Nicardipine (Cardene) - Uses, Dose, Side effects

Nicardipine (Cardene) belongs to the class of dihydropyridine calcium channel blockers.

Nicardipine Uses:

  • Angina:

    • It is used to treat long-term stable angina (oral immediate-release product only).
  • Hypertension:

    • It is indicated for treating hypertension (oral immediate/ sustained release or intravenous forms).
    • In cases where oral medication cannot be delivered, intravenous delivery may be employed.

Guideline recommendations:

If single-agent therapy is to be administered in the absence of comorbidities, the 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults suggests thiazide-like diuretics or dihydropyridine calcium channel blockers are preferred due to the prevention of heart failure and stroke.

ARBs and ACE inhibitors can also be used alone. In high-risk individuals (such as those with stage 2 hypertension and an atherosclerotic cardiovascular disease risk of 10% or more), combination therapy is initially chosen.

  • Off Label Use of Nicardipine (Cardene) in Adults:

    • Arterial hypertension in acute ischemic stroke.
    • Control of blood pressure in patients with spontaneous intracranial hemorrhage.
    • Perioperative hypertension.
    • Subarachnoid hemorrhage associated cerebral vasospasm.

Nicardipine (Cardene) dosage in adults:

Note: Cardene SR has been discontinued in the US for more than 1 year.

Nicardipine (Cardene) dose for the treatment of Angina:

  • Immediate-release:

    • 20 mg per oral thrice daily.
    • usual dosage: 20 to 40 mg 3 times daily (allow ≥3 days between dose increases)

Nicardipine (Cardene) dose for the treatment of Hypertension: 

  • Immediate-release:

    • Initial oral dose of 20 mg thrice daily.
    • The usual dosage: 20 to 40 mg 3 times daily (allow ≥3 days between dose increase)
  • Sustained-release:

    • The initial dose of 30 mg b.i.d daily
    • The usual dosage: 30 to 60 mg per oral b.i.d daily

Nicardipine (Cardene) dose for the treatment of Acute hypertension:

  • An initial intravenous dose of 5 mg/hour that can be increased by 2.5 mg/hour every 5 minutes (for fast titration) to every 15 minutes (for slow titration) up to a maximum of 15 mg/hour.
  • Adjust infusion rate according to the desired response
  • Consider reduction to 3 mg/hour after response in rapid titration.
  • The infusion should be stopped if severe hypotension/tachycardia occurs.

Nicardipine (Cardene) dose for the treatment of Arterial hypertension in acute ischemic stroke (off-label use):

  • In patients eligible for reperfusion treatment  except BP >185/110 mm Hg start intravenous dose 5 mg/hour, titrate by 2.5 mg/hour at 5- to 15-minute intervals (maximum dose: 15 mg/hour).
  • If BP still remains >185/110 mm Hg, alteplase should not be given.
  • Management of BP during and after reperfusion treatment to maintain BP ≤180/105 mm Hg:

    • If systolic BP >180 to 230 mm Hg or diastolic >105 to 120 mm Hg start with 5 mg/hour titrate by 2.5 mg/hour at 5- to 15-minute intervals
    • (maximum dose: 15 mg/hour).
    • If hypertension is refractory or diastolic BP >140 mm Hg, consider other intravenous antihypertensives (eg, nitroprusside).
  • Substitution for oral therapy (approximate equivalents):

    • 20 mg every 8 hours oral, equivalent to 0.5 mg/hour intravenous infusion
    • 30 mg every 8 hours oral, equivalent to 1.2 mg/hour intravenous infusion
    • 40 mg every 8 hours oral, equivalent to 2.2 mg/hour intravenous infusion
  • Conversion to oral antihypertensive agent:

    • Oral antihypertensive should be started once that intravenous nicardipine is stopped.

Nicardipine (Cardene) Dose in Children

Nicardipine dose in children for the treatment of hypertension:

Note: Use should be reserved for acute severe hypertension.

  • Infants, Children, and Adolescents:

    • Continuous intravenous infusion, Bolus dose:

      • Initially 30 mcg/kg to a maximum dose: 2 mg/dose, followed by continuous infusion: 0.5 to 1 mcg/kg/minute titrated according to BP.

