20 to 50     : Dose as in normal renal function
10 to 20     : Dose as in normal renal function. Start with small doses
<10           : Dose as in normal renal function. Start with small doses
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Unlikely to be dialysed. Dose as in GFR <10 mL/min
HD                     :Not dialysed. Dose as in GFR <10 mL/min
HDF/high flux   :Unknown dialysability. Dose as in GFR <10 mL/min
CAV/VVHD      :Unknown dialysability. Dose as in GFR 10 to 20 mL/min
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs
Anaesthetics: enhanced hypotensive effect
Antibacterials: metabolism possibly accelerated by rifampicin
Anti-epileptics: effect reduced by carbamazepine, barbiturates, phenytoin and primidone
Antifungals: metabolism possibly inhibited by itraconazole and ketoconazoleAntihypertensives: enhanced hypotensive effect, increased risk of first dose hypotensive effect of post-synaptic alpha-blockers
Antivirals: concentration possibly increased by ritonavirCardiac glycosides: digoxin concentration increased
Ciclosporin: concentration of ciclosporin increased
Grapefruit juice: concentration increased – avoid concomitant use
Tacrolimus: may increase tacrolimus levels Theophylline: possibly increased theophylline concentration
ADMINISTRATION
Reconstition
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Route
Oral
Rate of Administration
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Comments
Administration of nicardipine with food appears to reduce the bioavailability and delay the achievement of peak plasma concentrations
OTHER INFORMATION
Extensively metabolised in the liver and excreted in the urine and faeces, mainly as inactive metabolitesNicardipine blood levels may be elevated in some renally impaired patients. Therefore, start with a low dose and titrate to BP and response. The dose interval may also need to be extended to 12 hourly