of drug because of hepatic adverse events. Thus, clinically apparent liver injury with jaundice due to nicardipine must be rare, if it occurs at all.
Likelihood Score: E (unlikely cause of clinically apparent liver injury).
The reason why some calcium channel blockers are known to cause idiosyncratic liver injury while others such as nicardipine do not, is unknown.
REPRESENTATIVE TRADE NAMES
Nicardipine – Generic, Cardene®
Product labeling at DailyMed, National Library of Medicine, NIH
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References updated: 11 January 2017
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