Pregnancy Risk Factor C

 

  • Certain animal reproduction studies have shown negative results.
  • It can also be used to treat severe hypertension during pregnancy or preterm labor.
  • Nicardipine can cross the placenta, causing changes to the fetal heart rate or neonatal hypotension.

Nicardipine use during breastfeeding:

 

  • Breast milk contains a small amount of Nicardipine.
  • Some manufacturers do not recommend breastfeeding.

Nicardipine dose adjustment in renal disease:

  • Initial dose of 20 mg thrice daily (immediate release) or 30 mg b.i.d daily (sustained release) with slow titration.
  • The manufacturer's labelling does not include any particular dosage modifications for intravenous preparation; hence, titration should be gradual and under careful observation.

Nicardipine dose adjustment in liver disease:

  • Initial dose of 20 mg per oral b.i.d daily (immediate-release) with slow titration.
  • The manufacturer's labelling does not include any particular dosage modifications for intravenous preparation; hence, titration should be gradual and under careful observation.

Side Effects of Nicardipine (Cardene):

  • Cardiovascular:

    • Flushing
    • Pedal Edema
    • Exacerbation Of Angina Pectoris
    • Hypotension
    • Palpitations
    • Tachycardia
    • Chest Pain
    • Extrasystoles
    • Hemopericardium
    • Hypertension
    • Supraventricular Tachycardia
    • Edema
  • Central Nervous System:

    • Headache
    • Dizziness
    • Hypoesthesia
    • Intracranial Hemorrhage
    • Pain
    • Somnolence
  • Dermatologic:

    • Diaphoresis
    • Skin Rash
  • Endocrine & Metabolic:

    • Hypokalemia
  • Gastrointestinal:

    • Nausea And Vomiting
    • Nausea
    • Dyspepsia
    • Abdominal Pain
    • Xerostomia
  • Genitourinary:

    • Hematuria
  • Local:

    • Injection Site Reaction
    • Pain At Injection Site
  • Neuromuscular & Skeletal:

    • Weakness
    • Myalgia
    • Paresthesia

Contraindication to Nicardipine (Cardene):

 

  • Hypersensitivity to nicardipine and any component of the formulation
  • Advanced aortic stasis

Warnings and precautions

  • Angina/Myocardial Infarction:

    • Angina and MI are becoming more common. 
    • Patients with obstructive heart disease may experience reflex tachycardia, particularly if they are not taking combination beta-blockers.
  • Hypotension/syncope

    • Hypotension may be accompanied by or without syncope, which is rare. It is important to monitor pulse and BP closely.
  • Peripheral edema

    • Peripheral edoema may appear 2 to 3 weeks after beginning medication.
  • Tachycardia

    • It is important to monitor your heart rate closely.
  • Aortic stenosis

    • Nicardipine can reduce coronary perfusion, which could lead to ischemia. Patients with advanced aortic narrowing should not use Nicardipine.
  • Heart failure:

    • Combination beta-blockers may make symptoms worse in patients with severe heart failure or left ventricular dysfunction.
    • Patients with heart failure should be advised not to use calcium channel blockers.
  • Hepatic impairment

    • Patients with reduced liver function or reduced blood flow should reduce their doses.
  • Hypertrophic cardiomyopathy with outflow tract obstruction (HCM)

    • Nicardipine may cause reduced afterload or worsening symptoms.
  • Renal impairment

    • Those who take TItrate should exercise caution because Nicardipine clearance is lowered in patients with poor renal function.

Nicardipine: Drug Interaction

Risk Factor C (Monitor therapy)

Alfuzosin

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Alpha1-Blockers

The hypotensive effects of calcium channel blockers may be strengthened.

Amphetamines

May lessen the effectiveness of antihypertensive agents.

Antipsychotic Agents (Second Generation [Atypical])

Antipsychotic drugs' hypotensive effects may be enhanced by blood pressure-lowering medications (Second Generation [Atypical]).

Aprepitant

May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).

ARIPiprazole

ARIPiprazole's serum levels may rise in response to CYP2D6 Inhibitors (Weak). Management: Keep an eye out for enhanced pharmacologic effects of aripiprazole. Depending on the concurrent therapy and/or the indication, aripiprazole dosage modifications may or may not be necessary. For detailed advice, refer to the complete interaction monograph.

