Nicardipine Drip Titration Protocol for Acute Hypertension

Initial Dosing and Titration

The American Heart Association recommends initiating nicardipine at 5 mg/hr IV infusion and titrating by increasing 2.5 mg/hr every 5-15 minutes to a maximum of 15 mg/hr until the desired blood pressure is achieved, with a target of 10-15% reduction in blood pressure for patients with systolic BP >220 mmHg or Diastolic BP 121-140 mmHg 1, 2
For thrombolytic eligible patients, the American Heart Association suggests pre-treatment with nicardipine if systolic BP >185 mmHg or diastolic BP >110 mmHg, starting at 5 mg/hr 2

Continuous BP monitoring is essential during titration, with the American Heart Association recommending increases in dose every 15 minutes for gradual BP reduction and every 5 minutes for more rapid BP reduction 1, 2
The European Society of Cardiology notes that nicardipine is considered safe and effective in pregnancy/pre-eclampsia, with a target BP <160/105 mmHg 5
The American College of Cardiology recommends considering beta-blockers first for acute aortic dissection, with nicardipine as an alternative if needed 5, 6

The onset of action of nicardipine is 5-15 minutes, with a duration of 30-40 minutes after stopping infusion, according to the European Heart Journal 5