Atosiban

Calcium channel blockers may intensify Atosiban's harmful or hazardous effects. Particularly, pulmonary edoema and/or dyspnea may be at higher risk.

Barbiturates

Calcium Channel Blockers' metabolic rate might be increased. Management: Keep an eye out for any diminished therapeutic effects of barbiturate medication when concurrently using calcium channel blockers. There may need to be dose modifications with calcium channel blockers. The concurrent use of phenobarbital and nimodipine is not recommended.

Barbiturates

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Benperidol

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Bosentan

May lower the serum level of CYP3A4 substrates (High risk with Inducers).

Brigatinib

May lessen the effectiveness of antihypertensive agents. Antihypertensive Agents' bradycardic action may be strengthened by brutinib.

Brimonidine (Topical)

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Calcium Channel Blockers (Nondihydropyridine)

Dihydropyridine, a calcium channel blocker, may increase the hypotensive effects of calcium channel blockers (Nondihydropyridine). Calcium Channel Blockers (Nondihydropyridine) may cause an increase in serum calcium channel blocker concentration (Dihydropyridine).

Calcium Salts

The hypotensive effects of calcium channel blockers may become weak.

Carvedilol

Carvedilol's hypotensive impact could be strengthened by nicARdipine. In people on Carvedilol who are vulnerable, NiCARdipine may accelerate the signs of heart failure. Carvedilol's serum levels may rise in response to NiCARdipine.

Clofazimine

May enhance the serum level of CYP3A4 substrates (High risk with Inducers).

Clopidogrel

Calcium channel blockers may reduce Clopidogrel's therapeutic efficacy.

CycloSPORINE (Systemic)

The serum concentration of CycloSPORINE may rise when Calcium Channel Blockers (Dihydropyridine) are taken (Systemic). Calcium Channel Blockers' serum levels may rise when CycloSPORINE (Systemic) is used (Dihydropyridine).

CYP3A4 Inducers (Moderate)

May lower the serum level of CYP3A4 substrates (High risk with Inducers).

CYP3A4 Inhibitors (Moderate)

May lower the serum level of CYP3A4 substrates (High risk with Inducers).

Dapoxetine

The orthoststatic hypotensive effects of calcium channel blockers may be strengthened.

Deferasirox

May lower the serum level of CYP3A4 substrates (High risk with Inducers).

Dexmethylphenidate

May lessen the effectiveness of antihypertensive agents.

Diazoxide

The hypotensive effects of blood pressure-lowering medications may be strengthened.

DULoxetine

The hypotensive impact of DULoxetine may be enhanced by blood pressure lowering medications.

Duvelisib

May enhance the serum level of CYP3A4 substrates (High risk with Inducers).

Efavirenz

The hypotensive effects of calcium channel blockers may be decreased.

Erdafitinib

May lower the serum level of CYP3A4 substrates (High risk with Inducers).

Erdafitinib

May enhance the serum level of CYP3A4 substrates (High risk with Inducers).

Erdafitinib

P-glycoprotein/ABCB1 Substrates serum levels can rise.

Fluconazole

The hypotensive effects of calcium channel blockers may be strengthened.

Fosaprepitant

May enhance the serum level of CYP3A4 substrates (High risk with Inducers).

Fosnetupitant

May enhance the serum level of CYP3A4 substrates (High risk with Inducers).

Grapefruit Juice

NiCARdipine serum concentration can rise.

Herbs (Hypertensive Properties)

May lessen the effectiveness of antihypertensive agents.

Herbs (Hypotensive Properties)

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Hypotension-Associated Agents

The hypotensive action of hypotension-associated agents may be strengthened by blood pressure lowering medications.

Ivosidenib

May lower the serum level of CYP3A4 substrates (High risk with Inducers).

Larotrectinib

May enhance the serum level of CYP3A4 substrates (High risk with Inducers).

Levodopa-Containing Products

Levodopa-Containing Products' hypotensive effects may be strengthened by blood pressure-lowering medications.

Lormetazepam

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Magnesium Salts

Calcium channel blockers might make magnesium salts more harmful or poisonous. Calcium Channel Blockers' hypotensive effects may be strengthened by magnesium salts.

Melatonin

May reduce the effectiveness of calcium channel blockers as an antihypertensive (Dihydropyridine).

Methylphenidate

May lessen the effectiveness of antihypertensive agents.

Molsidomine

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Naftopidil

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Netupitant

May enhance the serum level of CYP3A4 substrates (High risk with Inducers).

Neuromuscular-Blocking Agents (Nondepolarizing)

The neuromuscular-blocking impact of neuromuscular-blocking agents may be enhanced by calcium channel blockers (Nondepolarizing).

Nicergoline

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Nicorandil

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Nitroprusside

Nitroprusside's hypotensive impact may be strengthened by blood pressure-lowering medications.

Palbociclib

May enhance the serum level of CYP3A4 substrates (High risk with Inducers).

Pentoxifylline

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Perhexiline

The quantity of perhexiline in the serum may rise in response to CYP2D6 Inhibitors (Weak).

P-glycoprotein/ABCB1 Inhibitors

P-glycoprotein/ABCB1 Substrates serum levels can rise. P-glycoprotein inhibitors may also make it easier for p-glycoprotein substrates to reach particular cells, tissues, and organs where p-glycoprotein is abundant (e.g., brain, T-lymphocytes, testes, etc.).

Pholcodine

Pholcodine's hypotensive impact may be strengthened by blood pressure lowering medications.

Phosphodiesterase 5 Inhibitors

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Prostacyclin Analogues

The hypotensive effects of blood pressure-lowering medications may be strengthened.

Quinagolide

The hypotensive effects of blood pressure-lowering medications may be strengthened.

QuiNIDine

The serum concentration of QuiNIDine may be lowered by calcium channel blockers (Dihydropyridine). The serum concentration of QuiNIDine may rise in response to calcium channel blockers (Dihydropyridine). Calcium Channel Blockers' serum levels may rise in response to quinine (Dihydropyridine).

Ranolazine

May enhance the serum level of CYP3A4 substrates (High risk with Inducers).

Sarilumab

May lower the serum level of CYP3A4 substrates (High risk with Inducers).

Siltuximab

May lower the serum level of CYP3A4 substrates (High risk with Inducers).

Simeprevir

May enhance the serum level of CYP3A4 substrates (High risk with Inducers).

SUNItinib

NiCARdipine may boost SUNItinib's serum levels.

Tacrolimus (Systemic)

Tacrolimus serum levels may rise when Calcium Channel Blockers (Dihydropyridine) are used (Systemic).

Tocilizumab

May lower the serum level of CYP3A4 substrates (High risk with Inducers).

Yohimbine

May lessen the effectiveness of antihypertensive agents.

Risk Factor D (Consider therapy modification)

Amifostine

Amifostine's hypotensive impact may be strengthened by blood pressure lowering medications. Treatment: Blood pressure-lowering drugs need to be avoided for 24 hours before amifostine is administered when used at chemotherapeutic doses. Amifostine should not be given if blood pressure lowering treatment cannot be stopped.

Antifungal Agents (Azole Derivatives, Systemic)

Calcium Channel Blockers' harmful or toxic effects could be exacerbated. In particular, itraconazole may make verapamil or diltiazem's unfavourable inotropic effects worse. Calcium Channel Blockers' metabolism may be slowed down by antifungal agents (systemic azole derivatives). Fluconazole and isavuconazonium, which are covered in different monographs, probably have less powerful effects than those of other azoles. Treatment: Itraconazole should not be used concurrently with felodipine or nisoldipine. With any such combination, regular monitoring is advised; calcium channel blocker dose decreases might be necessary. 

CarBAMazepine

Calcium Channel Blockers' metabolism could be accelerated (Dihydropyridine). In individuals receiving concurrent carbamazepine, consider adjusting the dosage of calcium channel blockers (CCBs) or switching to an alternative form of treatment. The Canadian labelling for nimodipine expressly forbids taking it alongside carbamazepine.

CYP3A4 Inducers (Strong)

May speed up CYP3A4 substrate metabolism (High risk with Inducers). Management: Take into account a substitute for one of the interfering medications. Specific contraindications may apply to some combinations. the relevant manufacturer's label.

CYP3A4 Inhibitors (Strong)

May slow down CYP3A4 substrate metabolism (High risk with Inhibitors).

Dabrafenib

May lower the serum level of CYP3A4 substrates (High risk with Inducers). Management: When possible, look for substitutes for the CYP3A4 substrate. If concurrent therapy cannot be avoided, pay special attention to the substrate's clinical consequences (particularly therapeutic effects).

Enzalutamide

May lower the serum level of CYP3A4 substrates (High risk with Inducers). Treatment: Enzalutamide should not be used concurrently with CYP3A4 substrates that have a limited therapeutic index. Enzalutamide use, like with the use of any other CYP3A4 substrate, should be done cautiously and under close observation.

Fosphenytoin

Calcium channel blockers may raise the level of fosphenytoin in the blood. Monitoring for phenytoin toxicity while using a calcium channel blocker (CCB) at the same time or reduced phenytoin effects while stopping the CCB are the two management options. Check for diminished therapeutic effects of CCB. The Canadian labelling for nimodipine specifically forbids the use of phenytoin.

Lorlatinib

May lower the serum level of CYP3A4 substrates (High risk with Inducers). Management: Avoid using lorlatinib concurrently with any CYP3A4 substrates when even a small drop in serum levels of the substrate could result in adverse effects.

Macrolide Antibiotics

Calcium Channel Blockers' metabolic rate might be decreased. Use a noninteracting macrolide as a possible management strategy. The Canadian labelling for felodipine expressly advises against using it in conjunction with clarithromycin. Exceptions: Fidaxomicin, Roxithromycin, Spiramycin, and systemic azithromycin.

MiFEPRIStone

May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors). Management: During and two weeks after mifepristone treatment, reduce doses of CYP3A4 substrates and keep an eye out for elevated amounts or toxicity. Fentanyl, pimozide, quinidine, sirolimus, and tacrolimus should all be avoided. Cyclosporine should also be avoided.

Mitotane

May lower the serum level of CYP3A4 substrates (High risk with Inducers). Treatment: When administered in individuals receiving mitotane, doses of CYP3A4 substrates may need to be significantly modified.

Obinutuzumab

The hypotensive effects of blood pressure-lowering medications may be strengthened. Management: Take into account temporarily stopping blood pressure-lowering drugs 12 hours before the start of the obinutuzumab infusion and keeping them off until 1 hour after the infusion is finished.

Phenytoin

The serum levels of phenytoin may rise when calcium channel blockers are used. Calcium Channel Blockers' serum levels may be reduced by phenytoin. Avoid combining nimodipine or nifedipine with phenytoin for management. With any concurrent use, keep an eye out for phenytoin toxicity and/or diminished calcium channel blocker effects.

Rifamycin Derivatives

Calcium Channel Blockers' serum concentration can drop. This predominantly affects calcium channel blockers used orally. Management: Using rifampin with certain calcium channel blockers is not advised according to the labelling in the US and Canada. Look up the relevant labelling.

Sincalide

The therapeutic benefit of Sincalide may be reduced by medications that affect gallbladder function. Prior to using sincalide to induce gallbladder contraction, you should think about stopping any medications that can impair gallbladder motility.

St John's Wort

May lower the serum level of CYP3A4 substrates (High risk with Inducers). Management: Take into account a substitute for one of the interfering medications. Specific contraindications may apply to some combinations. the relevant manufacturer's label.

Stiripentol

May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors). Management: Due to the increased potential for side effects and toxicity, stiripentol should not be used with CYP3A4 substrates that are thought to have a narrow therapeutic index. Use of stiripentol with any CYP3A4 substrate necessitates closer observation.

Risk Factor X (Avoid combination)

Bromperidol

The hypotensive impact of bromperidol may be enhanced by blood pressure lowering medications. Blood Pressure Lowering Agents' hypotensive effects may be lessened by bromperidol.

Conivaptan

May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).

Fusidic Acid (Systemic)

May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).

Idelalisib

May elevate CYP3A4 substrates' serum concentration (High risk with Inhibitors).

Monitoring  parameters:

Different parameters such as BP and pulse monitoring is recommended.

  • Confirmed hypertension and known CVD or 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥10%:

    • Target blood pressure <130/80 mm Hg is recommended.
  • Confirmed hypertension without markers of increased ASCVD risk:

    • Target blood pressure <130/80 mm Hg may be reasonable.
  • Diabetes and hypertension: The American Diabetes Association (ADA) guidelines (ADA 2019):

    • Patients 18-65 years without atherosclerotic disease and 10-year risk <15%:

      • Target blood pressure <140/90 mm Hg is recommended
    • Patients 18-65 years  and having atherosclerotic disease or 10-year ASCVD risk >15%:

      • Target blood pressure <130/80 mm Hg is advised.
    • Patients >65 years of age (healthy):

      • Target blood pressure <140/90 mm Hg is recommended
    • Patients >65 years of age (poor health):

      • Target blood pressure <150/90 mm Hg is recommended

How to administer Nicardipine (Cardene)?

  • Conversion should be done carefully because the daily sustained-release dose and the total oral daily dose of the immediate-release medicine are different.
  • It can be taken without regard to meals, although sustained release if given with meal may decrease the fluctuation in plasma levels.
  • The tablet should not be chewed or crushed but swallowed as a whole. Do not open or cut capsules.
  • Intravenous preparation is given as a slow continuous infusion via central line/large peripheral vein. 
  • By changing the site of infusion every 12 hours, peripheral venous irritation can be prevented.

Premixed bags:

  • Do not combine or run in the same line with other medications. 

Mechanism of action of Nicardipine (Cardene):

  • During depolarization, it prevents calcium ions from accessing "slow channels" and voltage-sensitive regions in the vascular smooth muscles and heart.
  • The smooth muscles in the coronary arteries relax as a result, causing coronary vasodilation. Myocardial oxygen supply is increased in vasospastic gina patients.

The onset of action:

  • Intravenous infusion is effective in minutes.
  • Oral: 0.5 to 2 hours

Peak effect:

  • Immediate capsules: 1 to 2 hours
  • Capsules with sustained release (at steady state): sustained 2 to 6 hours after the dose
  • Continuous intravenous infusion: By 45 minutes, half of the maximal effect is noticeable.

Duration:

  • Intravenous ≤8 hours upon discontinuation of continuous infusion, a 50% decrease in effect is seen in half an hour with gradual discontinuing antihypertensive effects for ~50 hours
  • Oral: Immediate release: ≤8 hours
  • Sustained-release: 8 to 12 hours

Absorption:

  • Oral: ~100%, but large first-pass effect

Protein binding:

  • >95%

Metabolism:

  • Occurs in the liver, extensive first-pass effect (saturable) The major pathway is via cytochrome P450 isoenzyme CYP3A4, 2C8, and 2D6.

Bioavailability:

  • Oral: ~35%

Half-life elimination:

  • lowered in liver impaired individuals, and perhaps decreased in renal impaired ones
  • Serum concentrations decrease tri-exponentially after intravenous infusion; alpha half-life: 3 minutes; beta half-life: 45 minutes; terminal half-life: 14 hours
  • Note: Terminal half-life can only be seen after long-term infusions).

Time to peak, serum: Oral:

  • Immediate release: 30 to 120 minutes (mean: 1 hour)
  • Sustained release: 60 to 240 minutes

Excretion:

  • Urine (oral: 60% as metabolites; IV: 49% as metabolites; <1% as unchanged drug)
  • feces (oral: 35%; IV: 43%)
  • Clearance:

Nicardipine Brand Names (International):

  • Cardene IV
  • Antagonil
  • Barizin
  • Binicapin
  • Blistra
  • Cardene
  • Cardene SR
  • Cardepine
  • Cardepine SR
  • Cardibloc SR
  • Cardibrain
  • Cardilon
  • Cardimed
  • Cardipene
  • Carsive
  • Convertal
  • Dacarel
  • Dafil
  • Dipitenz
  • Flusemide
  • Karden
  • Lincil
  • Loxen
  • Loxen LP
  • Nerdipina
  • Nicafer
  • Nicardal
  • Nicardin
  • Nidaven
  • Nimicor
  • Perdipina
  • Perdipine
  • Perdipine LA
  • Ridene
  • Rydene
  • Tensilo
  • Vasonase
  • Xian Li

Nicardipine Brand Names in Pakistan:

Nicapress-R 40 mg (Amson Vaccines and Pharmaceuticals)